Nerve Fiber Layer Research Articles

Peripapillary Microvascular and Structural Parameters in Atrophic Nonarteritic Anterior Ischemic Optic Neuropathy, Unaffected Fellow Eyes and Controls in an Indian Population

ABSTRACT Nonarteritic ischemic optic neuropathy (NAION) is believed to be an ischemic insult to the optic nerve head and is one of the most common acute optic neuropathies of adulthood. Prevention of NAION in the fellow eye has not yet been accomplished. Optical coherence tomography angiography (OCTA) is a new and emerging non-invasive technology that provides microvascular information that complements the structural data. This prospective study is aimed to fill the lacunae in data that is available in the Indian population. We included 36 patients with NAION, their 36 fellow eyes and 37 healthy controls. The peripapillary perfusion index, peripapillary flux, peripapillary retinal nerve fibre layer (RNFL) thickness values and disc volumes of eyes were evaluated. The NAION eyes had lower peripapillary perfusion index, flux and RNFL thickness values in all sectors compared with both the fellow and the healthy control eyes (p = < .05). A statistically significant difference was found in disc volume between control eyes and fellow eyes, which included eyes with disc at risk configuration as well as normal disc configuration. Eyes with disc at risk configuration had a numerically lower disc volume than eyes with normal disc configuration. Fellow eyes overall had numerically lower perfusion index, higher RNFL thickness, and similar flux which was statistically non-significant compared with the healthy eyes. Correlation between the localization of visual field defects and the quadrants showing impairments of perfusion index and peripapillary RNFL were also assessed. These findings may indicate the potential vascular risk factors for the development of NAION in fellow eyes.

Metabolic Dysfunction in New-Onset Idiopathic Intracranial Hypertension: Identification of Novel Biomarkers.

Idiopathic intracranial hypertension (IIH) is a neurometabolic disease with an increasing incidence. The pathophysiology is unknown, but improvement of diagnosis and management requires discovery of novel biomarkers. Our objective was to identify such candidate biomarkers in IIH, and secondarily, test for associations between identified metabolites and disease severity. This is a prospective case-control study with collection of cerebrospinal fluid (CSF), serum, and clinical data from new-onset, treatment-naïve patients with IIH (n = 60). Patients were included consecutively from 2 tertiary headache centers in Denmark, and age, sex, and body mass index (BMI) -matched healthy controls (n = 35) were recruited. Clinical data were retrieved at ocular remission (n = 55). Samples were analyzed using non-targeted mass spectrometry. Serum sphingosine 1-phosphate (S1P), adenosine, and glutamate were 0.46-fold (q < 0.0001), 0.25-fold (q = 0.0048), and 0.44-fold (q < 0.0001) lower, respectively, in IIH. CSF stearoyl-lysophosphatidylcholine (LysoPC-18) and 2-palmitoyl-lysophosphatidylcholine (LysoPC-16) were 0.42 (q = 0.0025) and 0.37 (q < 0.001) -fold lower. LysoPC-18 was higher in patients with moderate-severe versus mild papilledema (p = 0.022). LysoPC-18 correlated positively with retinal nerve fiber layer thickness (p = 0.0012, r = 0.42) and inversely with mean deviation on automated perimetry (p = 0.01, r = -0.35). Higher baseline serum S1P (p = 0.018) and lower CSF LysoPC-16 (p = 0.003) were associated with optic nerve atrophy at ocular remission. Pathway analysis suggests dysregulated lipid metabolism and redox disturbances in new-onset IIH. We identify perturbed metabolism in new-onset IIH. S1P and LysoPC-16 demonstrate potential prognostic value due to association with subsequent optic nerve atrophy. This association between specific, differential metabolites and outcome provides substantial evidence for novel biomarkers of clinical significance that should be the focus of further targeted studies. ANN NEUROL 2024;96:595-607.

Rates of retinal nerve fiber layer loss in early-stage pseudoexfoliation and primary open-angle glaucoma patients using optical coherence tomography.

To characterize glaucoma progression in early-stage patients with retinal nerve fiber layer (RNFL) using the change analysis software (CAS), which was utilized to track RNFL thinning. We retrospectively analyzed 92 eyes of 92 patients with early-stage glaucoma. Patients were divided into two subgroups based on their diagnosis of pseudoexfoliation glaucoma (PEG) and primary open-angle glaucoma (POAG). A complete ophthalmologic examination was performed on all patients. Additionally, automated perimetry was conducted on each patient. Furthermore, Fourier-domain optical coherence tomography (OCT) was employed to measure RNFL and central corneal thickness. Using the OCT device's CAS, we computed the annual rate of total and glaucomatous RNFL thinning for each patient. A total of 44 PEG and 48 POAG patients were included in the study. The right eye measurements of these patients were analyzed and compared. The two groups were not significantly different in age, gender, and the number of visits per year (p > 0.05, for each). However, the difference between the mean RNFL thickness at baseline (91.39 ± 10.71 and 96.9 ± 8.6µm) and at the last visit (85.2 ± 15.76µm and 91.56 ± 9.58µm) was statistically significant between the two groups (p = 0.043, p = 0.039, respectively). Additionally, the difference in annual RNFL thinning rates (1.43 ± 0.81µm and 1.07 ± 0.32µm) between the two groups was statistically significant (p = 0.009). The annual rate of glaucomatous RNFL loss in early-stage PEG patients (1.23µm) was higher than in POAG patients (0.87µm). However, despite these loss rates, scotoma was not detected in the visual field tests of these patients. Therefore, using CAS in the follow-up of early-stage glaucoma patients is a useful alternative for monitoring glaucomatous progression. Furthermore, this method can be utilized in future research for the diagnosis and follow-up of glaucoma in special populations (e.g., those with pathological myopia or high hyperopia) that are not included in normative databases.

Ocular blood flow biomarkers may predict long-term glaucoma progression

Background/aimTo examine the relationship between baseline blood flow biomarkers and long-term open-angle glaucoma (OAG) progression.Methods112 patients with early to moderate OAG (mean age 64.9±11.0 years; 68 female) were evaluated at...

Deep-learning-based prediction of glaucoma conversion in normotensive glaucoma suspects

Background/aimsTo assess the performance of deep-learning (DL) models for prediction of conversion to normal-tension glaucoma (NTG) in normotensive glaucoma suspect (GS) patients.MethodsDatasets of 12 458 GS eyes were reviewed. Two...

GUNN DOTS IN CHILDREN AGED 11-12 YEARS FROM THE GENERAL COMMUNITY SAMPLE COPENHAGEN CHILD COHORT 2000 STUDY.

To study characteristics and associations of Gunn dots in a cohort of healthy children aged 11 to 12 years. As part of the Copenhagen Child Cohort 2000 Study, red-free fundus photographs were taken on 761 healthy children aged 11 to 12 years. The photographs were centered on the optic disk. Gunn dots were annotated and counted within a disk-centered circular grid of 6 mm diameter. Data were analyzed in relation to age, sex, axial length, and retinal nerve fiber layer thickness. Gunn dots were found in 716 of the 761 participants (94%). The majority of dots were located both inferior and superior to the optic disk, situated within a distance of 3 mm from its center. The median number of Gunn dots was 64 (range 0-574) in right eyes and 68 (range 0-532) in left eyes. Having more than the median number of Gunn dots in the right eye was associated with older age (odds ratio 2.12, 95% CI 1.56 to 2.89, P < 0.0001, adjusted for sex, axial length, and retinal nerve fiber layer thickness) and was less common among the children with a thinner retinal nerve fiber layer (odds ratio 0.40, 95% CI 0.26-0.60, P < 0.0001 comparing bottom and top quartiles). Gunn dots were visible in the majority of healthy children aged 11 to 12 years, and large numbers of dots were associated with a thicker nerve fiber layer and with older age, within the limited age range of 1 year. The clinical significance of Gunn dots is unknown. Their location at the vitreoretinal interface makes them a parameter of interest in the study of aging, epiretinal fibrosis, macular pucker and retinal detachment.

Ocular Changes in Cystic Fibrosis: A Review.

Cystic fibrosis (CF), also known as mucoviscidosis, is the most common autosomal recessive genetic disease in the Caucasian population, with an estimated frequency of 1:2000-3000 live births. CF results from the mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene localized in the long arm of chromosome 7. The product of CFTR gene expression is CFTR protein, an adenosine triphosphate (ATP)-binding cassette (ABC) transporter that regulates the transport of chloride ions (Cl-) across the apical cell membrane. Primary manifestations of CF include chronic lung and pancreas function impairment secondary to the production of thick, sticky mucus resulting from dehydrated secretions. It is well known that CF can cause both anterior and posterior ocular abnormalities. Conjunctival and corneal xerosis and dry eye disease symptoms are the most characteristic manifestations in the anterior segment. In contrast, the most typical anatomical and functional changes relating to the posterior segment of the eye include defects in the retinal nerve fiber layer (RNFL), vascular abnormalities, and visual disturbances, such as reduced contrast sensitivity and abnormal dark adaptation. However, the complete background of ophthalmic manifestations in the course of CF has yet to be discovered. This review summarizes the current knowledge regarding ocular changes in cystic fibrosis.

Optical Coherence Tomography Advanced Parameters in Patients With Multiple Sclerosis: Ophthalmological and Neurological Assessments

PurposeTo evaluate ophthalmological, neurological, radiological, and laboratory data in patients with multiple sclerosis (MS) and to identify new ophthalmological factors that could be helpful as biomarkers of the disease, potentially leading to an earlier prediction of disease course and disability progression. DesignRetrospective, cross-sectional-study. MethodsBest-corrected visual acuity (BCVA), ophthalmological biomicroscopy of the anterior segment and fundus, structural optical coherence tomography (OCT) with retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), and OCT Angiography (OCTA) with vascular density (VD) were performed. The following clinical and neuro-radiological features were assessed: MS phenotype, disease duration, clinical severity, type of treatment, and T2-weighted lesion load plus T1-weighted Gd+-enhancing lesion number on the last brain and spinal cord MRI. ResultsOne hundred and six patients (212 eyes) were analyzed. Sixty-six of them (62.2 %) had MS and 40 (37.8%) were matched healthy controls (HCs). patients with MS showed lower RNFL, GCC, and VD in the radial peripapillary capillary plexus than controls in both eyes (p<0.05). By Performing a logistic regression with a distinct MS outcome for both eyes, we were able to demonstrate that the value that was most predictive of MS was the average GCC thickness (p=0.009). Regression analysis demonstrated that patients with a higher T2-weighted lesions showed a lower RNFL thickness value and reduced GCC and VD values than those with a low lesion load (p<0.01 and p<0.05, respectively). Similarly, relapsing MS patients showed lower RNFL values (p<0.05). ConclusionsSeveral OCT- and OCTA-optic nerve parameters could be useful prognostic biomarkers for the MS disease course in clinical practice. However, it is necessary to do additional research with larger sample sizes in order to validate these findings.

NFS-17. CORRELATIONS BETWEEN OPTICAL COHERENCE TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN NEUROFIBROMATOSIS TYPE 1 – RELATED OPTIC PATHWAY GLIOMAS

Abstract BACKGROUND Optic pathway glioma (OPG) is a prevalent tumor affecting children with Neurofibromatosis type 1 (NF1), representing a diagnostic hallmark. OPGs, typically WHO grade 1 pilocytic astrocytomas, are characterized by an indolent course. Diagnosis and surveillance traditionally rely on Magnetic Resonance Imaging (MRI). Routine NF1 pediatric surveillance includes annual eye examinations, encompassing visual acuity (VA) and Optical Coherence Tomography (OCT), with MRI reserved for ophthalmological abnormalities. However, the precise correlation between altered OCT findings and OPG presence or size remains unclear, while the role of MRI in screening is contentious due to cost and anesthesia requirements. METHODS In this retrospective study, we sought to establish correlations between OCT changes and MRI-observed tumor volume in NF1-diagnosed children at a tertiary center. Clinical and ophthalmological data, including VA, fundoscopy, and OCT, were collected. Tumor volumes were assessed using the software Sophia DDMTM for Radiomics in two consecutive MRI scans in a randomly selected cohort of 50 untreated patients. RESULTS Among 409 NF1 patients, 132 (31%) were diagnosed with OPG (48% females = 64), revealing a significant association with plexiform neurofibroma (pNF) (p=0.03), thus indicating an elevated risk of concurrent tumor development. In the subcohort of patients in whom volumetric analysis was performed, the mean age at OPG diagnosis was 5.56 ± 3.59 years. While tumor volume on MRI correlated with VA (p=0.0007), OCT values did not: larger OPGs did not consistently result in thinner retinal nerve fiber layers, suggesting independence between OCT alterations and OPG size. CONCLUSIONS The observed lack of correlation among VA, retinal thickness (OCT), and tumor volume (MRI) underscores the importance of MRI as the gold standard for diagnosis. The strong association between pNFs and OPGs suggests considering whole-body MRI when an OPG is detected, facilitating comprehensive evaluation in NF1 patients.

Peripapillary RNFL cross-sectional area and its association with other parameters in a Chinese population

BackgroundQuantitative analysis of retinal nerve fibers is important for the diagnosis and treatment of optic nerve diseases. Peripapillary retinal nerve fiber layer (RNFL) cross-sectional area may give a more accurate quantitative assessment of retinal nerve fibers than RNFL thickness but there have been no previous reports of the peripapillary RNFL cross-sectional area or other parameters. The purpose of the current study was to determine peripapillary RNFL cross-sectional area and its association with other factors in an adult Chinese population.MethodsRNFL cross-sectional area was measured during peripapillary circular optical coherence tomography (OCT) scan with a diameter of 12° centered on the optic disc. Correlation between RNFL cross-sectional area and other parameters was evaluated by linear regression analysis in a cross-sectional study of an adult Chinese population.ResultsA total of 2404 eyes from 2404 subjects were examined. Multivariate linear regression analysis showed that larger RNFL cross-sectional area correlated with younger age (p < 0.001), female gender (p = 0.001), no history of diabetes (p = 0.012) and larger optic disc area (p < 0.001).ConclusionsPeripapillary RNFL cross-sectional area is correlated positively with optic disc area, suggesting that eyes with larger optic discs have thicker RNFL. Further studies are needed to confirm whether this correlation is due to differences in the numbers of retinal nerve fibers or other factors.

Visual Field Prognosis From Macula and Circumpapillary Spectral Domain Optical Coherence Tomography.

To explore the structural-functional loss relationship from optic-nerve-head- and macula-centred spectral-domain (SD) Optical Coherence Tomography (OCT) images in the full spectrum of glaucoma patients using deep-learning methods. A cohort comprising 5238 unique eyes classified as suspects or diagnosed with glaucoma was considered. All patients underwent ophthalmologic examination consisting of standard automated perimetry (SAP), macular OCT, and peri-papillary OCT on the same day. Deep learning models were trained to estimate G-pattern visual field (VF) mean deviation (MD) and cluster MD using retinal thickness maps from seven layers: retinal nerve fiber layer (RNFL), ganglion cell layer and inner plexiform layer (GCL + IPL), inner nuclear layer and outer plexiform layer (INL + OPL), outer nuclear layer (ONL), photoreceptors and retinal pigmented epithelium (PR + RPE), choriocapillaris and choroidal stroma (CC + CS), total retinal thickness (RT). The best performance on MD prediction is achieved by RNFL, GCL + IPL and RT layers, with R2 scores of 0.37, 0.33, and 0.31, respectively. Combining macular and peri-papillary scans outperforms single modality prediction, achieving an R2 value of 0.48. Cluster MD predictions show promising results, notably in central clusters, reaching an R2 of 0.56. The combination of multiple modalities, such as optic-nerve-head circular B-scans and retinal thickness maps from macular SD-OCT images, improves the performance of MD and cluster MD prediction. Our proposed model demonstrates the highest level of accuracy in predicting MD in the early-to-mid stages of glaucoma. Objective measures recorded with SD-OCT can optimize the number of visual field tests and improve individualized glaucoma care by adjusting VF testing frequency based on deep-learning estimates of functional damage.

CORRELATION OF VISUAL FIELD CHANGES WITH OPTICAL COHERENCE TOMOGRAPHY IN PRIMARY OPEN ANGLE GLAUCOMA

PURPOSE: To detect morphological changes in Optic Nerve Head (ONH), macula and Retinal nerve fibre layer (RNFL) using spectral domain optical coherence tomography (SDOCT) and to correlate them with functional loss (Visual field changes) using 24-2 and 10-2 standard automated perimetry in Primary open angle glaucoma patients. RESULTS: Mean value of 90D cup to disc ratio (CDR) of study subjects was 0.64 ± 0.13 with median (25th-75th percentile) of 0.7(0.6-0.7). Mean value of average RNFL thickness(microns), superior quadrant thickness (micron), inferior quadrant thickness (micron), nasal quadrant thickness (micron) and temporal quadrant thickness (micron) of study subjects was 62.35 ± 14.43, 77.96 ± 14.29, 81.41 ± 22.84, 51.33 ± 21.14 and 50.71 ± 17.71 with median(25th-75th percentile) of 63(52-75), 78(66.25-89), 81.5(64.25-93.75), 54(46-63) and 50.5(39-57.75) respectively. Mean value of average macular thickness (micron), macular GCL-IPL thickness -Superior quadrant (micron) and macular GCL-IPL thickness -Inferior quadrant (micron) of study subjects was 65.6 ± 11.7, 76.49 ± 11.63 and 76.76 ± 16.86 with median (25th-75th percentile) of 64(56-75), 75(67-87.75) and 75.5(65.25-93) respectively. Mean value of MD and PSD of study subjects was -7.34 ± 4.47 and 6.8 ± 3.11 with median (25th-75th percentile) of -7.65(-11--3.1) and 6.9(3.9-9.1) respectively. 57(41.3%) eyes had early glaucoma, 51(37%) eyes had moderate glaucoma and 30(21.7%) eyes had advanced glaucoma. CONCLUSION: In present study, ONH parameters (rim area), RNFL parameter (inferior quadrant thickness) and macula parameters (average macular GCLIPL thickness) showed statistically significant correlation with VF MD. Correlation between VF parameters i.e. MD and PSD with OCT parameters shown that there was a relation between Macular GCLIPL thickness ,RNFL thickness and ONH with the changes in the results of VF.

Two Cases of Ischemic Optic Neuropathy after Extracorporeal Membrane Oxygenation (ECMO)

Purpose: We report two cases of non-arteritic ischemic optic neuropathy (NAION) following extracorporeal membrane oxygenation (ECMO) treatment.Case summary: (Case 1) A 36-year-old man underwent ECMO treatment. Upon regaining consciousness, he complained of a darkened peripheral visual field and was subsequently referred to an ophthalmologist. His best-corrected visual acuity was 0.9 in the right eye and 0.8 in the left eye. The intraocular pressure measured 12 mmHg in the right eye and 10 mmHg in the left eye; color vision was normal. A visual field test demonstrated concentric visual field defects in both eyes, and a fundus examination revealed a pale optic disc. Optical coherence tomography (OCT) indicated a decrease in retinal nerve fiber layer (RNFL) thickness. (Case 2) A 48-year-old woman underwent ECMO treatment. After regaining consciousness, she reported decreased vision in her right eye. Her best-corrected visual acuity was limited to hand motion in the right eye and was 1.2 in the left eye. A relative afferent pupillary defect in the right eye was observed. Color vision in the right eye was compromised, and a fundus examination revealed a pale optic disc. A visual field test demonstrated total visual field defect in the right eye, while OCT showed decreases in both the RNFL thickness and the ganglion cell-inner plexiform layer thickness of the right eye. Magnetic resonance imaging (MRI) revealed high signal intensity and abnormal enhancement in the right retrobulbar optic nerve.Conclusions: In cases where vision loss and visual field defects are observed following ECMO treatment, differential diagnoses for ischemic optic neuropathy are warranted.

Retinal structural thicknesses reflect clinically relevant microstructural white matter abnormalities in neuromyelitis optica spectrum disorders

BackgroundThinning of retinal thickness seen on optical coherence tomography (OCT) is frequent in patients with neuromyelitis optica spectrum disorder (NMOSD). We explored the association between OCT metrics, MRI measurements and clinical outcomes in NMOSD. Methods44 NMOSD and 60 controls underwent OCT and MR imaging. Mean peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thicknesses were measured. Diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) was used to measure the white matter microstructural integrity. In NMOSD patients, Expanded Disability Status Scale (EDSS) was used to quantify disability. Visual acuity (VA) was also performed for all participants. ResultspRNFL thickness was positively associated with mean diffusivity in left posterior thalamic radiation (pp = 0.010) and axial kurtosis in inferior cerebellar peduncle (p = 0.023). Similarly, GCC thickness in NMOSD patients was positively associated with fractional anisotropy in right superior longitudinal fascicules (p = 0. 041) and axial kurtosis of left cerebellar peduncle (p = 0.011). ConclusionsIn NMOSD, pRNFL and GCC reflect integrity of clinically relevant white matter structures underlying the value of OCT metrics as markers of neuronaxonal loss and disability.

Can Baseline Parapapillary Atrophy Morphology Predict Future Glaucoma Progression?—An OCT Glaucoma Imaging Study

PurposeTo investigate glaucoma progression based on Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) according to baseline β-zone parapapillary atrophy (PPA) morphology in glaucoma patients. DesignRetrospective cohort study. MethodsPatients over 20 years of age who had been diagnosed with primary open-angle glaucoma (POAG) at Seoul National University Hospital, Seoul, Korea between 2010 and 2020. This study included POAG patients with a minimum of 5 years of follow-up. We quantitatively measured the baseline β-zone PPA parameters, classified β-zone PPA morphology according to new classification standard we created and analyzed the corresponding GPA progression of the retinal nerve fiber layer (RNFL). ResultsA total of 210 patients with POAG (mean age: 53.8 years) were enrolled in the study. The mean follow-up period was 9.8 years. The average value of the baseline mean deviation in visual field perimetry was -2.48 dB. Longer radial extent and larger angular extent of β-zone PPA were significantly associated with progression on GPA, as was the presence of disc hemorrhage. Among the 4 classified β-zone PPA morphologies (Crescent type 1 & 2, Solar-eclipse type 1 & 2), the Solar-eclipse type 2 group showed the highest progression. A Kaplan-Meier survival analysis demonstrated significant differences among the 4 types. ConclusionsThe larger the radial and angular extents of β-zone PPA, the more progression that was shown on OCT GPA. Furthermore, significant differences in progression were noted based on the morphological type of β-zone PPA. Our findings indicate that baseline β-zone PPA parameters and morphology are valuable predictors of future glaucoma progression.

Could the thick of retinal nerve fiber layer be a potential measure of axonal loss in hearing loss?

The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.

Diagnostic ability of the combination of retinal microvasculature evaluation and static automated perimetry for early primary open-angle glaucoma.

To investigate the diagnostic ability of retinal superficial vasculature evaluation by optic coherence tomography angiography (OCTA) combined with visual field (VF) testing for early primary open-angle glaucoma (POAG). In this cross-sectional study, 84 participants were included, including 11 in the ocular hypertension (OHT) group, 11 in the preperimetric POAG (pre-POAG) group, 29 in the early POAG group and 33 in the control group. All participants underwent 6 × 6 mm2 scans of macula and optic nerved head by optic coherence tomography (OCT) and OCTA, along with white-on-white and blue-on-yellow VF testing by static automated perimetry. The ability of diagnosing early glaucoma by either various examinations separately or combination of examinations in both terms of function and structure was studied using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The superficial retinal vessel densities (VD) in peri-nasal, para-temporal, peri-temporal and peri-inferior regions around the macula, as well as vessel area densities (VAD) in all peripapillary regions, were significantly different among the four groups, with lower VD or VAD in the early POAG patients compared to the normal individuals. The diagnostic ability of peripapillary superficial retinal VAD alone or VF testing alone was limited for early POAG only. However, the combination of these two was more effective in distinguishing normal individuals from OHT subjects or pre-POAG patients without VF defects, with better performance than the combination of peripapillary retinal nerve fiber layer (RNFL) thickness and VF indicators. Peripapillary retinal vessel densities were generally lower in early POAG patients compared to normal individuals. The combination of peripapillary superficial retinal VAD by OCTA with white-on-white VF testing improved the ability to distinguish POAG patients at early stage without function impairment, which may help in providing reference and guidance for the following-up and treatment of suspected POAG patients.

Multimodal Imaging of Optic Nerve Head in Retinitis Pigmentosa

ABSTRACT Background A pallor optic nerve head (ONH) is one of the three features of retinitis pigmentosa (RP). This study aimed to assess the ONH prospectively by color tone, presence of hyper-reflective tissue, blood flow, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) and investigate the change in these parameters with and without ONH pallor. Methods The presence of ONH pallor was assessed by three independent examiners through careful examination using fundus photographs. The presence of a hyper-reflective structure on the ONH was carefully evaluated using a volume scan optical coherence tomography (OCT). RNFL thickness and ellipsoid zone (EZ) width around the macula were also evaluated by OCT. Laser speckle flowgraphy was used to measure the mean blur rate of the entire ONH area, which was subsequently divided into the vessel area (MV) and tissue area (MT). Results Twenty-eight eyes of 28 patients with RP (55.4 ± 16.23 years of age) were included. The pale ONH was observed in 10 (35%) eyes. Hyper-reflective structures were observed in seven (25%) eyes. No significant correlation was found between the pale ONH and the presence of a hyper-reflective structure (Pearson’s chi-squared test, p = .364). The average of the ONH area, MV, and MT was 8.65 ± 3.08 AU, 17.81 ± 7.54 AU, and 6.4 ± 2.66 AU, respectively, which significantly decreased in patients with pallor ONH (all p < .05). The global RNFL thickness was 73.54 ± 18.82 μm. The nasal and superior quadrants and global RNFL thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH (all p < .05). The global and superior and inferior GCC thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH(all p < .05).There was no difference in the EZ width between patients with and without a pale ONH (p = .107). Conclusion We conducted multiple assessments of the ONH in RP patients and investigated its clinical significance. Our findings suggest that ONH pallor may indicate a comprehensive change that emerges alongside the progression of retinal degeneration in RP. Trial registration This trial was retrospectively registered in the UMIN Clinical Trial Registry (UMIN ID: 000048168).

Sociodemography, diabetes mellitus clinical parameters, and retinal morphology as predictors of neurodegeneration in preclinical diabetic retinopathy

Abstract PURPOSE: The current prediction of preclinical diabetic retinopathy (DR) in asymptomatic patients with diabetes mellitus (DM) is limited due to a lack of suitable indicators. This study aimed to identify the predictors of neurodegenerative changes in type 2 DM patients during the preclinical stage of DR using sociodemographic and DM clinical parameters and retinal morphology. METHODS: Fifty-six adult DM participants (mean age: 40.41 ± 7.281 years) were classified into three groups: DM without DR, DM with mild nonproliferative DR (NPDR), and DM with moderate-to-severe NPDR. Demographic data, including age, gender, race, DM duration, glycated hemoglobin levels, household income, comorbidities, and insulin dependency, were collected. Retinal morphology, including macular retinal layer thickness, peripapillary retinal nerve fiber layer, and vascular caliber, were analyzed. Multinomial logistic regression models explored these factors’ influence on NPDR prediction. RESULTS: Participants with moderate-to-severe NPDR were less likely to have DM without comorbidities (odds ratio [OR]: 0.048, 95% confidence interval [CI]: 0.003–0.823, P = 0.036). Those with longer DM duration were 27% more likely to develop moderate-to-severe NPDR (OR: 1.272, 95% CI: 1.035–1.564, P = 0.022). Retinal morphology parameters did not predict NPDR risk and severity levels in DM patients, except for mild NPDR, which had a 1.05 times higher risk of wider central retinal arteriolar equivalent (CRAE) (OR: 1.052, 95% CI: 1.002–1.105, P = 0.043). CONCLUSION: DM duration, comorbidity presence, and widened CRAE are critical parameters for assessing neurodegenerative changes in preclinical DR. These parameters could be incorporated into DR screening programs to mitigate NPDR progression and enhance long-term visual outcomes of DM patients.

Macular OCT's Proficiency in Identifying Retrochiasmal Visual Pathway Lesions in Multiple Sclerosis-A Pilot Study.

Optical coherence tomography (OCT) is a non-invasive imaging technique based on the principle of low-coherence interferometry that captures detailed images of ocular structures. Multiple sclerosis (MS) is a neurodegenerative disease that can lead to damage of the optic nerve and retina, which can be depicted by OCT. The purpose of this pilot study is to determine whether macular OCT can be used as a biomarker in the detection of retrochiasmal lesions of the visual pathway in MS patients. We conducted a prospective study in which we included 52 MS patients and 27 healthy controls. All participants underwent brain MRI, visual field testing, and OCT evaluation of the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer (GCL), and macular inner plexiform layer (IPL). OCT measurements were adjusted for optic neuritis (ON). VF demonstrated poor capability to depict a retrochiasmal lesion identified by brain MRI (PPV 0.50). In conclusion, the OCT analysis of the macula appears to excel in identifying retrochiasmal MS lesions compared to VF changes. The alterations in the GCL and IPL demonstrate the most accurate detection of retrochiasmal visual pathway changes in MS patients.