RNFL Defects Research Articles

Diagnostic ability of macular nerve fiber layer thickness measured by swept-source optical coherence tomography in preperimetric glaucoma.

We evaluated the diagnostic ability of macula retinal nerve fiber layer (mRNFL) thickness in preperimetric glaucoma (PPG) patients. This prospective study included 83 patients with PPG and 83 age- and refractive error-matched normal control subjects. PPG was defined as a localized RNFL defect corresponding to glaucomatous optic disc changes with a normal visual field test. We used spectral-domain (SD) optical coherence tomography (OCT) to measure the circumpapillary RNFL (cpRNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Swept-source (SS) OCT was used to measure cpRNFL thickness, macular ganglion cell layer + inner plexiform layer (IPL) thickness (GCL+), and macular ganglion cell layer + IPL+ mRNFL thickness (GCL++). The mRNFL thickness was defined as GCL++ minus GCL+. To evaluate the diagnostic power of each parameter, the area under the receiver operating characteristics curve (AUROC) was analyzed to differentiate PPG from the normal groups. Using SD-OCT, all GCIPL parameters and most cpRNFL parameters, except at the nasal and temporal quadrant, were significantly lower in PPG versus normal controls. PPG eyes had significantly smaller values than normal controls for all cpRNFL and GCL parameters measured by SS-OCT, except mRNFL at the superonasal area. The inferotemporal GCL++ had the largest AUROC value (0.904), followed by inferotemporal GCL+ (0.882), inferotemporal GCIPL thickness (0.871), inferior GCL++ (0.866), inferior cpRNFL thickness by SS-OCT (0.846), inferior cpRNFL thickness by SD-OCT (0.841), and inferotemporal mRNFL thickness (0.840). The diagnostic performance was comparable between inferotemporal mRNFL thickness and the best measures of GCL (inferotemporal GCL++, p = 0.098) and cpRNFL (inferior cpRNFL thickness by SS-OCT, p = 0.546). The diagnostic ability of mRNFL thickness was comparable to that of the best measures of cpRNFL and GCL analysis for eyes with PPG. Therefore, mRNFL thickness could be a new parameter to detect early structural changes in PPG.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma and comparison to retinal nerve fiber layers.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma (PPG) and comparison to retinal nerve fiber layers. This study was a prospective hospital-based study. A total of 30 PPG and control patients were studied for retinal nerve fiber layer thickness (RNFL) and ganglion cell-inner plexiform layer complex (GC-IPL) by spectral-domain optical coherence tomography. PPG was defined as eyes with a normal visual field and one or more localized RNFL defects that were associated with a typical glaucomatous disc appearance. Diagnostic abilities of GC-IPL, optic nerve head (ONH), and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity, and specificity. GC-IPL parameters showed significant changes in PPG cases as compared to normal subjects in each region ( P value < 0.001). RNFL parameters also differed significantly from normal subjects in all quadrants ( P value 0.003 to < 0.001). Within GC-IPL parameters, the superotemporal region had the maximum area under the curve (AUC), followed by inferior, superior, and inferotemporal regions. Within RNFL parameters, the inferior quadrant had the maximum AUC, followed by superior and nasal quadrants. the GC-IPL parameters in PPG showed that the AUC of the GC-IPL parameters was much higher than those of the ONH and RNFL values. Although both the parameters RNFL and GC-IPL showed significant changes in PPG patients compared to healthy subjects, a higher AUC of GC-IPL points toward the higher sensitivity of GC-IPL than RNFL for detecting glaucoma in early stages.

Ocular manifestations in Arnold Chiari syndrome

AbstractPurpose: Arnold‐Chiari disease is a rare congenital malformation of the cerebellum. Symptoms are dominated by occipital headache, torticollis, and sometimes swallowing disorders. Regarding ophthalmological manifestations, convergence abnormalities, oculomotor paralysis and diplopia are the main clinical signs. We report two cases of ocular manifestations in Arnold Chiari type 1 syndrome.Methods: Two case reports and a literature review.Results:Case 1: A 40‐year‐old patient with no medical history presented an acute loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/63. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed a bilateral papillary edema. Visual field test showed a borderline diffuse loss in both eyes.Case 2: A 17‐year‐old patient with no medical history presented intermittent headaches and a progressive loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/80. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed atrophy not excavated in both eyes. Visual field test showed nasal and temporal scotomas in both eyes. Temporal, superior and inferior RNFL defects were detected in both eyes. A brain MRI revealed a Chiari type 1 malformation without associated hydrocephalus in both patients.Conclusions: Arnold Chiari type 1 malformation is an uncommon pathology. The discovery of ophthalmologic signs requires a neurosurgical intervention as soon as possible to stop progression towards the loss of visual function by optic atrophy.

Relationship between Optic Disc Hemorrhage and Glaucoma among patients diagnosed with Systemic Hypertension and Diabetes Mellitus: The Colombian Glaucoma Study

Introduction: Glaucoma is a leading cause of irreversible blindness worldwide; several risk factors have been identified as major underlying causes for developing this condition. Optic disc hemorrhage has been identified as a risk factor for the development and progression of primary open-angle glaucoma, as well it has been related to playing an important role in normal-tension glaucoma. Material and methods: A cross-sectional study was conducted in Colombia among hypertensive and diabetic patients. This study included 2,067 subjects older than 50 years who were attended by a group of ophthalmologists in six cities in Colombia who conducted a complete medical and ophthalmological examination and applied standardized questionnaires and interviews aiming to evaluate participant’s health conditions and lifestyles. Results: We found a prevalence of Optic disc hemorrhage (ODH) of 0.4%. ODH presented an OR: 8.82 (95% CI 1.60 - 48.52) for the presence of Glaucoma. Patients diagnosed with systemic hypertension had an OR: 0.02 (95% CI 0.00 - 0.96); Patients with Retinal Nerve Fiber Layer Defect (RNFL) presented an OR: 509.40 (95% CI 8.60 - 30152.97) for the presence of ODH and 50% of patients with ODH did not have a diagnosis of glaucoma. Conclusions: Despite the low prevalence of ODH in our study (0.4%), its presence is a High-risk factor for the presence of Glaucoma. RNFL defect is also highly related to ODH and the presence of Glaucoma.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of preperimetric glaucoma and comparison to retinal nerve fiber layer.

Purpose:The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals.Methods:This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs).Results:All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters.Conclusion:Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.

Topographic Relationship with a Retinal Nerve Fiber Layer Defect Differs between β-Zone and γ-Zone Parapapillary Atrophy.

Introduction γ-Zone parapapillary atrophy (PPA), an associated feature in myopic tilted optic disc, is considered to be relevant with glaucomatous optic nerve damage in myopic eyes. This study determines the topographic relationship of γ-zone PPA with a retinal nerve fiber layer defect. Purpose To determine the topographic relationship of γ-zone PPA with a RNFL defect and to compare it with that of β-zone PPA. Design Cross-sectional, observational study. Participants. Eighty-nine eyes from 89 patients with primary open-angle glaucoma who had β-zone PPA (n = 49) or γ-zone PPA (n = 40) and a single localized RNFL defect. Methods PPA was classified according to the presence or absence of Bruch's membrane on the PPA bed in spectral-domain optical coherence tomography. The angular location of the point of maximum radial extent of PPA (PMRE) and the RNFL defect was measured with the fovea-disc axis set at 0° in color and red-free fundus photographs. Main Outcome Measures. Angular distance between the RNFL defect and the PMRE. Results There was no significant intergroup difference in the extent of the RNFL defect (P=0.920). The angular distance between the RNFL defect and the PMRE was significantly greater in γ-zone than β-zone PPA (26.49 ± 17.27° vs. 60.31 ± 17.12°, P < 0.001). The angular location of the PMRE was significantly correlated with the location of the RNFL defect in the β-zone group (r = 0.822, P < 0.001) but not in the γ-zone group. The RNFL defect was mostly located near the edge of γ-zone PPA in the γ-zone group (10.56 ± 9.47°). Conclusions An RNFL defect was observed near the edge of PPA in eyes with γ-zone PPA, in contrast to it being close to the PMRE in eyes with β-zone PPA.

Association between peripapillary scleral deformation and choroidal microvascular circulation in glaucoma

Peripapillary vessel density, which is reduced in eyes with glaucoma, has been proposed as a diagnostic tool for the desease and peripapillary choroidal microvasculature dropout(MvD) is considered one of pathophysiological manifestation of glaucomatous damage. However, little is known about the underlying pathogenic mechanism of dropout. According to recent studies, MvD is associated with structural changes in ONH structures. Therefore, we investigated the association between peripapillary scleral deformation and MvD. Data from 62 open-angle glaucoma (OAG) eyes with MvD and 36 eyes without MvD were analyzed in this study. And eyes with MvD were classified into two groups based on location: a juxtapapillary group and a non-juxtapapillary group for further analysis. More eyes with MvD had focal scleral deformation than did those without MvD (64.5% versus 2.8%; P < 0.001). Peripapillary choroidal thickness and focal scleral deformation were significantly associated with MvD. And juxtapapillary group was more associated with focal scleral deformation and coincidental RNFL defects than non-juxtapapillary groups. Peripapillary choroidal MvD was associated with the presence of scleral deformation, especially with juxtapapillary MvD, which was related to corresponding RNFL defects.

Clinical characteristics of glaucoma patients with disc hemorrhage in different locations

To compare the clinical characteristics and outcomes of eyes with unilateral disc hemorrhage (DH) in different locations. This was a retrospective cohort study. DHs were classified by locations: the superior, superotemporal, inferotemporal, or inferior sectors of optic disc were classified as the susceptible area, while other sectors were defined as the less susceptible area. Structural and functional outcomes were analyzed by the Humphrey field analyzer and spectral domain optical coherence tomography. Forty-three eyes with DHs in the susceptible area were less myopic and had more peripapillary-type DH, larger cup-to-disc ratio, cup volume, and disc area. Thirty-three eyes with DHs in the less susceptible area had less association with RNFL defects, greater tilted ratio, and less torsion of the disc. Follow-up revealed that the change in sectoral RNFL (μm) thickness was significantly greater for DHs in the susceptible area within oneyear (- 6.0 ± 14.0 vs. 0.7 ± 13.0, p = 0.035) and two years (- 10.0 ± 17.4 vs. - 1.1 ± 7.6, p = 0.012), while the change in average RNFL thickness was not different. Eyes with DHs in the susceptible area had faster MD deterioration (dB/year) than those in the less susceptible area within four years (- 0.32 ± 0.51 vs. - 0.05 ± 0.45, p = 0.047). A total of 16.9% of eyes, all in the susceptible area, had localized VF progression at DH corresponding area. Disc hemorrhage in the superotemporal and inferotemporal regions had more subsequent structural and functional deterioration compared with the eyes with DHs in the temporal quadrant and nasal area.

Has Spectral-Domain Optical Coherence Tomography Retinal Nerve Fiber Layer Assessment Become the Method of Choice for Glaucoma Evaluation in Clinical Practice?

AIM:The aim of the study was to assess the role of spectral-domain optical coherence tomography (SD-OCT) as a method of choice for early glaucoma diagnosis in glaucoma suspects.DESIGN:This was a retrospective cross-sectional study.MATERIALS AND METHODS:After a comprehensive ophthalmic examination and visual field analysis, 20 patients were included in each of the three groups: Normal group, possible glaucoma, definitive glaucoma, respectively. The optic nerve head (ONH) and peripapillary retinal nerve fiber layer parameters of participants were analyzed using SD-OCT optic disc cube protocol scans. Data was analyzed using one.way analysis of variance test.RESULTS:ONH RNFL defects in possible glaucoma patients were frequently found in superior, inferior, and temporal quadrants.CONCLUSION:Diagnostic capability of SD-OCT parameters for detection of structural changes in the ONH and retinal nerve fiber layer differed in three groups significantly. Hence, using SD-OCT has become an imperative and quick way of timely diagnosis of glaucoma in private practice.

RNFL defect with vitamin B12 deficiency correlating diet pattern: Experience in tertiary care hospital

RNFL defect with vitamin B12 deficiency correlating diet pattern: Experience in tertiary care hospital

Lamina cribrosa defects in eyes with glaucomatous disc haemorrhage.

To investigate the frequency of focal abnormalities of the lamina cribrosa (LC) in eyes with glaucomatous disc haemorrhage (DH) using swept-source optical coherence tomography (SS-OCT). We analysed 72 glaucomatous eyes with DH (72 subjects) detected by masked grading of stereophotographs along with 63 glaucomatous eyes without DH (63 subjects) consecutively recruited from the cohort of DH Study from Seoul National University Hospital. All of the subjects underwent stereoscopic optic disc photography and invivo SS-OCT LC imaging based on a customized optic disc scanning protocol (Topcon, Inc., Tokyo, Japan). Two masked graders evaluated each eye's serial en face images for focal LC defects. En face image/optic disc photograph overlay images were evaluated to determine the relationship between the respective focal LC defect and DH locations. Among the eyes with DH, the proportion with ≥1 LC defect was 80.6% (58 of 72 eyes), significantly higher than that for eyes without DH (39.7%, 25 of 63 eyes; p<0.001). In the 58 eyes with DH and ≥1 LC defect, the location of the focal LC defect corresponded with that of the RNFL defect in 47 eyes (81.0%), and the location of the focal LC defect corresponded with the DH in 36 eyes (62.1%). Focal LC defects are more frequently visible in eyes with glaucomatous DH than in eyes without DH. DH and LC defects, moreover, are often spatially correlated. These findings suggest that DH is associated with focal abnormalities of the LC.

THE ANALYSIS OF THE FREQUENCY AND LOCATION OF PERIPAPILLARY RETINAL DEFECTS REVEALED BY SCANNING LASER POLARIMETRY

The medical screening included 375 patients (680 eyes): Group 1 - patients with POAG with myopia; Group 2 - Patients with POAG associated with emmetropia and hyperopia; Group 3 - patients with myopia; Group 4 - patients with hyperopia. All the patients underwent laser polarimetry. The frequency and location of RNFL defects was analyzed. The patients with POAG observed RNFL defects significantly more often than patients without the disease. The patients of Group 1 had had lesions in the upper RNFL part before and to a greater extent, the patients of Group 2 - the lower part of RNFL.

Artificial Neural Network Approach for Differentiating Open-Angle Glaucoma From Glaucoma Suspect Without a Visual Field Test.

To increase the effectiveness of treating open-angle glaucoma (OAG), we tried to find a screening method of differentiating OAG from glaucoma suspect (GS) without a visual field (VF) test. Data were collected from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted in 2010. Of 8958 participants, 386 suspected OAG subjects underwent a VF test. For the training dataset, five OAG risk prediction models were created using multivariate logistic regression and an artificial neural network (ANN) with various clinical variables. Informative variables were selected by an algorithm of consistency subset evaluation, and cross validation was used to optimize performance. The test dataset was used subsequently to assess OAG-prediction performance using the area under the curve (AUC) of the receiver-operating characteristic. Among five OAG risk prediction models, an ANN model with nine noncategorized factors had the greatest AUC (0.890). It predicted OAG with an accuracy of 84.0%, sensitivity of 78.3%, and specificity of 85.9%. It included four nonophthalmologic factors (sex, age, menopause, and duration of hypertension) and five ophthalmologic factors (IOP, spherical equivalent refractive errors, vertical cup-to-disc ratio, presence of superotemporal retinal nerve fiber layer [RNFL] defect, and presence of inferotemporal RNFL defect). Though VF tests are considered the most important examination to distinguish OAG from GS, they sometimes are impractical to conduct for small private eye clinics and during large scale medical check-ups. The ANN approach may be a cost-effective screening tool for differentiating OAG patients from GS subjects.

Relationship between Visual Field Sensitivity and Parameters of Retinal Nerve Fiber Layer Measured by Cirrus OCT in Eyes with Localized RNFL Defects

Relationship between Visual Field Sensitivity and Parameters of Retinal Nerve Fiber Layer Measured by Cirrus OCT in Eyes with Localized RNFL Defects

Intereye Comparison of Cirrus OCT in Early Glaucoma Diagnosis and Detecting Photographic Retinal Nerve Fiber Layer Abnormalities.

To compare the ability of various maps constructed using Cirrus optical coherence tomography (OCT), including the "intereye comparison" derived from the temporal superior inferior nasal temporal (TSNIT) map, in terms of glaucoma diagnosis and detection of RNFL defects identified in red-free fundus photographs. This cross-sectional study was conducted on a total of 131 open-angle glaucoma patients with early-stage visual field defects (mean deviation ≤ -6.0 dB) and 56 healthy controls. Intereye differences were identified on TSNIT maps constructed by comparing the RNFL thickness curves of both eyes of individual patients and a separation of the RNFL thickness curves of either eye (by >50 μm) was defined as an abnormality. Among 131 red-free fundus photographic RNFL defects, 57 (44.0%) in the Clock-hour map, 51 (39.0%) in the Quadrant map, 37 (28%) in the Deviation map, 16 (12%) in the Thickness map, and 3 (2%) in the intereye difference obtained from the TSNIT map were misidentified. The intereye difference derived from the TSNIT map afforded a sensitivity superior to that of all other maps when used to evaluate eyes with glaucoma (98.0%, all P values < 0.05), and preperimetric eyes (97.7%, all P values < 0.001). Of the various maps constructed by the Cirrus OCT, comparison of the RNFL thickness curves of both eyes of an individual, which was possible using TSNIT map data, afforded the best diagnostic capability in terms of detecting photographic RNFL defects. Intereye comparisons of TSNIT thickness curves may be useful to detect early-stage glaucoma.

Topographical Correlation Between Macular Layer Thickness and Clockwise Circumpapillary Retinal Nerve Fiber Layer Sectors in Patients with Normal Tension Glaucoma

Purpose: To define topographical areas of the macula in optical coherence tomography (OCT) scans by identifying regions in which macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (mGCL + IPL) thickness was highly correlated with clockwise circumpapillary RNFL (cpRNFL) thickness in patients with normal tension glaucoma (NTG).Methods: This study included 101 eyes of 101 patients with mild or moderate NTG. CpRNFL, mRNFL, and mGCL + IPL thickness were assessed with spectral-domain OCT (3D OCT-2000). The region of interest (6 × 6 mm square) was centered on the fovea and layer thickness was measured at each point on a 10 × 10 grid. Spearman’s rank correlation coefficient was determined between each temporal clockwise sector (7, 8, 9, 10, 11 o’clock) of the cpRNFL and each grid point in the mRNFL and mGCL + IPL. Grid points were defined as correlated to specific clockwise sectors when the correlation coefficient was more than 0.4. To validate the areas comprised by these points, they were superimposed on a swept-source OCT image (12 × 9 mm, EnView software, Topcon) showing the anatomical trajectory of nerve fiber defects.Results: Macular areas with a high correlation coefficient (r ≥ 0.4, p < 0.05) to clockwise cpRNFL were identified. The number of grid points in the mRNFL and mGCL + IPL correlated to specific clockwise cpRNFL sectors was, respectively, 40 and 18 (7 o’clock), 41 and 22 (8), 33 and 44 (9), 39 and 39 (10), and 18 and 19 (11) (r = 0.40–0.79). Interestingly, the distribution of mRNFL sectors closely matched the RNFL defects in the OCT image, although the mGCL + IPL sectors differed and were closer to the fovea than the mRNFL sectors.Conclusion: The identification of these topographical macular areas, and the different layouts in the mRNFL and the mGCL + IPL, may increase the accuracy of clinical research on NTG.

Topographic localization of macular retinal ganglion cell loss associated with localized peripapillary retinal nerve fiber layer defect.

To investigate the topographic relationship between ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) defects in open-angle glaucoma patients with localized RNFL defects, using spectral-domain optical coherence tomography (SD-OCT). We analyzed 140 eyes of 140 patients showing a localized RNFL defect in one hemifield, the angular width of which was limited to one clock-hour sector. The RNFL and macular GCIPL scans were obtained using SD-OCT. The clock-hour location and width of pRNFL defects on the RNFL deviation map were determined, and their topographic association with corresponding GCIPL defects on the GCIPL deviation map was assessed. A "GCIPL deviation frequency map" demonstrating GCIPL defects corresponding to six different clock-hour locations of pRNFL defects was obtained, and it revealed the following specifics: (1) pRNFL defect at 12, 11, and 10 o'clock corresponded to GCIPL defect in the superior macula, as those at 8, 7, and 6 o'clock did to those in the inferior macula; (2) the overall GCIPL defect had an arcuate shape that appeared as a continuation of the pRNFL defect; (3) the temporal macular region was the frequently damaged site in either hemifield, and was larger in the inferior hemifield than in the superior hemifield. Additionally, an interindividual variability of GCIPL defect was noted for patients with the same clock-hour location of pRNFL defect. The GCIPL deviation frequency map demonstrating the topographic relationship between pRNFL and GCIPL defects was generated using SD-OCT. Our results indicated the topographic location of retinal ganglion cell death associated with clock-hour location of pRNFL loss in vivo.

Influence of the obstructive sleep apnea treatment in the glaucoma control

The information of the relationship between the obstructive Sleep Apnea Syndrome treatment (OSAS) with glaucoma and the importance of the approach to treatment of both together, is limited. Purpose: Formulate the association of Obstructive Sleep Apnea Syndrome (OSAS) and Glaucoma, through the presentation of a clinical case. A retrospective study in 41 patients with Glaucoma and OSAS was held over two years in joint management with Ophtalmology and Sleep Neuroly Service.The patients were controlled with applanation tonometry, Photo of the optic disc, Gonioscopy, Computerized Visual field, Optic disk OCT, in spite of the medical glaucoma treatment, there was Visual Field and RNFL defects progress. At the clinical control of the cardiovascular risk factors, OSAS was diagnosed by Polisomnography. A sample case of a male patient of 62 years of age with open angle glaucoma of 8 years of evolution under treatment with Timolol and Bimatoprost and 14 mmHg Intraocular Pressure) IOP with progression on the defects of the Visual Field and OCT will be discussed as an example. (became worse) Distant visual acuity with correction (sph + 2) was 20/20 in both eyes until December 2012 lowered to 20/25 in both eyes (macular epiretinal membrane was detected). Slit Lamp Biomicroscopy without any peculiarities (was normal). Both eyes with open angle and some mesodermal remnants at the trabecular meshwork at the gonioscopy. A Polisomnography for OSAS was performed successfully. The target IOP < 11 mmHg reached in all the control with Timolol and Dorzolamide and Bimatoprost (not advised in OSAS Brimonidine and had used without good tolerance when it was referred to). The patients began treatment with an air generator (CPAP) during the night well tolerated (something very difficult to achieve),stabilizing the visual fields (until December 2012 ) and RNFL OCT.In our series (n 41), the average age was 62.5, 39% did not know that they suffered from glaucoma and 56% did not know they had OSAS. The 35.8% patients had glaucoma associated with Plateau Iris, the 23% Pseudoexfoliation Glaucoma, 20.5% Open-angle glaucoma, 12.8% Low tension Glaucoma and 7.7% Primary angle-closure glaucoma. The OSA Index,was mild to moderate. In OSAS there’s an alteration of the optic nerve irrigation which is of great importance for the development and progression of the glaucoma. Most of our population don’t know Glaucoma–apnea Association. In a high percentage on the apnea/ hypopnea Index,was mild to moderate. That is why the emphasis must be put on its treatment. In the same way, in patients with OSAS, the focus must be on detection of glaucoma, as the prevalence in this group is higher, especially associated with Plateau Iris. Our results are different from literature reviewed. We must work in an interdisciplinary team with physicians in Neurology and Pneumonology to improve and/or stop the progression in these patients. Very low IOP Target is recommend for this group. Carolina Cuello Ortiz.

Discrepancy between optic disc and nerve fiber layer assessment and optical coherence tomography in detecting glaucomatous progression

To compare the outcomes of Cirrus spectral-domain optical coherence tomography (OCT) and optic disc/retinal nerve fiber layer (RNFL) photographic assessment in detecting glaucomatous progression. Two-hundred twenty-six eyes of 130 glaucoma patients (mean follow-up: 2.5years) with at least 5 OCT examinations were included. Eyes were classified into one of four groups (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. After performing the entire series of optic disc/RNFL photographic assessments, the eyes were classified into one of three groups: stable, progressed, and undetermined. Progression was divided into one of four categories (optic disc rim thinning; widening RNFL defect; deepening RNFL defect; new disc hemorrhage). OCT progression was determined using guided progression analysis (GPA) software. One-hundred thirty-nine eyes had diffuse RNFL defects, 34 eyes had localized RNFL defects, 42 eyes had no RNFL defects, and 11 eyes had unidentifiable RNFL at baseline. Forty-six eyes showed at least one category of progression upon expert assessment of optic disc/RNFL photographs, while OCT GPA detected progression in 35 eyes. Among the 34 eyes in which progression was observed in photographs only, 15 showed a new disc hemorrhage, 12 presented deepening of an RNFL defect, 10 showed optic disc rim change, and 6 had widening of an RNFL defect. Among the 23 eyes processed only by OCT GPA, 18 had a diffuse RNFL defect at baseline. OCT GPA was more sensitive in eyes with a diffuse RNFL defect whereas photographic assessment was better for detecting optic disc hemorrhage and deepening of an RNFL defect when evaluating structural progression.

Secondary glaucoma in familial amyloid polyneuropathy

AbstractPurpose To describe the clinical features of secondary glaucoma associated with transthyretin (TTR)‐related Familial Amyloid Polyneuropathy (FAP).Methods In this retrospective monocentric study, 5 patients with FAP associated secondary glaucoma were seen at the ophtalmologic consultation of the french national center for FAP between 2011 and 2012. The mutation of the amyloidogenic TTR variants was analysed for all patients. All patients had a complete ophthalmic examination including BCVA, IOP, slit lamp and optic disc photographs, gonioscopy, pachymetry, automated perimetry, and OCT‐RNFL. Glaucomatous optic neuropathy was diagnosed based on the presence of visual field abnormalities, neuroretinal rim thining, excavation or RNFL defects. Medical and surgical treatments were analysed for all patients.Results All cases had bilateral involvement except 2 monophtalmic patients. All patients were of portuguese origin and carriers of the Val30Met mutation. There were 4 women and 1 man with a mean age of 58.8±7.7 years. Mean BCVA was 0,83±0.9 LogMAR. Three eyes had a BCVA below 20/400. Mean IOP was 26.6±6.6 mmHg. Mean deviation was ‐17.6±11.2dB. Fringed pupil and anterior chamber amyloid deposition were noted in all affected eyes. Three patients had concomitent vitreous involvement. Patients were treated with 1.2±1.5 ocular hypotensive drugs. Four eyes had been treated with at least 1 filtrating surgery.Conclusion FAP‐associated secondary glaucoma is a very severe disease, associated with amyloid deposits in the anterior chamber and characteristic pupil deformation. Systematic and comprehensive eye examination should be performed in all patients affected with FAP in order to improve early detection of glaucoma.