Goji Tomita

Variation in optic nerve and macular structure with age and race with spectral-domain optical coherence tomography.

PURPOSEnTo evaluate the effects of age and race on optic disc, retinal nerve fiber layer (RNFL), and macular measurements with spectral-domain optical coherence tomography (SD OCT).nnnDESIGNnCross-sectional observational study.nnnPARTICIPANTSnThree hundred fifty adult subjects without ocular disease.nnnMETHODSnData from SD OCT imaging of the optic nerve head, peripapillary RNFL, and macula of 632 eyes from 350 subjects without ocular disease were imaged with SD OCT. Multivariate models were used to determine the effect of age and race on quantitative measurements of optic disc, RNFL, and macula.nnnMAIN OUTCOME MEASURESnOptic nerve, RNFL, and macular measurements with SD OCT across racial strata and age.nnnRESULTSnFor optic nerve parameters, participants of European descent had significantly smaller optic disc area than other groups (P<0.0001), and Indian participants had significantly smaller rim area than other groups (P<0.0001). Indian and Hispanic participants had thicker global RNFL measurements than other groups (P<0.0001). Participants of African descent were associated with thinner inner retinal thickness in the macula (P<0.0001). Age was associated with several parameters, with rim area reducing by 0.005 mm(2)/year, RNFL thickness reducing by 0.18 μm/year, and inner retinal thickness reducing by 0.1 μm/year (P<0.0001 for all age associations).nnnCONCLUSIONSnOptic nerve, RNFL, and macular measurements with SD OCT all varied across racial groups and with age. These differences are important in defining the range of normal variation in differing populations and should be considered in the use of these instruments in the detection of optic nerve and macular disease across these population groups.nnnFINANCIAL DISCLOSURE(S)nProprietary or commercial disclosure may be found after the references.

Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients ☆

PURPOSESnTo describe the clinical characteristics of functioning blebs in Japanese glaucoma patients after primary trabeculectomy with adjunctive mitomycin-C (MMC) and to correlate their associations with postoperative bleb leakage.nnnDESIGNnA prospective, observational case series.nnnPARTICIPANTSnOne hundred sixty-two glaucoma patients who had undergone primary trabeculectomy with MMC at the University of Tokyo Hospital at least 3 months before were examined between December 1997 and February 1998.nnnMETHODSnA predesigned data form was completed at each visit. Ophthalmologic examinations included Goldmann applanation tonometry, slit-lamp examination, and Seidel tests with and without digital ocular pressure (DOP).nnnMAIN OUTCOME MEASURESnProperties of the functioning bleb, including bleb appearance, thickness of bleb wall, dimensions of bleb and avascular area, and leakage status with and without DOP.nnnRESULTSnOf 162 Japanese patients, 162 eyes with functioning blebs were included. There were no differences in bleb characteristics among the different types of primary glaucoma. With a long postoperative duration, blebs tended to be thinner (P = 0.024). With DOP, the leaking rate increased from 3.1% to 5.6%, and the oozing rate increased from 11.1% to 35.8% (P < 0.001). Logistic regression analysis indicated that the larger the avascular area, the more likely the bleb leaked without DOP (P = 0.016). When DOP was applied, leakage was more likely to occur in the blebs with a long postoperative duration (P = 0.002) or with a large avascular area (P < 0.001).nnnCONCLUSIONSnThe clinical characteristics of filtering blebs were similar in Japanese patients with different types of primary glaucoma. Blebs with a large avascular area were associated with a higher risk of bleb leakage. Attention to the increased chance of leakage induced by DOP is important, especially for blebs with a long postoperative duration. Ophthalmologists should be aware of late bleb-related complications in addition to bleb function.

Laser Scanning Tomography of Optic Discs of the Normal Japanese Population in a Population-based Setting

OBJECTIVEnTo evaluate the optic disc characteristics using the Heidelberg retina tomograph (HRT) II in a large sample of normal Japanese subjects.nnnDESIGNnCross-sectional study.nnnPARTICIPANTSnA total of 3576 eyes of 2036 normal subjects, with good-quality HRT II images, of 6042 eyes of 3021 subjects aged 40 years or more who participated in the Tajimi Study, a population-based eye study in Japan.nnnMETHODSnOptic disc parameters were obtained using HRT II, and the association of gender, age, height, weight, blood pressure, ocular perfusion pressure, refraction, intraocular pressure (IOP), central corneal thickness (CCT), and disc size on HRT parameters was assessed using simple and multiple regression analyses.nnnMAIN OUTCOME MEASURESnHRT parameters, including disc area, cup area, rim area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, maximum cup depth, height variation contour, cup shape measure, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area, and the crude and partial correlations of the potential confounders with the HRT parameters.nnnRESULTSnDisc area, cup-to-disc area ratio, and rim area averaged 2.06+/-0.41 mm(2) (mean+/-standard deviation), 0.23+/-0.13, and 1.55+/-0.29 mm(2), respectively. All HRT parameters were strongly or moderately correlated between right and left eyes (Pearsons correlation coefficients = 0.45-0.83, P<0.001). Absolute inter-eye differences in several HRT parameters were positively correlated with disc area (P<0.05). Multiple regression analyses adjusting for the confounders showed weak but significant correlations of height, refractive error, IOP, and CCT with several HRT parameters (partial correlation coefficient (absolute value) = 0.04-0.16, P<0.05), and moderate or weak but significant correlations of disc area with all HRT parameters (partial correlation coefficient [absolute value] = 0.05-0.73, P<0.05). Gender, weight, blood pressure, and ocular perfusion pressure did not significantly correlate with HRT parameters.nnnCONCLUSIONSnThis report presents reference data of normality for the HRT parameters based on a large sample of normal Japanese subjects. There were small but significant influences of height, refractive error, IOP, and CCT on several HRT parameters. Many HRT parameters were moderately or weakly affected by disc size.nnnFINANCIAL DISCLOSURE(S)nProprietary or commercial disclosure may be found after the references.

Optic disc excavation in the atrophic stage of Leber's hereditary optic neuropathy: comparison with normal tension glaucoma

BackgroundAbnormal optic disc excavations are reportedly seen in patients with Lebers hereditary optic neuropathy (LHON), a mitochondrial dysfunction disease. We examined the disc morphology in the eyes of patients with LHON at the atrophic stage and compared it to that in eyes with normal-tension glaucoma (NTG).MethodsWe studied 15 LHON patients with the 11778 mutation, 15 patients with NTG, and 25 normal subjects. The optic disc morphology was analyzed by Heidelberg retinal tomographyxa0(HRT). Ten parameters of the optic disc obtained by HRT were evaluated, including the diagnostic classification of glaucoma.ResultsSix of the nine morphological HRT parameters of the LHON patients, the exceptions being disc area, mean cup depth, and maximum cup depth, differed significantly from those of the normals. NTG patients had a significantly greater mean and maximum cup depth than LHON patients. The HRT glaucoma diagnostic software classified 22 (73%) of the 30 optic discs in LHON patients as glaucomatous.ConclusionThe optic discs at the atrophic stage of LHON eyes have glaucoma-like morphological changes. However, the cups were significantly deeper in NTG than LHON. The similarity in the optic disc findings in LHON and NTG suggests that alterations in mitochondrial function may be related to optic disc excavations.

Efficacy and Complications After Trabeculectomy with Mitomycin C in Normal-Tension Glaucoma

PurposeTo evaluate the efficacy of and complications after trabeculectomy using mitomycin C (MMC) in Japanese normal-tension glaucoma (NTG) patients by a retrospective analysis based on the Kaplan-Meier life table method.MethodsClinical records of 39 NTG patients who underwent trabeculectomy with 0.04% MMC and had postoperative follow-up periods of 3 years or more (50.5 ± 8.4 months, mean ± SD) were reviewed. Postoperative intraocular pressure (IOP) at every 1 or 2 months, complications, visual acuity, and visual field at every 6 months were recorded.ResultsIOP significantly decreased from 15.9 ± 1.9 preoperatively to 8–11u2009mmHg throughout the postoperative follow-up period (P < 0.0001). The life table analysis, in which failure of IOP control was defined as an IOP above a level either 30% or 20% lower than the preoperative IOP at three consecutive visits, showed a cumulative survival rate of 39.4 ± 7.8% (mean ± SEM) or 41.3 ± 8.9%, respectively, at 4 years after surgery. Mean deviation of the visual field results did not significantly change (P > 0.5). The cumulative survival rate from postoperative late-onset hypotony was 74.7 ± 6.3% at 4 years after surgery. Postoperative complications observed were shallow anterior chamber (six eyes), choroidal detachment (nine eyes), hypotonous maculopathy (seven eyes), bleb leak (one eye), cataract development (three eyes), and blebitis (two eyes). No eyes developed endophthalmitis.ConclusionsIn NTG patients, trabeculectomy with MMC showed significant efficacy in reducing IOP up to 4 years after surgery. Since risks of postoperative complications are unavoidable, indications for surgery should be carefully considered, and careful follow-up is necessary to avoid severe postoperative complications. Jpn J Ophthalmol 2005;49:223–227

Optic Disc and Peripapillary Morphology in Unilateral Nonarteritic Anterior Ischemic Optic Neuropathy and Age-and Refraction-Matched Normals

PURPOSEnTo compare optic disc morphologic features and peripapillary retinal nerve fiber layer (RNFL) thickness between the unaffected eyes of patients with unilateral nonarteritic anterior ischemic optic neuropathy (NAION) and their affected eyes and the eyes of age- and refraction-matched normal control subjects.nnnDESIGNnCross-sectional comparative study.nnnPARTICIPANTSnThirty-one patients with unilateral NAION and 62 age- and refraction-matched normal control subjects.nnnMETHODSnOptic disc morphologic features and peripapillary RNFL thickness were evaluated in both eyes of patients with unilateral NAION and in one randomly chosen eye of the normal control subjects.nnnMAIN OUTCOME MEASURESnOptic disc and cup parameters were measured using the Heidelberg Retina Tomograph II (Heidelberg Engineering GmbH, Dossenheim, Germany), and RNFL thickness was measured by scanning laser polarimetry with variable corneal compensation (GDx VCC; Carl Zeiss Meditec, Dublin, CA).nnnRESULTSnThere was no significant difference in the disc area between the NAION affected eyes and the unaffected fellow eyes. The cup area, cup-to-disc area ratio, cup volume, and cup shape measure were greater, whereas the peripapillary RNFL thickness was smaller in the former than the latter (P = 0.001 to approximately 0.043). When the unaffected eyes of patients with NAION and the age- and refraction-matched normal control eyes were compared, the disc area, cup area, cup-to-disc area ratio, cup volume, mean cup depth, and cup shape measure were smaller in the former (P = 0.0006 to approximately 0.03); there was no significant difference in the RNFL thickness between the two (P>0.06).nnnCONCLUSIONSnA comparison of the eyes with NAION and the fellow eyes indicated that the cup was slightly larger in the former than in the latter, suggesting the acquired enlargement of the cupping after NAION develops. A comparison of the unaffected fellow eyes in patients with NAION and the age- and refraction-matched normal control eyes suggested that a smaller disc area and smaller cupping were predisposing risk factors for the development of NAION.

A three-year prospective, randomized and open comparison between latanoprost and timolol in Japanese normal-tension glaucoma patients

AbstractPurpose To compare the longitudinal effects of treatment on intraocular pressure (IOP) and visual field performance in Japanese normal-tension glaucoma (NTG) between latanoprost and timolol.Patients and methods This is an open-label, randomized, study. A total of 62 NTG patients were prospectively, consecutively enrolled. All study subjects were randomly assigned to 0.005% latanoprost instillation once daily in the morning or 0.5% timolol instillation twice daily for a prospective 3-year follow-up, and underwent a routine ocular examination every month. Automated perimetry was performed every 6 months using Humphrey field analysers. Stereophotographs of optic discs were also obtained every 6 months.Results Percentage of IOP reduction or the magnitude of IOP reduction showed no intergroup differences either at any time point (13–15%). In the visual field, the estimated rate of change in the MD value (dB/year) was −0.34±0.17 (SE) for the latanoprost group, and −0.10±0.18 (SE) for the timolol group. The estimated rate of change in MD showed no significant difference from zero in both groups, and there were no statistical intergroup differences. No changes in the optic nerve head topography in the vertical cup-to-disc ratio and rim area measured by image-analysis techniques were observed in either group. There were no patients who dropped out due to the side effects of treatment regimens.Conclusion Both latanoprost and timolol single treatments reduced IOP by 13–15% at their trough effects for 3 years in Japanese NTG patients; both showed similar effects on visual field performance.

Prevalence of primary angle closure and primary angle-closure glaucoma in a southwestern rural population of Japan: the Kumejima Study.

PURPOSEnTo determine the prevalence and ocular biometry of primary angle closure (PAC) and primary angle-closure glaucoma (PACG) in a rural population in southwestern Japan.nnnDESIGNnPopulation-based cross-sectional study.nnnPARTICIPANTSnAll residents aged 40 years or older in Kumejima, Okinawa, Japan.nnnINTERVENTIONnOf the 4632 residents 40 years of age or older, 3762 (participation rate, 81.2%) underwent a detailed ocular examination, including measurement of the best-corrected visual acuity, slit-lamp examination, Goldmann applanation tonometry, static and dynamic gonioscopy, undilated stereoscopic optic fundus photographs, autorefractometry, partial coherence laser interferometry, noncontact specular microscopy, and screening visual field (VF) testing using frequency-doubling technology. If glaucoma or related or other ocular disorders were suspected, the subject was referred for a definitive examination including VF testing with the 24-2 Swedish Interactive Thresholding Algorithm Standard program of the Humphrey Field Analyzer (Carl Zeiss Meditec, Dublin, CA).nnnMAIN OUTCOME MEASURESnPrevalence rates of primary angle-closure suspects (PACS), PAC, PACG, and PACG suspects.nnnRESULTSnUnder the standard definitions of the International Society of Geographical and Epidemiological Ophthalmology, the prevalence rates of PACS, PAC, and PACG were 8.8%, 3.7%, and 2.0%. Extending the diagnosis of PAC and PACG to include people with narrow but open angles and primary peripheral anterior synechiae, the prevalence rates of PAC and PACG increased to 6.0% and 2.2%, respectively. Hence, broadening the diagnostic categories in PAC and PACG increased the prevalence rates by 62% and 10%. Twenty-three subjects (0.6%; 95% confidence interval, 0.4%-0.9%) had a history of or were diagnosed with acute PAC. Older age, female gender, hyperopic refractive error, short axial length, and shallow anterior chamber depth were independent predictors of an occludable angle.nnnCONCLUSIONSnThe prevalence of PACG in Kumejima (2.2%) was one of the highest reported in population-based studies, that is, 3.7 times higher than in the Tajimi Study carried out in an urban center located in the central area of the main island of Japan.nnnFINANCIAL DISCLOSURE(S)nThe author(s) have no proprietary or commercial interest in any materials discussed in this article.

Topical application of autologous serum for the treatment of late-onset aqueous oozing or point-leak through filtering bleb

AbstractPurposeTo evaluate the efficacy of topical autologous serum application to stop aqueous oozing or point-leak through filtering bleb after trabeculectomy.Patients and MethodsA total of 21 consecutive eyes with oozing and 21 eyes with a point-leak through a functional bleb after trabeculectomy with 5-fluorouracil or mitomycin C were enrolled in this randomized, case–control study. In eyes randomly assigned to the serum group, an antibiotic and the autologous serum, which was sterilely diluted to 20% with physiological saline, were topically applied four times a day for up to 12 weeks. In eyes assigned to the control group, the antibiotic alone was applied according to the same protocol. Intraocular pressure (IOP) and the presence of oozing or a point-leak were tested before and every 2 weeks after starting the treatments.ResultsIn the serum and control groups, oozing stopped in 62.5 and 0% of eyes, respectively (P=0.003), and point-leaks stopped in 27.3 and 18.2%, respectively (P>0.9). IOP significantly increased from 10.0±3.2 (mean±standard deviation) to 11.8±3.3 mmHg in eyes in which oozing stopped (P=0.066), and from 11.4±2.7 to 15.4±2.3 mmHg in eyes in which a point-leak stopped (P=0.042).ConclusionsAutologous serum application was significantly effective to stop aqueous oozing but not point-leaks. Stopping oozing or point-leaks was significantly associated with an increase in IOP.

Ability of optical coherence tomography-determined ganglion cell complex thickness to total retinal thickness ratio to diagnose glaucoma.

Purpose:To evaluate the usefulness of the spectral-domain optical coherence tomography (SD OCT)–determined ganglion cell complex thickness to total retinal thickness ratio (G/T ratio) in diagnosing glaucoma. Methods:A total of 99 eyes with primary open-angle glaucoma and 35 normal eyes were enrolled in the study. SD OCT (RTVue-100) was used to measure the macular ganglion cell complex thickness, total retinal thickness, outer retinal thickness, and circumpapillary retinal nerve fiber layer (RNFL) thickness. A new macular parameter, the G/T ratio, was also calculated. The ability of each parameter to diagnose glaucoma was examined by analyzing the area under the receiver operating characteristics curve (AUROC) and the sensitivity at fixed specificity. Results:The G/T ratio was 36.0±1.5% in normal eyes, 31.8±1.7% in early glaucoma, and 30.2±2.6% in advanced glaucoma. These decreases in the ratio were statistically significant. For the AUROC, the individual SD OCT parameters were 0.982 for the G/T ratio, 0.968 for the macular ganglion cell complex thickness, 0.942 for the RNFL thickness, and 0.841 for the total retinal thickness. The AUROC for the G/T ratio was significantly higher than that seen for the total retinal and RNFL thicknesses (P<0.05). Analyses of the sensitivity at a specificity of >90% indicated that the G/T ratio (sensitivity, 93.94%) was the best diagnostic parameter. Conclusions:Decreases in the G/T ratio occur during the early stages of glaucoma. When using SD OCT to diagnose glaucoma, the G/T ratio may improve the diagnostic ability of the macular parameter.