Jung Hwa Na

Progression Detection Capability of Macular Thickness in Advanced Glaucomatous Eyes

PURPOSEnTo evaluate the progression rate of macular and circumpapillary retinal nerve fiber layer (RNFL) thickness in advanced glaucomatous eyes using spectral domain optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA).nnnDESIGNnLongitudinal, observational study.nnnPARTICIPANTSnA total of 98 eyes of 98 patients with advanced glaucoma (visual field [VF] mean deviation [MD] <-10 dB) with a mean follow-up time of 2.2 years.nnnMETHODSnThree glaucoma experts independently reviewed optic disc and RNFL photographs and classified patients into 3 groups: progressed, stable, and undetermined (criterion 1). Patients in the undetermined group could not be evaluated because of advanced optic disc cupping. The eyes were also classified into 2 groups, progressed and stable, by serial VF data (criterion 2).nnnMAIN OUTCOME MEASURESnProgression rates as determined by linear regression analysis against patient age using serial macular and RNFL thickness parameters were compared among different groups.nnnRESULTSnBy criterion 1, 25 eyes (25.5%) were classified as stable, 13 eyes (13.3%) were classified as progressed, and 60 eyes (61.2%) were classified as undetermined. By criterion 2, 86 eyes (87.8%) were classified as stable, and 12 eyes (12.2%) were classified as progressed. By criterion 1, the mean progression rate of average macular thickness was significantly higher in the progressed group than in the stable and undetermined groups (-4.74±4.40, -0.53±1.44, and -2.72±4.75 μm/year, respectively; P = 0.01). The undetermined group showed a higher progression rate than the stable group (P = 0.045). However, the progression rate of average RNFL thickness did not differ significantly among the 3 groups (-1.19±2.62, -0.33±1.29, and -1.21±2.75 μm/year, respectively; P = 0.34). By criterion 2, the mean progression rate of average RNFL thickness did not differ significantly between the stable and progressed groups (-0.90±2.42 and -2.08±2.85 μm/year; P = 0.459). However, the progression rate as revealed by average macular thickness was significantly different between the 2 groups (-2.22±4.33 and -5.12±2.40 μm/year, respectively; P = 0.039).nnnCONCLUSIONSnExploration of changes over time in macular thickness may improve detection of progression in patients with advanced glaucoma.

Detection of Glaucomatous Progression by Spectral-Domain Optical Coherence Tomography

PURPOSEnTo compare the rate of change of circumpapillary retinal nerve fiber layer (cRNFL) thickness, macular volume and thickness, and optic nerve head (ONH) parameters assessed using spectral-domain optical coherence tomography (SD-OCT) between eyes with progressing and nonprogressing glaucoma.nnnDESIGNnLongitudinal, observational study.nnnPARTICIPANTSnTwo hundred seventy-nine eyes from 162 glaucoma patients followed for an average of 2.2 years.nnnMETHODSnEyes were classified as progressors and nonprogressors according to assessment of optic disc and RNFL photographs and visual field progression analysis. Linear mixed effects models were used to evaluate the overall rate of change of cRNFL thickness, macular volume and thickness, and ONH parameters after adjustment for age, spherical equivalent, signal strength, and baseline SD-OCT measurements.nnnMAIN OUTCOME MEASURESnThe rate of change of cRNFL thickness, macular volume, and thickness and ONH parameters.nnnRESULTSnSixty-three eyes (22.6%) from 52 subjects were identified as progressors. Average, inferior quadrant, and 6- and 7-oclock sector cRNFL thickness decreased faster in progressors than in nonprogressors (-1.26 vs -0.94, -2.47 vs -1.75, -3.60 vs -2.52, and -2.77 vs -1.51 μm/year, respectively; all P<0.05). The ONH rim area decreased faster, and average and vertical cup-to-disc ratio increased faster in progressors than in nonprogressors (-0.016 vs -0.006 mm(2)/year, and 0.004 vs 0.002 and 0.006 vs 0.004 per year, respectively; all P<0.05). Macular cube volume and the thickness of temporal outer and inferior inner macular sectors decreased faster in progressors than in nonprogressors (-0.068 vs -0.048 mm(3)/year, and -2.27 vs -1.67 and -2.51 vs -1.73 μm/year, respectively; all P<0.05).nnnCONCLUSIONSnSerial measurement of parameters in all 3 areas (cRNFL, macula, and ONH) by SD-OCT may permit identification of progression in glaucomatous eyes.nnnFINANCIAL DISCLOSURE(S)nThe authors have no proprietary or commercial interest in any of the materials discussed in this article.

Circadian (24-hour) Pattern of Intraocular Pressure and Visual Field Damage in Eyes with Normal-Tension Glaucoma

PURPOSEnTo characterize the circadian (24-hour) pattern of habitual-position intraocular pressure (IOP) and its association with visual field (VF) damage in eyes with normal-tension glaucoma (NTG).nnnMETHODSnA total of 177 eyes with NTG were examined over a 3-year period. IOP was recorded at 8 AM, 10 AM, 12 PM, 2 PM, 4 PM, 6 PM, 8 PM, 10 PM, 12 AM, 3 AM, and 6 AM by a single, well-trained ophthalmology resident using a hand-held tonometer. The circadian pattern and peak hours of habitual-position IOP and seated IOP were analyzed in all patients. Subgroup analysis was also performed, with groups defined by the time of maximum habitual-position IOP. The relationship between 24-hour habitual-position IOP parameters and VF indices was evaluated.nnnRESULTSnThere were 72 men and 105 women, all of whom were Koreans. Analysis of the entire population indicated a nocturnal peak (acrophase) for habitual-position IOP. Subgroup analysis indicated that 28 (15.8%) patients had diurnal acrophase, 91 (51.4%) patients had nocturnal acrophase, and 58 (32.8%) patients had no evident acrophase. There were no correlations between various 24-hour habitual-position IOP parameters and VF indices.nnnCONCLUSIONSnIn the 177 NTG patients, there was a significant nighttime elevation of habitual-position IOP, and nocturnal seated IOP was significantly less than nocturnal habitual-position IOP. Subgroup analysis indicated three distinct daily patterns of peak IOP in the patients. There was no relationship between nocturnal elevation of habitual IOP and the magnitude of VF damage.

Dynamic Changes in Anterior Segment (AS) Parameters in Eyes with Primary Angle Closure (PAC) and PAC Glaucoma and Open-Angle Eyes Assessed Using AS Optical Coherence Tomography

PURPOSEnTo evaluate serial changes in anterior segment (AS) parameters in terms of variation in pupil diameter (PD) using AS optical coherence tomography (OCT) in eyes with primary angle closure or primary angle closure glaucoma (PCG), age-matched open-angle (AO) eyes, and young open-angle (YO) eyes.nnnMETHODSnForty-four PCG (mean ± SD; 62.2 ± 7.5 years), 36 AO (62.0 ± 12.3 years), and 58 YO eyes (29.1 ± 7.0 years) were imaged under four standardized lighting conditions (3.25, 100.8, 426, and 1420 cd/m(2)). PD, anterior chamber depth (ACD), iris cross-sectional area (IA), iris thicknesses at 750 and 1500 μm from the scleral spur (IT750, IT1500), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA), were calculated. The slope of the change in each AS parameter in terms of variation in PD was determined by a linear mixed-effect model.nnnRESULTSnThe mean ACD was significantly shallower (P < 0.001), the IC higher (P < 0.001), the IT750 greater (P = 0.026), the ACA smaller (P < 0.001), the LV greater (P < 0.001), and the IA wider (P = 0.019) in PCG eyes compared with AO eyes. However, the mean slope of no parameter differed significantly between PCG and AO eyes. The mean slopes of IC, IT1500, and IA differed between AO and YO eyes.nnnCONCLUSIONSnOlder eyes showed significantly different dynamic AS parameter responses in terms of change in PD compared with younger eyes. Thus, the authors suggest that changes in the dynamic features of AS parameters with age may contribute to angle closure development, in addition to any predisposing anatomic condition.

Effect of myopia on the progression of primary open-angle glaucoma.

PURPOSEnTo evaluate the effect of myopia on the progression of primary open-angle glaucoma.nnnMETHODSnIn this retrospective cohort study, eyes were classified into nonmyopic (NMG, >0 diopters [D]), mild to moderate (MMG, 0 to -6 D), and highly myopic glaucoma (HMG, <-6 D) groups according to the level of spherical equivalent. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer (RNFL) photographs or by serial visual field (VF) data. Coxs proportional hazard models were used to detect associations between potential risk factors and glaucoma progression.nnnRESULTSnAmong 369 eyes from 369 glaucoma patients (average follow-up, 4.4 years), 54 of 178 eyes (30.3%) in the NMG, 49 of 151 eyes (32.5%) in the MMG, and 8 of 40 eyes (20.0%) in the HMG showed progression. When VF was used as a progression criterion, thinner baseline RNFL (hazard ratio [HR]: 0.942, P < 0.001) was predictive of progression. When optic disc/RNFL photographs were used, worse baseline visual field mean deviation (VF MD) and thinner RNFL were associated. The HMG category was a preventive factor for optic disc/RNFL photographic progression (HR: 0.323, P = 0.031).nnnCONCLUSIONSnNo levels of myopia were associated with glaucoma progression in our study. High myopia was a protective factor for optic disc/RNFL progression. These results may be interpreted as a lower progression detection rate because of the difficulty in detecting changes in the optic disc/RNFL in HMG, or as a consequence of some of highly myopic eyes that may not be true cases of glaucoma.

Relationship Between 24-Hour Mean Ocular Perfusion Pressure Fluctuation and Rate of Paracentral Visual Field Progression in Normal-Tension Glaucoma

PURPOSEnTo investigate the relationship between unstable mean ocular perfusion pressure (MOPP) and the rate of paracentral visual field (PVF) progression in patients with medically treated normal-tension glaucoma (NTG).nnnMETHODSnThe data of 157 eyes of 122 patients with NTG who were followed for more than 6 years (mean follow-up, 8.7 years ± 12.6 months) and had more than 5 reliable standard visual field (VF) tests were analyzed retrospectively. Groups in the highest, middle, and lowest tertiles of 24-hour MOPP fluctuation (HMF, MMF, and LMF, respectively) were compared in terms of rates of change of mean thresholds in the central 10° (PVF), 10° to 24°, and global areas by using a linear mixed model. Clinical factors associated with rapid PVF progression were also investigated.nnnRESULTSnThe LMF and HMF groups did not differ significantly in the mean global rate of VF changes (-0.52 vs. -0.71 dB/y; P = 0.07). The HMF group had a significantly faster progression of VF defects in the central 10° area than the LMF group (-1.02 vs. -0.54 dB/y; P < 0.001) but did not differ in terms of progression of VF defects in the peripheral 10° to 24° area (-0.39 vs. -0.495 dB/y; P = 0.425). PVF progression was significantly associated with 24-hour MOPP fluctuation (β = -0.31, P < 0.001) and VF damage severity at initial presentation (β = 0.134, P = 0.011).nnnCONCLUSIONSnMedically treated NTG eyes with greater 24-hour MOPP fluctuations (HMF) had faster PVF defect progression than eyes with stable 24-hour MOPP (LMF). Twenty-four hour MOPP fluctuation associated significantly with PVF progression velocity.

Progression of Retinal Nerve Fiber Layer Thinning in Glaucoma Assessed by Cirrus Optical Coherence Tomography-guided Progression Analysis

ABSTRACT Purpose: To evaluate the performance of Cirrus spectral domain optical coherence tomography (SD-OCT)-guided progression analysis (GPA) software to detect progression of retinal nerve fiber layer (RNFL) thinning in glaucoma patients. Materials and methods: This retrospective cohort study included 272 eyes of 154 glaucoma patients. Median follow-up time was 2.2 years, during which time data from at least four good-quality OCT examinations were collected. Glaucomatous eyes were classified as either early or advanced group according to visual field (VF) severity. Reference standard of glaucoma progression was defined by expert assessment of optic disc/RNFL photographs or VF GPA data, or visual field index (VFI) linear regression analysis. Sensitivity and specificity of OCT GPA, and agreement between OCT GPA findings and each reference standard strategy were estimated. Results: Fifty-three eyes (19.5%) showed progression by at least one of the reference standard strategies, while OCT GPA detected progression in 36 eyes (13.2%). When expert assessment of optic disc/RNFL photographs and/or VF analysis was used as the reference standard, the sensitivity and specificity of OCT GPA employed to detect glaucoma progression were 20.8% and 88.6%. Agreement between OCT GPA and either optic disc/RNFL photographic evaluation or VF analysis was poor (κu2009=u20090.12 and 0.03, respectively). RNFL photographic assessment in early stage glaucoma showed best agreement with OCT GPA in terms of progression detection. Discussion: The Cirrus OCT GPA detected a considerable number of eyes exhibiting glaucoma progression. OCT GPA may be useful for progression detection in earlier stage of glaucoma to complement other reference standard strategies.

Detection of macular ganglion cell loss in preperimetric glaucoma patients with localized retinal nerve fibre defects by spectral-domain optical coherence tomography.

To evaluate and compare the utility of ganglion cell complex with peripapillary retinal nerve fibre layer and optic nerve head measurements for detection of localized defects in patients with preperimetric glaucoma using spectral‐domain optical coherence tomography.

Lamina Cribrosa-Related Parameters Assessed by Optical Coherence Tomography for Prediction of Future Glaucoma Progression

Abstract Purpose: To evaluate the value of lamina cribrosa (LC)-related parameters assessed by optical coherence tomography (OCT) in the future prediction of glaucomatous progression. Methods: Glaucoma or glaucoma suspect eyes were followed up for more than 2 years. Glaucoma progression was defined by optic disc/retinal nerve fiber layer (RNFL) photographic assessment or serial visual field exams. LC thickness, anterior LC distance (ALD) and prelaminar tissue thicknesses were determined with optic disc images obtained by Spectralis OCT enhanced depth imaging. Kaplan–Meier life table analyses were carried out, and survival experience was compared between eyes with thicker baseline LC (HLC) and thinner baseline LC (LLC) by a log rank test. Hazard ratios (HRs) of various risk factors, including LC-related parameters, for future glaucomatous progression, were determined using uni- and multi-variate Cox’s proportional hazard models. Results: Among the 118 eyes, 33 showed progression during follow-up period. The progression group had a significantly thinner average circumpapillary RNFL (cRNFL, pu2009=u20090.005), LC (pu2009=u20090.005) and prelaminar tissue (pu2009=u20090.023) than the non-progression group at baseline. The LLC group showed a greater cumulative probability of glaucoma progression than did the HLC group (pu2009=u20090.001). Average cRNFL thickness (HR, 0.972, pu2009=u20090.007), prelaminar tissue thickness (0.990, pu2009=u20090.028) and LC thickness (0.971, pu2009=u20090.002) were significantly associated with progression of glaucoma. In multivariate analysis, only LC thickness (0.975, pu2009=u20090.015) showed significant association with progression. Conclusion: Thinner baseline LC was independently associated with glaucoma progression in our study. LC thickness may be a risk factor for predicting future glaucoma progression.