Younhea Jung

Glaucoma Diagnostic Accuracy of Optical Coherence Tomography Parameters in Early Glaucoma with Different Types of Optic Disc Damage

PURPOSE To compare the initial visual field (VF) defect pattern and the spectral-domain optical coherence tomography (OCT) parameters and investigate the effects of distinct types of optic disc damage on the diagnostic performance of these OCT parameters in early glaucoma. DESIGN Retrospective, observational study. PARTICIPANTS A total of 138 control eyes and 160 eyes with early glaucoma were enrolled. The glaucomatous eyes were subdivided into 4 groups according to the type of optic disc damage: focal ischemic (FI) group, myopic (MY) group, senile sclerotic (SS) group, and generalized enlargement (GE) group. METHODS The values of total deviation (TD) maps were analyzed, and superior-inferior (S-I) differences of TD were calculated. The optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured. MAIN OUTCOME MEASURES Comparison of diagnostic ability using area under the receiver operating characteristic curves (AUCs). RESULTS The S-I and central S-I difference of the FI group were larger than those of the GE group. The rim area of the SS group was larger than those of the 3 other groups, and the vertical cup-to-disc ratio (CDR) of the GE group was larger than that of the MY group. In addition, the minimum and inferotemporal GCIPL thicknesses of the FI group were smaller than those of the GE group. The AUC of the rim area (0.89) was lower than that of the minimum GCIPL (0.99) in the SS group, and the AUC of the vertical CDR (0.90) was lower than that of the minimum GCIPL (0.99) in the MY group. Furthermore, the AUCs of the minimum GCIPL thicknesses of the FI and MY group were greater than those of the average pRNFL thickness for detecting glaucoma, as opposed to the SS and GE. CONCLUSIONS The OCT parameters differed among the 4 groups on the basis of the distinct optic disc appearance and initial glaucomatous damage pattern. Clinicians should be aware that the diagnostic capability of OCT parameters could differ according to the type of optic disc damage in early glaucoma.

The Ability of 10-2 Short-Wavelength Perimetry in Detecting Functional Loss of the Macular Area in Preperimetric Glaucoma Patients

PURPOSE To better understand functional loss in the macular area of preperimetric glaucoma patients exhibiting structural loss by exploring correlations between parameters of the ganglion cell-inner plexiform layer (GCIPL) and 10-2 short-wavelength perimetry (SWAP). METHODS One hundred thirty-four patients underwent 10-2 SWAP and conventional 24-2 visual field (VF) testing using a Humphrey field analyzer and macular scanning via Cirrus optical coherence tomography (OCT). Correlations between GCIPL thickness (GCIPLT) and the mean sensitivity (MS) of topographically corresponding areas explored in various VF tests were calculated. Correlations between GCIPL parameters and MS of the VF, in terms of the asymmetries of various VF sectors, were also determined. RESULTS Glaucoma patients, preperimetric by standard 24-2 VF analysis but exhibiting GCIPL thinning, had lower MS in 10-2 SWAP and central 24-2 VF analyses. The correlations between average GCIPLT and the corresponding MS were significant for both 10-2 SWAP (r = 0.291, P = 0.018) and 24-2 standard automated perimetry (r = 0.235, P = 0.029). The associations between sectoral GCIPLT and the corresponding 10-2 SWAP MS were significant for all sectors, with the highest correlation evident in the inferotemporal (r = 0.324, P = 0.009) and the lowest in the superonasal GCIPL sectors (r = 0.214, P = 0.043). Asymmetric relationships between GCIPLT and 10-2 SWAP MS exhibited similar yet stronger correlations. CONCLUSIONS Preperimetric glaucoma patients exhibiting structural loss in the macula also had functional loss revealed by 10-2 SWAP, which was less prominent in conventional 24-2 VF. Therefore, if structural abnormality is evident in the macular area, the central VF areas should be further examined even if the standard 24-2 data appear to be normal.

The Location of the Deepest Point of the Eyeball Determines the Optic Disc Configuration

Tilted and rotated appearances are hallmarks of the myopic optic disc. As the eyeball grows axially, the posterior pole elongates not only globally but in a localized manner as well. In this process, the optic disc is pulled towards the deepest point of the elongated eyeball, which might result in a change in optic disc configuration. Thus, we hypothesized that analyzing the variation of posterior pole contour can play a major role in understanding optic disc configuration in myopic subjects. By analyzing consecutive images of swept source OCT coronal sections at the posterior pole, the deepest interface between Bruch’s membrane and the choroid could be identified as the deepest point of the eyeball (DPE). The location and the properties of the DPE differed significantly between the 125 eyes of non-glaucomatous myopic group and the 40 eyes of non-glaucomatous emmetropic group classified based on 24 mm axial length. The results suggested that the larger disc to DPE angle and the larger disc to DPE depth strongly predicts the optic disc torsion degree and the optic disc tilt. Our findings suggest that identifying the posterior pole profile plays a major role in understanding the optic disc alterations found in myopic subjects.

Difference in Outcomes between First-Operated vs. Fellow-Operated Eyes in Patients Undergoing Bilateral Trabeculectomies.

Main Objective To compare the course and outcome of first- and fellow-operated eyes in patients who underwent bilateral trabeculectomies and to investigate the factors associated with the difference. Methods Preoperative characteristics, including the interval between surgeries, were compared between the first- and fellow-operated eyes in 42 patients who underwent bilateral trabeculectomies. Postoperative intraocular pressure and bleb vascularity, using postoperative anterior segment photos, were compared at various time points between the first- and fellow-operated eyes. Surgical success was evaluated at 1 year after surgery and at the final follow-up. Factors affecting the difference between the first and fellow eyes were analyzed. Results There was no significant difference in success or failure rates at 1 year postoperatively and at the final follow-up between the first- and fellow-operated eyes. Early postoperative IOP and the degree of bleb vascularity were higher in the fellow-operated eyes (P = 0.001 and 0.003, respectively at week 1 postoperative). The difference in IOP between the first- and fellow-operated eyes was greater in patients whose interval between surgeries was shorter than 3 weeks (P = 0.026). Conclusions In patients undergoing bilateral trabeculectomies, early postoperative IOP was higher in the fellow-operated eyes than the first-operated eyes; the difference was greater when the interval between surgeries was shorter. The first-operated eye may influence the early postoperative inflammatory response in the fellow-operated eye. Our findings have clinical implications for planning treatment of patients who may need bilateral surgery.

Usefulness of 10-2 Matrix Frequency Doubling Technology Perimetry for Detecting Central Visual Field Defects in Preperimetric Glaucoma Patients

It is generally acknowledged that structural loss can precede functional loss in some patients with early glaucoma. However, conventional standard automated perimetry (SAP) has limitations in the detection of functional loss, especially in the macular area. This study explores visual field loss in the macular areas of patients with preperimetric glaucoma exhibiting structural thinning in the area by examining the correlations between the ganglion cell-inner plexiform layer (GCIPL) and the results of matrix frequency-doubling technology (FDT) 10-2 tests. The structure-function relationships between the GCIPL thicknesses and the mean sensitivities (MSs) of the corresponding areas based on conventional SAP 24-2, FDT 10-2, and FDT 24-2 were examined in 62 patients. The highest correlation was found for FDT 10-2 (r = 0.544, P < 0.001) followed by FDT 24-2 (r = 0.433, P = 0.002) and SAP (r = 0.346, P = 0.007). The correlation coefficients between each GCIPL sector and the corresponding central MS according to FDT 24-2 and 10-2 were all statistically significant, and the correlations were significantly stronger for FDT 10-2 than 24-2 in the inferior and inferonasal sectors. In conclusion, preperimetric glaucoma patients with structural loss in the macula as indicated by GCIPL thinning also exhibited functional loss as revealed by FDT 10-2, and the functional loss was less evident with conventional SAP.

Optic Disc Hemorrhage and Lamina Cribrosa Defects in Glaucoma Progression

Both disc hemorrhages (DH) and focal lamina cribrosa (LC) defects are recently considered as a progression factor in glaucoma. However, the clinical relevance of the presence of LC findings at the site of the DH has not yet been determined. We conducted a prospective study enrolling a total of 98 glaucoma eyes with DH and 37 OAG eyes with focal LC defect without DH to determine whether visual field (VF) progression differs according to the findings of the LC that had been evaluated by enhanced depth imaging (EDI) of optical coherence tomography (OCT) and its relationship with DH. Only the presence of focal LC defects was significantly different between the progressing and stable patients (P < 0.001). Baseline intraocular pressure (hazard ratio [HR], 1.076; P = 0.098) and the presence of focal LC defects at the DH site (HR, 2.620; P = 0.002) were found to be associated with VF progression. Glaucoma eyes with DH at the site of focal LC defects showed frequent and faster VF progression compared with DH not accompanied by LC alterations or LC alterations not accompanied by DH. Evaluating LC alterations in glaucoma eyes with DH may be important in predicting the progression of glaucoma.

Type 2 diabetes mellitus and risk of open-angle glaucoma development in Koreans: An 11-year nationwide propensity-score-matched study

PURPOSE To evaluate the risk of primary open-angle glaucoma (POAG) development in type 2 diabetes mellitus (T2DM) patients. METHODS In this 11-year longitudinal study based on the Korean National Health Insurance research database, the data collected comprised 1,025,340 (2.2%) participants who were randomly selected from 46,605,433 Korean residents in 2002. The database was analyzed to identify participants with an initial diagnosis of T2DM in 2003-2004. The control group was composed of participants without T2DM who were propensity-score-matched, five controls per T2DM patient, according to age, gender, household income, residential area and underlying diseases, including hypertension, dyslipidaemia, coronary heart disease, cerebrovascular disease and thyroid disease. Cox proportional-hazards regression was used to calculate the overall hazard ratios (HRs) in participants with and without T2DM for development of POAG before and after adjusting for confounding factors. RESULTS There were 12,657 participants with T2DM and 63,285 propensity-score-matched controls without T2DM. POAG developed in 413 (3.3%) and 1188 (1.9%) participants in the T2DM and control groups, respectively. T2DM was associated with an increased risk of POAG development [HR: 1.80; 95% confidence interval (CI): 1.58-2.04] after adjusting for age, gender, household income and other potential confounders. CONCLUSION T2DM was significantly associated with the development of POAG after adjusting for potential confounders in the Korean population.

Effect of Glaucoma Surgery on the Progression Rate and Pattern in Glaucoma Patients With Myopia.

PURPOSE To evaluate the effect of myopia on the changes of visual field (VF) and retinal nerve fiber layer (RNFL) thickness after glaucoma surgery. METHODS Patients with primary open-angle glaucoma who underwent glaucoma surgery due to uncontrolled IOP, with at least four VF and optical coherence tomography (OCT) examinations before and after surgery (total of eight VF and OCT examinations), and follow-ups of at least 4 years, were enrolled and classified according to axial length. Disc ovality ratio, degree of disc torsion, and ratio between peripapillary atrophy area and disc area were measured from disc photographs. The rate of change of the VF parameters and RNFL thickness was determined by using a linear regression analysis and compared according to the degree of myopia. RESULTS A total of 63 eyes with myopia and 46 eyes without myopia were analyzed. The rate of change in the sensitivity of the central VF (within 10° region) and temporal RNFL thickness differed significantly between the myopic and nonmyopic groups (P < 0.01 and P < 0.01, respectively). Axial length (P < 0.01), magnitude of IOP change after surgery (P < 0.01), the presence of postoperative hypertensive phase (P < 0.01), and peripapillary atrophy to disc area ratio (P < 0.01) were significantly related to the change of the central VF and temporal RNFL thickness. CONCLUSIONS Myopic eyes with large peripapillary atrophy relative to the disc area seem to show greater central VF progression and temporal RNFL thinning after glaucoma surgery when they are exposed to large IOP change of glaucoma surgery.