Fully Automated Segmentation of Human Eyeball Using Three-Dimensional U-Net in T2 Magnetic Resonance Imaging.

Purpose: To develop and validate a fully automated deep-learning-based tool for segmentation of the human eyeball using a three-dimensional (3D) U-Net, compare its performance to semiautomatic segmentation ground truth and a two-dimensional (2D) U-Net, and analyze age and sex differences in eyeball volume, as well as gaze-dependent volume consistency in normal subjects. Methods: We retrospectively collected 474 magnetic resonance imaging (MRI) scans, including different gazing scans, from 119 patients. A 10-fold cross-validation was applied to separate the dataset into training, test, and validation sets for both the 3D U-Net and 2D U-Net. Performance accuracy was measured using four quantitative metrics compared to the ground truth, and Bland-Altman plot analysis was conducted. Age and sex differences in eyeball volume and variability in eyeball volume differences across gazing directions were analyzed. Results: The 3D U-Net outperformed the 2D U-Net with mean accuracy scores >0.95, showing acceptable agreement in the Bland-Altman plot analysis despite a tendency for slight overestimation (mean difference = -0.172 cm³). Significant sex differences and age effects on eyeball volume were observed for both methods (P < 0.05). No significant volume differences were found between the segmentation methods or within each method for the different gazing directions. Significant differences in performance accuracy were identified among the five gazing directions, with the upward direction showing a notably lower performance. Conclusions: Our study demonstrated the effectiveness of 3D U-Net human eyeball volume segmentation using T2-weighted MRI. The robustness and reliability of 3D U-Net across diverse populations and gaze directions support enhanced ophthalmic diagnosis and treatment strategies. Translational Relevance: Our findings demonstrate the feasibility of using the proposed 3D U-Net model for the automatic segmentation of the human eyeball, with potential applications in various ophthalmic research fields that require the analysis of 3D geometric eye globe shapes or eye movement detection.

Causes of Childhood Blindness in the United States Using the IRIS® Registry (Intelligent Research in Sight).

PURPOSE: To investigate causes of childhood blindness in the United States using the IRIS® Registry (Intelligent Research in Sight). DESIGN: Cross-sectional study. PARTICIPANTS: Patients ≤ 18 years of age with visual acuity (VA) 20/200 or worse in their better-seeing eye in the IRIS Registry during 2018. METHODS: Causes of blindness were classified by anatomic site and specific diagnoses. MAIN OUTCOME MEASURES: Percentages of causes of blindness. RESULTS: Of 81 164 children with 2018 VA data in the IRIS Registry, 961 (1.18%) had VA 20/200 or worse in their better-seeing eye. Leading causes of blindness were retinopathy of prematurity (ROP) in 301 patients (31.3%), nystagmus in 78 patients (8.1%), and cataract in 64 patients (6.7%). The retina was the leading anatomic site (47.7%) followed by optic nerve (11.6%) and lens (10.0%). A total of 52.4% of patients had treatable causes of blindness. CONCLUSIONS: This analysis offers a unique cross-sectional view of childhood blindness in the United States using a clinical data registry. More than one-half of blind patients had a treatable cause of blindness. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Wide-field optical coherence tomography deviation map for early glaucoma detection.

BACKGROUND/AIMS: This study aimed to establish a wide-field optical coherence tomography (OCT) deviation map obtained from swept-source OCT (SS-OCT) scans. Moreover, it also aimed to compare the diagnostic ability of this wide-field deviation map with that of the peripapillary and macular deviation maps currently being used for the detection of early glaucoma (EG). METHODS: Four hundred eyes, including 200 healthy eyes and 200 eyes with EG were enrolled in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT (DRI-OCT Triton; Topcon, Tokyo, Japan). The individual wide-field scan was converted into a uniform template using the fovea and optic disc centres as fixed landmarks. Subsequently, the wide-field deviation map was obtained via the comparison between individual wide-field data and a normative wide-field database that had been created by combining images of healthy eyes into a uniform template in a previous study. The ability of the new wide-field deviation map to distinguish between EG and healthy eyes was assessed by comparing it with conventional deviation maps based on the area under the receiver operating characteristic curve (AUC). RESULTS: The wide-field deviation map obtained using the normative wide-field database showed the highest diagnostic ability for the diagnosis of EG (AUC=0.980 and 961 for colour-coded pixels presenting <5% and <1%, respectively) among various deviation maps. Its AUC was significantly superior to that of most conventional deviation maps (p<0.05). The wide-field deviation map demonstrated early structural glaucomatous damage well over a wider area. CONCLUSION: The wide-field SS-OCT deviation map exhibited good performance for distinguishing between eyes with EG and healthy eyes. The visualisation of the wider damaged area on the wide-field deviation map could be useful for the diagnosis of EG in clinical settings.

Immediate and Quantitative Changes in Tear Film Parameters and Meibomian Gland Structures after Warm Compression and Meibomian Gland Squeezing in Meibomian Gland Dysfunction Patients and Normal Subjects.

Meibomian gland dysfunction (MGD), a chronic abnormality of meibomian glands, causes various dry eye symptoms. Principal treatments for MGD are warm compression and mechanical squeezing of the eyelids. In this study, the immediate impact of this treatment on tear film lipid layer thickness (TFLLT) and the meibomian gland (MG) structure in MGD and normal groups was investigated to establish its efficacy and potential side effects. Nineteen MGD patients and seven normal subjects were enrolled. TFLLT and blinking parameters were evaluated before and after warm compression. Morphological changes of MG structures after mechanical squeezing were analyzed using Image J and Fiji. Differential analysis of the MGD and the normal groups of TFLLT changes after warm compression showed a significant increase in the normal group. In normal eyes, the average, maximum, and minimum TFLLT were significantly increased, and in the MGD group, only the minimum TFLLT was improved. Blinking parameters showed no significant change in either group. Morphometric analysis showed no damages of the MG after MG squeezing. A significant increase in MG length was observed in normal eyes. Warm compression immediately increased TFLLT more significantly in the normal group than in the MGD patients. Mechanical expression is a safe therapeutic option without remarkable structural MG damages.

Glioblastoma-educated mesenchymal stem-like cells promote glioblastoma infiltration via extracellular matrix remodelling in the tumour microenvironment.

BACKGROUND: The biological function of mesenchymal stem-like cells (MSLCs), a type of stromal cells, in the regulation of the tumour microenvironment is unclear. Here, we investigated the molecular mechanisms underlying extracellular matrix (ECM) remodelling and crosstalk between MSLCs and glioblastomas (GBMs) in tumour progression. METHODS: In vitro and in vivo co-culture systems were used to analyze ECM remodelling and GBM infiltration. In addition, clinical databases, samples from patients with GBM and a xenografted mouse model of GBM were used. RESULTS: Previous studies have shown that the survival of patients with GBM from whom MSLCs could be isolated is substantially shorter than that of patients from whom MSLCs could not be isolated. Therefore, we determined the correlation between changes in ECM-related gene expression in MSLC-isolatable patients with that in MSLC non-isolatable patients using gene set enrichment analysis (GSEA). We found that lysyl oxidase (LOX) and COL1A1 expressions increased in MSLCs via GBM-derived clusters of differentiation 40 ligand (CD40L). Mechanistically, MSLCs are reprogrammed by the CD40L/CD40/NFκB2 signalling axis to build a tumour infiltrative microenvironment involving collagen crosslinking. Importantly, blocking of CD40L by a neutralizing antibody-suppressed LOX expression and ECM remodelling, decreasing GBM infiltration in mouse xenograft models. Clinically, high expression of CD40L, clusters of differentiation 40 (CD40) and LOX correlated with poor survival in patients with glioma. This indicated that GBM-educated MSLCs promote GBM infiltration via ECM remodelling in the tumour microenvironment. CONCLUSION: Our findings provide mechanistic insights into the pro-infiltrative tumour microenvironment produced by GBM-educated MSLCs and highlight a potential therapeutic target that can be used for suppressing GBM infiltration.

Quantitative evaluation of intraorbital optic nerve in optic atrophy using diffusion tensor imaging.

The aim of this study is to quantitatively investigate the microstructural properties of the optic nerve (ON) in vivo using diffusion tensor imaging (DTI) in patients with unilateral optic atrophy (OA) and to determine their association with retinal nerve fiber layer (RNFL) thickness of the optic nerve head (ONH). Six patients with unilateral OA and 11 control subjects underwent DTI. ONs from ONH to the orbital apex were tracked. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were computed in both ONs and their correlation with RNFL thickness measured using optical coherence tomography was also analyzed. FA of atrophic ON was lower than that of non-affected and control ONs (atrophic [A], 0.136 ± 0.059; non-affected [N], 0.384 ± 0.048; control [C], 0.389 ± 0.053). MD and RD of atrophic ONs were higher than those of non-affected and control ONs (MD, A, 0.988 ± 0.247; N, 0.658 ± 0.058; C, 0.687 ± 0.079; RD, A, 0.920 ± 0.247; N, 0.510 ± 0.054; C, 0.532 ± 0.078). All DTI measures of atrophic ON except for AD showed a significant correlation with RNFL thickness of ONH; FA showed the strongest correlation, followed by RD and MD (FA, R2 = 0.936, P < 0.001; RD, R2 = 0.795, P < 0.001; MD, R2 = 0.655, P = 0.001). This study reports quantitative analysis of the ON using DTI and differences in DTI measures between atrophic and normal ONs. The significant correlation between DTI measures and RNFL thickness suggests the applicability of DTI as a clinical tool to evaluate the ON.

Analysis of MicroRNA Expression in Tears of Patients with Herpes Epithelial Keratitis: A Preliminary Study.

Purpose: Herpes epithelial keratitis (HEK) is the most common form of herpes simplex virus (HSV) eye involvement, and understanding the molecular mechanisms underlying HEK is important. We investigated the expression of microRNAs (miRNAs) in the tears of patients with HEK. Methods: Tear samples from eight patients with HEK and seven age-matched controls were evaluated. Clinical ophthalmologic evaluation was performed, and an anterior segment photograph was obtained after fluorescence staining. Dendritic or geographic ulcer areas were measured using ImageJ software. The expression of 43 different miRNAs in tears was measured using real-time polymerase chain reaction and compared between patients with HEK and controls. Differences in miRNA expression between the dendritic and geographic ulcer groups and correlations involving miRNA expression and ulcer area were evaluated. Results: Of the 43 miRNAs, 23 were upregulated in patients with HEK compared to normal controls. MiR-15b-5p, miR-16-5p, miR-20b-5p, miR-21-5p, miR-23b-3p, miR-25-3p, miR-29a-3p, miR-30a-3p, miR-30d-5p, miR-92a-3p, miR-124-3p, miR-127-3p, miR-132-3p, miR-142-3p, miR-145-5p, miR-146a-5p, miR-146b-5p, miR-155-5p, miR-182-5p, miR-183-5p, miR-221-3p, miR-223-3p, and miR-338-5p were significantly upregulated in patients with HEK. MiR-29a-3p exhibited significant differences between the dendritic and geographic ulcer groups. All 23 miRNAs with significant differences between patients with HEK and the control group were not significantly correlated with ulcer area. Conclusions: Twenty-three miRNAs were significantly upregulated in the tears of patients with HEK, and the expression of miRNAs may play important roles in herpes infection in relation to host immunity.

Quantitative Analysis of Translatory Movements in Patients With Horizontal Strabismus.

Purpose: To investigate translatory movement during the lateral gaze in patients with horizontal strabismus using magnetic resonance imaging. Methods: Patients with esotropia or exotropia and normal controls underwent orbital magnetic resonance imaging during the central gaze and lateral gaze at 40°. The position of the static tissues was superimposed three-dimensionally for all gazes using a self-developed software, allowing the analysis of the net eyeball movement. Then, the eyeball centroid coordinates were extracted for each gaze, and the distance and direction of centroid movement from the central to lateral gaze were calculated. Results: The mean distance ± standard deviation of the centroid movement was 1.0 ± 0.5 mm during abduction in the exotropia group, which was significantly longer than that in the esotropia (0.6 ± 0.3 mm; P = 0.003) and control (0.7 ± 0.2 mm; P = 0.002) groups. Conversely, the centroid moved farther in the esotropia group (0.9 ± 0.3 mm) than the exotropia (0.6 ± 0.3 mm; P = 0.005) and control (0.7 ± 0.2 mm; P = 0.023) groups during adduction. Posterior translation during abduction was longer in the exotropia group (-0.8 ± 0.3 mm) compared with the esotropia (-0.5 ± 0.3 mm; P = 0.017) and control (-0.4 ± 0.3 mm; P = 0.001) groups, whereas that during adduction was longer in the esotropia group (-0.4 ± 0.4 mm) than the exotropia (-0.1 ± 0.2 mm; P = 0.033) and control (-0.1 ± 0.2 mm; P = 0.026) groups. Conclusions: During abduction, more translatory movement occurred in the exotropia group, whereas the centroid moved farther in the esotropia group during adduction. The translatory movement difference between both strabismus groups implies that there is a difference in biomechanics among the types of strabismus.

Combined wide-field optical coherence tomography angiography density map for high myopic glaucoma detection.

The present study aimed to evaluate the diagnostic ability of wide-field optical coherence tomography angiography (OCTA) density map for detection of glaucomatous damage in high myopic (HM) eyes and to further compare the diagnostic ability of OCTA with that of conventional imaging approaches including red-free photography and swept-source OCT (SS-OCT) wide-field maps. A total of 77 healthy HM eyes and 72 HM eyes with open angle glaucoma (OAG) participated in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT scan and peripapillary area and macular OCTA scans. An integrated OCTA density map thereafter was merged by vascular landmark-guided superimposition of peripapillary and macular superficial vascular density maps onto the red-free photography (resulting in the OCTA-PanoMap). Glaucoma specialists then determined the presence of glaucomatous damage in HM eyes by reading the OCTA-PanoMap and compared its sensitivity and specificity with those of conventional images. Sensitivity and specificity of OCTA-PanoMap for HM-OAG diagnosis was 94.4% and 96.1%, respectively. Compared with other imaging methods, the sensitivity of OCTA-PanoMap was significantly higher than that of red-free photography (P = 0.022) and comparable to that of wide-field SS-OCT maps. Specificity of OCTA-PanoMap was significantly higher than those of other conventional imaging methods (except for wide-field thickness map). The OCTA-PanoMap showed good diagnostic ability for discrimination of HM-OAG eyes from healthy HM eyes. As a complementary method of an alternative imaging modality, OCTA-PanoMap can be a useful tool for detection of HM-OAG.

In vivo Analysis of Normal Optic Nerve in an Elderly Population Using Diffusion Magnetic Resonance Imaging Tractography.

Purpose: To quantitatively investigate the microstructural properties of the optic nerve (ON) in vivo using diffusion magnetic resonance imaging (dMRI) tractography in an elderly population and to determine the differences between the ON diffusion properties stratified by basic demographics. Methods: We measured fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of the intraorbital ON in cognitively normal controls selected from the Alzheimer's Disease Neuroimaging Initiative 3 database (n =104; mean age = 73. 8 ± 8.1 years) using dMRI probabilistic tractography and evaluated the correlation between diffusion parameters and demographic factors. Diffusion parameters were measured in 20 equidistant nodes along the tract, and the data from proximal 70% (14 nodes) of the intraorbital ON were averaged. Results: The mean FA of the intraorbital ON was 0.392 ± 0.063, and the mean MD was 1.163 ± 0.165 µm2/s. The mean RD was 0.882 ± 0.152 µm2/s, and the mean AD was 1.693 ± 0.183 µm2/s. The multiple linear regression model showed a negative correlation between FA and age. FA in females was significantly higher than males, whereas RD in female was significantly lower. Conclusions: We measured the diffusion properties of the intraorbital ON using dMRI tractography in an elderly cognitively normal population. The diffusion properties detected by dMRI tractography may substantially reflect the microstructure of the ON.

Quantitative Analysis of Eyeball Rotation During Lateral Gaze in Intermittent Exotropia: A Magnetic Resonance Imaging Study.

Purpose: To evaluate the eyeball rotation during lateral gaze in patients with intermittent exotropia (IXT) using three-dimensional magnetic resonance imaging (MRI). Methods: In this prospective observational study, patients with IXT (n = 29) underwent orbital MRI during central, right, and left gazes. Fixation targets were placed at a 40° angle for lateral gaze. After acquisition of MR images, the position of the static tissues other than the eyeball in the MR images were matched three-dimensionally. The optical axis was defined as the perpendicular line to its lens passing through the corneal vertex. The rotation angle was measured as the angle between optical axes in central gaze and lateral gaze using ImageJ. A difference of 3° or more in the rotational angle between both eyes was considered a significant difference. Results: Eight patients (26.7%) had a larger adduction angle than the abduction angle of the fellow eye and six patients (20.0%) showed a smaller adduction angle during lateral gaze on at least one side. There was no significant factor associated with the pattern of rotation. Conclusions: Almost one-half of the patients with IXT had significant difference in the rotation angle between both eyes during lateral gaze. Measurement of the rotation angle during lateral gaze using MRI showed that IXT is not a perfectly comitant disturbance of gaze in some subjects. Translational Relevance: Quantitative analysis for eye movements using MRI can provide useful information for physiologic mechanism and proper surgical planning in patients with IXT.

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus.

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.

Intraocular Pressure According to Eye Gaze by iCare Rebound Tonometry in Normal Participants and Glaucoma Patients.

PRECIS: We investigated changes of intraocular pressure (IOP) according to eye gaze. IOP was significantly elevated in adduction, abduction, and supraduction. However, there was no significant difference between glaucoma and control groups. PURPOSE: We assessed changes in IOP according to eye gaze and identified their correlations with various risk factors of glaucoma. PATIENTS AND METHODS: In this prospective observational study that included 56 glaucoma patients and 34 healthy participants, we measured IOP in the primary position with a Goldmann applanation tonometry and rebound tonometer. Then, this IOP was measured in abduction, adduction, supraduction using a rebound tonometer. IOP changes according to eye gaze were measured based on the baseline IOP, and IOP changes between glaucoma and the control groups were compared. Correlations between IOP changes and risk factors of glaucoma were evaluated. RESULTS: The baseline IOP was not significantly different between glaucoma and the control groups. Compared with the IOP in the primary position, a significant increase in IOP was 2.3±2.7 mm Hg during abduction (P<0.0001), 0.7±2.7 mm Hg during adduction (P<0.0001), and 1.2±2.8 mm Hg during supraduction (P<0.0001). However, there was no significant difference in the amount of IOP elevation or the ratio of IOP change between glaucoma and the control groups in all gazes. The baseline IOP measured by Goldmann applanation tonometry and IOP changes according to eye gaze showed a significant negative correlation in all gazes. CONCLUSIONS: IOP was significantly elevated in adduction, abduction, and supraduction than in the primary position in both the normal and glaucoma groups. However, there was no significant difference of IOP changes between glaucoma and normal groups.

A Wide-Field Optical Coherence Tomography Normative Database Considering the Fovea-Disc Relationship for Glaucoma Detection.

Purpose: One purpose of this study was to collect wide-field swept-source optical coherence tomography (SS-OCT) data from healthy eyes and build a wide-filed normative database. Another purpose was to compare the glaucoma diagnostic ability of new parameters based on this normative database to the parameters that are currently in use, such as the peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell-inner plexiform layer, and ganglion cell complex (GCC) thickness. Methods: This study had 220 healthy eyes and 292 eyes with early-stage glaucoma (EG) and moderate-stage glaucoma (MG) enrolled. Using the wide-field SS-OCT images (12 × 9 mm) of healthy eyes, a wide-field normative database was constructed by transforming and combining the individual images into a uniform template using the fovea and optic disc centers as fixed landmarks. Adjustment for the disc size was conducted. With this normative database, new parameters based on the ratio of the fovea-disc distance (FDD) consisting of the fovea-disc relationship were evaluated. The glaucoma diagnostic ability was assessed based on the area under the receiver operating characteristic curve (AUC). Results: Among the new peripapillary parameters, the RNFL of the circumference of the circle with diameter 0.8 FDD showed the highest AUC value for EG and MG, but the value was not significantly superior to that of the initial RNFL (AUC = 0.940 vs. 0.937, P = 0.631). Among the macular parameters, the GCC of the area of the circle of 1.5 FDD showed the highest AUC value for EG and MG, and the value was significantly superior to that of initial GCC (AUC = 0.929 vs. 0.919, P = 0.033). However, there was no significant difference between the initial and adjusted GCC thickness in patients included in the EG or MG groups separately. Conclusions: A wide-field normative database was built to consider the relationship between the fovea and the optic disc. Considering this aspect, we found that the GCC analysis using a broader area presented a significantly greater glaucoma diagnostic performance for EG and MG in the macula than the initial parameter for the GCC. Translational Relevance: Based on this wide-field normative database, the clinical use of a wide-field deviation map may help diagnose the patients with EG and MG in the future.

Investigation of MicroRNA Expression in Anterior Lens Capsules of Senile Cataract Patients and MicroRNA Differences According to the Cataract Type.

Purpose: We investigated the microRNAs (miRNAs) expression in the anterior lens capsules of patients with senile cataract and compared it to that in the anterior lens capsules of healthy controls. Moreover, we compared the differences in miRNAs expression according to the types of cataracts. Methods: Individual lens epithelium samples were collected from 33 senile patients and 10 controls. The cataract patients were classified into cortical, nuclear, posterior and anterior subcapsular and mixed. The expression of 12 different miRNAs in lens epithelium was measured using real-time polymerase chain reaction and compared between the senile cataract patients and controls. The differences of miRNA levels according to cataract type were analyzed. Results: The expression levels of let-7g-5p, miR-23a-3p, miR-23b-3p, and miR-125a-5p were significantly upregulated in patients with senile cataract when compared with those in the control group (P < 0.05). The expressions of let-7a-5p, let-7d-5p, miR-16-5p and miR-22-3p were significantly downregulated in the senile cataracts (P < 0.05). Let-7a-5p, let-7d-5p, let-7g-5p and mir-23b-3p had significant difference in expression between nuclear and anterior subcapsular cataracts. Conclusions: The eight differentially expressed miRNAs may be involved in the pathogenesis of senile cataract, in particular, related to oxidative stress and autophagy. Translational Relevance: We infer that several miRNAs in lens epithelial cells are promising candidate biomarkers of senile cataracts.

A pilot study for intraocular pressure measurements based on vibroacoustic parameters.

The present study aimed to identify vibroacoustic properties associated with intraocular pressure (IOP) changes and to suggest a new way to measure the IOP based on these properties. Ten ex vivo porcine eyeballs were used in this study. Each eyeball was fixated in a central hole of a Styrofoam block, and vibration applied to the Styrofoam block was transmitted to the eyeball. An accelerometer directly attached to the eyeball measured the vibration response. Excitations and measurements were performed for 1 s, and the excitation magnitude was varied for the same signal in repeat measurements. A 30-gauge needle was inserted into the anterior chamber of the eyeball to inject a balanced salt solution, and the height of the bottle was adjusted to adjust the IOP. A tonometer was used under identical conditions to measure the IOP five times, and the mean value was determined for further analyses. The measurements showed that the parameters resonance frequency and change in the magnitude of the vibration response (CMVR) increased with rising IOP values. The CMVR was highly correlated with the IOP (p-value < 0.0001). A linear mixed effects model (LMM) was used as a statistical analysis method. We confirmed that vibroacoustic properties of the eyeball are correlated with IOP changes. It is expected that the CMVR will serve as a new parameter for IOP measurements. Thus, in the future, continuous IOP measurements would be easily performed using the CMVR.

Clinical Use of PanoMap for Glaucoma: Frequently Damaged Areas in Early Glaucoma.

PRCIS: Recognizing the shortcomings of poor consistency of the fovea-disc relationship at different time points and comparing PanoMaps may well facilitate the understanding of the spatial relationship between parapapillary and macular areas in glaucoma. PURPOSE: The aims of this study are to analyze the spatial distribution of the frequently damaged areas in early glaucoma, compare the patterns between nonprogressors and progressors using the combined wide-field parapapillary and macular deviation maps (PanoMap), and to evaluate the consistency of the fovea-disc relationship in PanoMap. The fovea-disc distance (FDD) and fovea-disc axis (FDA) were compared at baseline and at the last follow-up. MATERIALS AND METHODS: In total, 118 patients with early glaucoma and a minimum follow-up period of 3 years were included in this retrospective observational study. The pattern of structural changes was evaluated by averaging the PanoMaps of the enrolled patients at baseline and last follow-up. Longitudinal comparison of the FDD and FDA was performed at baseline and the last follow-up. Patients were divided into nonprogressor (n=44) and progressor (n=74), and the patterns of glaucoma progression in PanoMaps were compared between them. RESULTS: At baseline, the glaucomatous damage was found more frequently in the macular compared with the parapapillary area. The spatial distribution of frequently damaged areas was similar between the nonprogressor and progressor. At the last follow-up, compared with the baseline structural change on the PanoMap, the progressive structural changes extended toward the fovea at both the parapapillary and macular areas in the progressor. The FDD and FDA were significantly different between the baseline and the last follow-up. CONCLUSIONS: The PanoMaps showed a clear spatial distribution of early glaucomatous changes, indicating that the damaged area was frequently observed in the macular area. As the consistency of the fovea-disc relationship in PanoMaps was not excellent, this aspect should be considered when interpreting the PanoMap.

Progression of Parapapillary Choroidal Microvascular Dropout After Disc Hemorrhage in Glaucoma Patients: 2 Case Reports.

PURPOSE: Microvasculature dropout (MvD) is a novel finding seen in optical coherence tomography angiography (OCTA), which is characterized by a localized dehiscence of the choriocapillaris in the parapapillary atrophy area. Disc hemorrhage (DH) is an important factor often associated with the development and especially progression of glaucoma. Here, we present 2 cases of MvD progression with DH. METHODS AND RESULTS: Case 1: A 62-year-old female patient with normal tension glaucoma in both her eyes had recurrent DH at the inferior area of her right eye. A new DH was observed in the inferotemporal area of the right eye with MvD progression on OCTA in the same direction three months from the baseline.Case 2: A 57-year-old female patient with bilateral steroid-induced secondary glaucoma also had recurrent DH in her right eye. Four months from the baseline, DH occurred in the superotemporal and inferotemporal area of the right eye, and MvD was detected on OCTA in the superotemporal corresponding direction. After 19 months from the baseline, OCTA was repeated. The DH had resolved, but the superotemporal MvD persisted. CONCLUSIONS: The 2 cases presented here are the first to report on the relationship between MvD progression and DH. MvD as visualized in OCTA imaging looks to be of clinical importance, and hopefully future studies will reveal the actual connection between MvD, DH, and glaucoma progression.

Positional Change of the Eyeball During Eye Movements: Evidence of Translatory Movement.

Purpose: To investigate the positional change of the eyeball induced by horizontal and vertical gazing to deduce translatory movement, using three-dimensional (3D) magnetic resonance imaging (MRI). Methods: In this prospective observational study participants underwent orbital MRI during central, right, left, up, and down gazing. MRI scans were processed using self-developed software; this software enabled 3D MR image reconstruction and the superimposition of reconstructed image sets between different gazes. After acquiring the coordinates of the eyeball centroid in each gaze, the changes in centroid coordinates from central gaze to the other gazes were estimated, and correlations with associated factors were evaluated. Results: The mean distance of centroid movement was 0.69 ± 0.27 mm in abduction, 0.68 ± 0.27 mm in adduction, 0.43 ± 0.23 mm in elevation, and 0.44 ± 0.19 mm in depression. The mean angle of centroid movement in horizontal gaze, measured in terms of the movement of the left eye centroid in the axial plane, was 228.7° in abduction and -4.2° in adduction. In vertical gaze, the mean angle of centroid movement was -96.8° in elevation and 101.8° in depression. Axial length and ocular volume were negatively correlated with the distance of centroid movement in horizontal gaze. Conclusions: The position of the eyeball moved in the same direction as the gaze during horizontal gaze, but in the opposite direction during vertical gaze. For accurate eye movement analyses, such as the measurement of the deviation angle in strabismus, translation should be considered in addition to rotation.