Optic Disc Characteristics and Visual Field Progression in Normal Tension Glaucoma Patients With Tilted Optic Discs.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the optic disc characteristics associated with visual field (VF) progression in normal tension glaucoma (NTG) eyes with tilted optic discs. METHODS: Sixty-six eyes of 66 NTG patients with tilted optic disc were included in this cross-sectional study, who were examined by at least 5 Humphrey 30-2 VFs. Glaucomatous VF progression was evaluated using pointwise linear regression. Optic nerve heads were scanned with enhanced-depth imaging optical coherence tomography (EDI-OCT), and evaluated for the focal lamina cribrosa (LC) defects and LC thicknesses. Optic disc torsion degrees and tilt ratios were measured from disc photographs. Logistic regression analyses were used to identify the risk factors for VF progression and focal LC defects. RESULTS: Multivariate analysis showed that VF progression was associated with the presence of focal LC defects and greater number of VFs. The eyes with focal LC defects were associated with greater torsion degree and tilt ratio in multivariate analysis. The VF mean deviation slopes and localized VF progression rates in eyes with focal LC defects were greater than those without defects. CONCLUSIONS: The greater optic disc tilt and torsion in NTG eyes with tilted optic disc were associated with focal LC defects, but not with VF progression. The focal LC defects were associated with VF progression. This study suggests that the focal LC defects in NTG patients with tilted optic disc may be an independent risk factor for glaucomatous VF progression, and the development of focal LC defects could be influenced by optic disc torsion or tilt.

Clinical Characteristics of Juvenile-onset Open Angle Glaucoma.

PURPOSE: To demonstrate the clinical characteristics of juvenile-onset open angle glaucoma (JOAG) and to evaluate the prognostic factors for visual field (VF) progression in eyes with JOAG. METHODS: The medical records of 125 eyes of 72 patients with JOAG were analyzed retrospectively. At least four reliable VF tests were required to determine the VF progression, and the progression was defined using the modified Anderson criteria. Comparisons in clinical manifestations among groups were performed using independent t-test, and generalized estimating equations were also conducted. RESULTS: The mean follow-up duration was 94.4 ± 50.5 months. Patients with JOAG showed a male preponderance (64 %), myopia (-4.99 ± 4.01 diopters) and a severe elevation of intraocular pressure (35.6 ± 10.8 mmHg). Forty-two JOAG patients (58 %) had complained of symptoms associated with vision and pain; however, one-third presented with no definite symptoms. Fifty-seven patients were diagnosed with JOAG in both eyes, and they were significantly older (p = 0.039) and had a greater family history (p = 0.035) than patients with unilateral JOAG. The progression group exhibited a significantly higher intraocular pressure at the last visit (p = 0.023) than the non-progression group. CONCLUSIONS: Because patients with considerable JOAG had no definite symptoms, periodic eye examinations are needed. To prevent the VF's progression, JOAG patients may require more careful management of intraocular pressure.

Comparison of lamina cribrosa thickness in normal tension glaucoma patients with unilateral visual field defect.

PURPOSE: To compare the lamina cribrosa thickness, measured by swept-source optical coherence tomography (SS OCT), between each eye of normal tension glaucoma (NTG) patients with unilateral visual field (VF) defect and to investigate the correlation between lamina cribrosa thickness and VF loss. DESIGN: Prospective, cross-sectional study. METHODS: Optic nerve heads were scanned using SS OCT, and laminar thickness was measured on mid-superior, central, and mid-inferior regions of vertical midline of the optic disc. The inter-eye differences of lamina cribrosa thickness in NTG patients with unilateral VF defect and the intra-eye difference of lamina cribrosa thickness in VF-affected eyes were analyzed using the paired t test. We evaluated the correlation between lamina cribrosa thickness and mean deviation, measured using standard automated perimetry, in NTG patients. RESULTS: This study included 102 eyes in 51 NTG patients with unilateral VF defect and 47 eyes in 47 normal subjects without glaucomatous change in either eye. The mean lamina cribrosa thickness of normal fellow eyes was thicker than VF-affected eyes in NTG patients (P < .001), but thinner than normal subject eyes (P < .001). Within VF-affected eyes, lamina cribrosa thickness of regions correlated with visual field defect was thinner than horizontally contralateral locations (P < .001). The mean deviation was statistically correlated with inter-eye difference of lamina cribrosa thickness in NTG patients (n = 51; r(2) = 0.12; P = .01). CONCLUSIONS: The lamina cribrosa was thinner in VF-unaffected eyes of NTG patients than in normal subject eyes, in VF-affected eyes than in normal fellow eyes of NTG patients, and in regions correlated with visual field loss than in horizontally contralateral ones in VF-affected eyes.

Association Between Systemic Hypertension and Macular Thickness Measured by Optical Coherence Tomography.

PURPOSE: This study aimed to evaluate an association between hypertension and macular thickness. METHODS: A total of 827 Korean adults composed of 163 pairs of twins and their family members were included in this population-based cross-sectional study. Macular thickness was measured with optical coherence tomography at nine macular subfields defined by the Early Treatment of Diabetic Retinopathy Study. Cardiometabolic risk factors, including body mass index (BMI), hypertension, diabetes, lipid profiles, and smoking status, were assessed. Linear mixed regression analysis was conducted with consideration of familial correlations and adjustment for covariates. RESULTS: Age-, sex-, and axial length-adjusted analysis showed that systemic hypertension was associated with a significant change in macular thickness in most subfields except for the fovea. Compared with normotensive subjects, macular thickness was lower in subjects with systemic hypertension (P ≤ 0.05), with the highest difference (2.52%) in the outer temporal region and the lowest difference (1.44%) in the inner temporal region. This association persisted even after adjusting for other cardiometabolic risk factors. Other cardiometabolic risk factors were not independently associated with macular thickness in any subfields. Stratified analysis showed that the inverse association between macular thickness and hypertension was stronger in the group with elevated fasting glucose compared with the group with normal fasting glucose (P for interaction ≤ 0.05). CONCLUSIONS: Systemic hypertension was inversely associated with macular thickness in most macular subfields, particularly in subjects with an elevated fasting glucose level. This finding suggests that it may be necessary to consider the presence of hypertension when macular thickness and pericentral macular area volume are evaluated.

Genetic influences on macular thickness in Koreans: the healthy twin study.

PURPOSE: To estimate genetic influences accounting for macular thickness in the Korean population. METHODS: Study subjects were 830 healthy Korean adults (117 monozygotic twin pairs and 523 family members) from the Healthy Twin study. Macular thickness was measured with optical coherence tomography for nine subfields including the fovea, four inner quadrants (within 1 to 3 mm of the center), and four outer quadrants (within 3 to 6 mm of the center). Quantitative genetic analyses were performed to estimate the heritability of macular thickness with respect to familial correlations. RESULTS: Macular thickness varied by subfield and was thinnest at the fovea and thickest at the inner superior area. Heritability of macular thickness at each subfield was 0.76, 0.73, 0.70, 0.56, 0.67, 0.70, 0.73, 0.29, and 0.36 at the fovea, inner superior area, inner inferior area, inner nasal area, inner temporal area, outer superior area, outer inferior area, outer nasal area, and outer temporal area, respectively. CONCLUSIONS: Genetic factors play a significant role in determining macular thickness in the Korean population.