Impact of socioeconomic status on open globe injuries during the COVID-19 pandemic.

PURPOSE: We explored the associations between socioeconomic status, as evaluated by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI), and characteristics of open globe injury (OGI) in a Level I trauma center during the COVID-19 pandemic. METHODS: Retrospective review of electronic medical records of patients who underwent OGI evaluation and repair at Harborview Medical Center between March/2017 and March/2021. Demographic data and patient characteristics were recorded. The SVI was obtained based on the patient's home address. Patients were grouped into the "historical" (pre-COVID) cohort, including dates from March 2017 - March 2020, and the "COVID" cohort, including dates from March 2020 - March 2021. RESULTS: 318 patients (77.4% male) were included. Average ± S.D. age (years) and SVI scores were 44.7 ± 22.7 and 0.413 ± 0.195, respectively. SVI scores were significantly higher (more vulnerable) during the COVID-19 pandemic compared to years prior (p = 0.017), however when compared to scores for the same patients prior to the pandemic, no difference was found (p = 0.609). There was no significant difference between intentional and non-intentional trauma, work-related injuries, OGI type, presence of endophthalmitis, or ocular trauma score (p ≥ 0.293). Still, significantly fewer motor vehicle-associated (MVA) OGIs occurred during the pandemic (p = 0.041). CONCLUSIONS: Patients with OGI during the COVID-19 pandemic had higher SVI scores, however when considering the overall effect of the pandemic, our findings are likely reflective of the societal changes at large. There was no identifiable impact on the mechanisms or characteristics of ocular injuries, except for fewer MVA injuries.

In-vivo characterization of scleral rigidity in myopic eyes using fundus-pulsation optical coherence elastography.

The sclera plays an important role in the structural integrity of the eye. However, as myopia progresses, the elongation of the eyeball exerts stretching forces on the posterior sclera, which typically happens in conjunction with scleral remodeling that causes rigidity loss. These biomechanical alterations can cause localized eyeball deformation and vision impairment. Therefore, monitoring scleral rigidity is clinically important for the management and risk assessment of myopia. In this study, we propose fundus pulsation optical coherence elastography (FP-OCE) to characterize posterior scleral rigidity in living humans. This methodology is based on a choroidal pulsation model, where the scleral rigidity is inversely associated with the choroidal max strain obtained through phase-sensitive optical coherence tomography (PhS-OCT) measurement of choroidal deformation and thickness. Using FP-OCE, we conducted a pilot clinical study to explore the relationship between choroidal strain and myopia severity. The results revealed a significant increase in choroidal max strain in pathologic myopia, indicating a critical threshold beyond which scleral rigidity decreases significantly. Our findings offer a potential new method for monitoring myopia progression and evaluating therapies that alter scleral mechanical properties.

Automated Detection of Glaucoma With Interpretable Machine Learning Using Clinical Data and Multimodal Retinal Images.

PURPOSE: To develop a multimodal model to automate glaucoma detection DESIGN: Development of a machine-learning glaucoma detection model METHODS: We selected a study cohort from the UK Biobank data set with 1193 eyes of 863 healthy subjects and 1283 eyes of 771 subjects with glaucoma. We trained a multimodal model that combines multiple deep neural nets, trained on macular optical coherence tomography volumes and color fundus photographs, with demographic and clinical data. We performed an interpretability analysis to identify features the model relied on to detect glaucoma. We determined the importance of different features in detecting glaucoma using interpretable machine learning methods. We also evaluated the model on subjects who did not have a diagnosis of glaucoma on the day of imaging but were later diagnosed (progress-to-glaucoma [PTG]). RESULTS: Results show that a multimodal model that combines imaging with demographic and clinical features is highly accurate (area under the curve 0.97). Interpretation of this model highlights biological features known to be related to the disease, such as age, intraocular pressure, and optic disc morphology. Our model also points to previously unknown or disputed features, such as pulmonary function and retinal outer layers. Accurate prediction in PTG highlights variables that change with progression to glaucoma-age and pulmonary function. CONCLUSIONS: The accuracy of our model suggests distinct sources of information in each imaging modality and in the different clinical and demographic variables. Interpretable machine learning methods elucidate subject-level prediction and help uncover the factors that lead to accurate predictions, pointing to potential disease mechanisms or variables related to the disease.

Incidence of and Risk Factors for Steroid Response After Cataract Surgery in Patients With and Without Glaucoma.

PRECIS: Steroid response after cataract surgery was more frequent in glaucoma patients than nonglaucoma patients. Longer axial length and more preoperative medications were risk factors for steroid response in glaucoma patients. PURPOSE: The aim was to evaluate incidence and risk factors for topical steroid response after uneventful cataract surgery in patients with and without glaucoma. SETTING: Academic glaucoma clinics. DESIGN: This was a retrospective review. PARTICIPANTS: Consecutive patients with and without glaucoma and no prior incisional glaucoma surgery undergoing cataract surgery between March 2007 and September 2016. All patients routinely received topical prednisolone acetate 1% postoperatively. METHODS: Pertinent clinical information was recorded. Steroid response was defined as intraocular pressure >50% above the baseline intraocular pressure measurement, occurring at or after the second postoperative week. RESULTS: We included 472 eyes of 472 nonglaucoma patients and 191 eyes of 191 glaucoma patients. Ten (2.1%) nonglaucoma eyes and 16 (8.4%) glaucoma eyes were diagnosed as steroid responders (relative risk=3.72; 95% confidence interval: 1.71-8.07; P<0.001). Logistic regression showed that for nonglaucoma, longer axial length (AL) and younger age were associated with a higher incidence of steroid response (P≤0.003), while for glaucoma patients, longer AL and more preoperative medications were associated with steroid response (P≤0.030). An AL ≥26 mm was associated with steroid response for both groups (P≤0.024). CONCLUSION: Although glaucoma patients were 3.72 times more likely to have steroid response after uneventful cataract surgery, the incidence of steroid response with prednisolone acetate 1% was relatively low after phacoemulsification in both nonglaucoma and glaucoma eyes. Steroid response was associated with longer AL in both groups and with more preoperative medications in glaucoma patients.

Macular microvascular parameters in the ganglion cell-inner plexiform layer derived by optical coherence tomography angiography: Vascular structure-central visual function analysis.

PURPOSE: To investigate the relationships between global and sectoral macular vascular microcirculation parameters in the ganglion cell-inner plexiform layer (GCIPL) assessed by optical coherence tomography angiography (OCTA), and global and sectoral visual field (VF) central mean sensitivity (CMS) assessed by standard automated perimetry. METHODS: Fifty-four eyes with open angle glaucoma were scanned using a swept-source OCTA (Plex Elite 9000, Zeiss, Dublin, CA) and macular vascular microcirculation was measured by calculating the overall flux and vessel area density (VAD) over the entire 6mm x 6mm area, excluding large retinal vessels. Central 10-degree VF CMS was calculated based on 24-2 VF. Pearson correlation was used to investigate the correlation between global and sectoral OCTA parameters and global and sectoral VF CMS. RESULTS: Both global GCIPL flux and VAD were significantly correlated with VF CMS (p<0.001). For the sectoral analysis, sectoral VAD was significantly correlated with sectoral VF CMS in all comparisons except for the inferonasal VF CMS with supero-temporal (ST) GCIPL VAD (p = 0.097). Although highest correlation was observed for both ST VF CMS with inferior GCIPL VAD and infero-temporal VF CMS with superior GCIPL VAD (r = 0.683, p<0.001), there was no significant difference in correlation when compared to the global VAD and other sectors' correlation coefficients (p≥ 0.091), except for the ST GCIPL VAD (p = 0.001). CONCLUSIONS: Global and sectoral macular vascular microcirculation in the GCIPL, as determined by OCTA, was significantly correlated with global and sectoral VF CMS in glaucomatous patients. OCTA can aid in the understanding of the structure-function relationships of the macular region.

Peripapillary and Macular Microcirculation in Glaucoma Patients of African and European Descent Using Optical Coherence Tomography Angiography.

PRéCIS:: We found no significant differences in peripapillary and macula microcirculation blood flow metrics in eyes with open-angle glaucoma of African descent (AD) and European descent (ED) as detected by optical coherence tomography angiography (OCTA). PURPOSE: The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) and macular vascular microcirculation in subjects of AD and ED with open-angle glaucoma using OCTA. PATIENTS AND METHODS: One eye from each subject was scanned using AngioPlex OCTA system covering both a 6×6 mm scanning area centered at the optic nerve head and at the foveola. Peripapillary RNFL and macular microcirculation were measured by calculating the overall flux and vessel area density excluding the large retinal vessels. Two-sample, independent t tests were used to compare the OCTA metrics between AD and ED eyes. Linear regression models were used to investigate the correlation between OCTA metrics and structural and functional parameters. RESULTS: Twenty-eight eyes of AD and 56 eyes of ED were included in the study. There was no significant difference in age, sex, hypertension, antihypertensive medications, diabetes, systolic and diastolic blood pressure, mean ocular perfusion pressure, RNFL thickness and visual field (VF) mean deviation and VF pattern standard deviation (P≥0.054) between AD and ED eyes included. Both groups had similar OCTA blood flow metrics (P≥0.161). OCTA blood flow metrics were significantly correlated with VF mean deviation (r≥0.466), VF pattern standard deviation (r≤-0.366) and RNFL thickness (r≥0.333). CONCLUSIONS: No significant differences were found in peripapillary and macular microcirculation detected by OCTA between AD and ED glaucomatous eyes. Peripapillary and macular microcirculation were significantly correlated with disease severity in AD and ED glaucomatous eyes.

Macular Vascular Microcirculation in Eyes With Open-angle Glaucoma Using Different Visual Field Severity Classification Systems.

PRECIS: We found significant differences in macular vascular microcirculation between normal and glaucomatous eyes using optical coherence tomography angiography (OCTA). Macular vascular microcirculation changes also showed significant correlations with visual field (VF) severity classification systems. PURPOSE: To correlate VF severity defined by different classification systems and macular vascular microcirculation in eyes with glaucoma using OCTA. PATIENTS AND METHODS: Twenty normal and 58 open-angle glaucoma (OAG) eyes were scanned using a swept-source OCTA (Plex Elite 9000) and macular vascular microcirculation was measured by calculating the overall blood flux index (BFI) and vessel area density (VAD) over the entire 6×6 mm area excluding the big retinal vessels. Glaucomatous eyes were staged into severity groups based on 4 VF severity classifications: Hodapp-Parrish-Anderson scale, Glaucoma Severity Staging system, ICD-10 glaucoma staging definitions, and VF mean deviation. Central 10-degree VF mean sensitivity (CMS) was calculated based on 24-2 VF. One-way analysis of variance was used to analyze the differences and correlation between macular vascular microcirculation and other clinical parameters. RESULTS: Glaucomatous eyes had significantly lower ganglion cell and inner plexiform layer BFI and VAD (P<0.0001) compared with normal eyes. In OAG patients, BFI and VAD were significantly higher in mild OAG compared with severe OAG with all VF disease severity classification systems (P<0.001). Glaucoma Severity Staging had the highest correlation with changes in macular vascular microcirculation metrics (r=0.734 for BFI; r=0.647 for VAD) and VF CMS had highest correlation with macular vascular microcirculation metrics (r=0.887 for BFI; r=0.903 for VAD). CONCLUSION: Macular vascular microcirculation metrics detected by OCTA correlate with disease severity in glaucomatous eyes. VF CMS, calculated from only 12 tested central 10-degree points, correlated best with macular OCTA.

Optical coherence tomography angiography in glaucoma.

PURPOSE OF REVIEW: Optical coherence tomography angiography (OCTA) studies have demonstrated reduced microcirculation in the superficial optic nerve, peripapillary retina, and the macula of glaucoma patients. The scope of this review is to outline recent studies using OCTA in glaucoma and highlight how OCTA may help improve diagnosis and follow-up in glaucoma patients. RECENT FINDINGS: OCTA studies have provided evidence of vascular changes in the optic nerve head, peripapillary, and macula region in glaucoma in comparison to glaucoma suspects and normal eyes. Additionally, OCTA can detect longitudinal reduction of peripapillary and macula vessel density in glaucoma patients. It remains unclear whether the reduced microcirculation in glaucoma patients induces the neuronal damage or arises through reduced circulation requirements in damaged tissue. SUMMARY: OCTA is a novel imaging modality that has great potential to enhance our understanding of glaucoma and to improve our ability to detect and treat it.

Intraocular Pressure After Phacoemulsification in Open-angle Glaucoma Patients With Uncontrolled or Marginally Controlled Glaucoma and/or With Severe Visual Field Loss.

BACKGROUND/AIMS: To evaluate intraocular pressure (IOP) after phacoemulsification in open-angle glaucoma (OAG) patients with uncontrolled or marginally controlled glaucoma and/or severe visual field (VF) loss. PATIENTS AND METHODS: Retrospective case series of OAG patients without prior glaucoma surgery undergoing phacoemulsification. Uncontrolled or marginally controlled glaucoma was defined as IOP>21 mm Hg despite maximally tolerated medications or requiring >3 topical drugs for IOP control. Severe VF loss was defined as VF mean deviation ≤-12 dB. Eyes with postoperative IOP elevation were identified using 4 different definitions. RESULTS: Of 56 eyes (56 patients), 10 eyes (17.8%) had IOP elevation ≥10 mm Hg at postoperative day 1. At 1 year (N=45), the average preoperative IOP of 14.3±3.5 mm Hg decreased to 13.8±3.6 mm Hg (P=0.312), and number of medications of 3.2±1.1 decreased to 2.8±1.2 (P=0.165). Eleven eyes (24.4%) had increase in IOP of ≥3 mm Hg, whereas 14 eyes (31.1%) had decrease of ≥3 mm Hg. Nine eyes (20.0%) had higher IOP without medication changes and 9 eyes (20.0%) required additional medications or surgery for IOP control; 3 eyes (6.7%) required trabeculectomy. Higher IOP at 1 year was associated with IOP elevation ≥10 mm Hg at postoperative week 1 (P=0.020). CONCLUSIONS: Phacoemulsification resulted in nonsignificant 1-year IOP change in OAG patients with uncontrolled or marginally controlled glaucoma and/or with severe VF loss. Although 40% of eyes had higher IOP after phacoemulsification at 1-year postoperatively, only 6.7% required trabeculectomy.

Successful Treatment of Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome with the Addition of Linezolid.

Necrotizing fasciitis is a deep-seated subcutaneous tissue infection that is commonly associated with streptococcal toxic shock syndrome (TSS). Surgical debridement plus penicillin and clindamycin are the current standard of care. We report a case of necrotizing fasciitis and streptococcal TSS where linezolid was added after a failure to improve with standard therapy. Briefly after isolation of Streptococcus pyogenes from tissue cultures, the patient underwent two surgical debridement procedures and was changed to standard of care therapy. While the patient was hemodynamically stable, the patient's wounds, leukocytosis, and thrombocytopenia all progressively worsened. After initiation of linezolid, the patient slowly improved clinically. The present report is the first to highlight the role of linezolid in streptococcal necrotizing fasciitis and TSS not improving with standard therapy.

Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss.

Importance: Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma. Objective: To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography. Design, Setting, and Participants: Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured. Main Outcomes and Measures: Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and correlations among blood flow metrics, VF thresholds, and clinical optical coherence tomography structural measurements were assessed. Results: Twenty-one eyes from 21 patients with glaucoma (7 men and 14 women; mean [SD] age, 63.7 [9.9] years) and 20 eyes from 20 healthy control individuals (9 men and 11 women; mean [SD] age, 68.3 [10.7] years) were studied. In eyes with glaucoma, the abnormal hemisphere showed a thinner RNFL (mean [SE] difference, 23.5 [4.5] µm; 95% CI, 15.1-32.0 µm; P < .001), lower RNFL blood flux index (mean [SE] difference, 0.04 [0.01]; 95% CI, 0.02-0.05; P < .001), and less vessel area density (mean [SE] difference, 0.08% [0.02%]; 95% CI, 0.05%-0.10%; P < .001) than did the normal hemisphere. Compared with normal eyes, reduced RNFL microcirculation was found in the normal hemisphere of eyes with glaucoma, measured by mean [SE] differences in blood flux index (0.06 [0.01]; 95% CI, 0.04-0.09; P < .001) and vessel area density (0.04% [0.02%]; 95% CI, 0.02%-0.08%; P = .003) but not in RNFL thickness (3.4 [4.7] µm; 95% CI, -6.2 to 12.9 µm; P = .48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman ρ = 0.44; P = .045) and RNFL thickness (Spearman ρ = 0.65; P = .001) in the normal hemisphere of the eye with glaucoma. Conclusions and Relevance: Reduced RNFL microcirculation was detected in the normal hemisphere of eyes with glaucoma, with strong correspondence with VF loss and RNFL thinning. Although the results suggest that vascular dysfunction precedes structural changes seen in glaucoma, longitudinal studies would be needed to confirm this finding.

Refractive Outcome of Cataract Surgery in Eyes With Prior Trabeculectomy: Risk Factors for Postoperative Myopia.

PURPOSE: To examine refractive outcomes after phacoemulsification in eyes with prior trabeculectomy. DESIGN: Retrospective observational case-control study METHODS:: Comparison of eyes of glaucoma patients undergoing cataract surgery after trabeculectomy (study group) with a matched group with medically controlled glaucoma (control group). Laser interferometry was used to obtain ocular biometry. We measured the difference between the expected and actual postoperative refraction using third-generation and fourth-generation intraocular lens (IOL) prediction formulae (Haigis, Holladay 2, Hoffer Q, and SRK-T). A residual difference of >1.0 D of hyperopia or myopia was considered a "refractive surprise." RESULTS: In total, 86 eyes (85 patients) were included, including 23 eyes (22 patients) in the study group and 63 eyes (63 patients) in the control group. The mean follow-up was 12.2±4.1 months. Eyes (n=13) with trabeculectomy and a preoperative intraocular pressure (IOP)≤9 mm Hg had significantly more large myopic surprises than the control group for all IOL formulae (P=0.015 Haigis, P=0.003 Holladay 2, P=0.004 Hoffer Q, P=0.003 SRK-T). Eyes (n=10) with trabeculectomy and preoperative IOP>9 mm Hg, however, did not have significantly more myopic errors than the control (P>0.05, all formulae). An "IOP spike" defined as a >50% rise in IOP from baseline within 1 month of cataract surgery in the subgroup with preoperative IOP≤9 mm Hg (n=8) was associated with increased risk of large myopic surprise (3/8 subset vs. 1/63 control eyes for all formulae; P=0.004 Haigis, P=0.004 Holladay 2, P=0.001 Hoffer Q, P=0.004 SRK-T) as well as for large myopic and hyperopic surprises overall (4/8 subset vs. ≤2/63 depending upon formulae; all P≤0.001). CONCLUSIONS: Low posttrabeculectomy IOP (≤9 mm Hg) is a risk factor for significant myopic surprise when undergoing subsequent cataract surgery despite using laser interferometry to measure ocular biometry and later generation formulae to determine IOL power. In addition, an IOP spike was associated with a 50% risk for large refractive surprise in this low IOP group.

Lamina depth and thickness correlate with glaucoma severity.

PURPOSE: To evaluate the correlation between lamina cribrosa (LC) morphology and glaucoma severity in patients with primary forms of open-angle glaucoma (OAG) using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT) and Humphrey visual field test (HVF). SUBJECTS AND METHODS: Patients with OAG (n = 166), divided into normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) groups (n = 66 and n = 100), were imaged using SD-OCT to obtain horizontal B-scan images of the optic nerve head (ONH). Laminar depth (LD) and laminar thickness (LT) were measured at the center of ONH. RESULTS: The mean (±standard deviation) values of LD, LT, and visual field mean deviation (MD) were 555.4 ± 142.3 µm, 179.9 ± 49.7 µm, and - 5.7 ± 6.4 dB, respectively. In the multivariate linear regression analysis, LD, LT, and intraocular pressure (IOP) were significantly correlated with MD (P = 0.007, P = 0.037, and P = 0.004, respectively). In the subgroup analyses, only LD was associated with MD in the NTG group (n = 66), whereas LT and IOP were correlated with MD in the HTG group (n = 100). Neither axial length nor central corneal thickness was associated with LD or LT. CONCLUSIONS: Glaucoma severity, as measured by HVF MD, shows significant correlations with LD and LT, with greater severity associated with increasing LD and decreasing LT. Normal- and high-tension OAG patients have different associations with LD and LT, which implies that the pathogenesis of these two entities might be different.

Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Glaucoma Using Optical Coherence Tomography-Based Microangiography.

PURPOSE: To investigate the vascular microcirculation changes in the retinal nerve fiber layer (RNFL) in normal, glaucoma suspect, and open-angle glaucoma (OAG) groups using optical coherence tomography-based microangiography (OMAG). METHODS: One eye from each subject was scanned with a Cirrus HD-OCT 5000-based OMAG prototype system montage scanning protocol centered at the optic nerve head (ONH). Blood flow signals were extracted using OMAG algorithm. Retinal nerve fiber layer vascular microcirculation was measured by calculating the blood flux index and vessel area density within a 1.2-mm width annulus centered at the ONH with exclusion of big retinal vessels. One-way ANOVA were performed to analyze the RNFL microcirculation among groups. Linear-regression models were constructed to analyze the correlation between RNFL microcirculation and clinical parameters. Discrimination capabilities of the flow metrics were assessed with the area under the receiver operating characteristic curve (AROC). RESULTS: Twenty normal, 26 glaucoma suspect, and 42 OAG subjects were enrolled. Eyes from OAG subjects and glaucoma suspects showed significantly lower blood flux index compared with normal eyes (P ≤ 0.0015). Retinal nerve fiber layer blood flow metrics showed significant correlations with visual field indices and structural changes in glaucomatous eyes (P ≤ 0.0123). Similar discrimination capability of blood flux index compared with RNFL thickness was found in both disease groups. CONCLUSIONS: Peripapillary RNFL vascular microcirculation measured as blood flux index by OMAG showed significant differences among OAG, glaucoma suspect, and normal controls and was significantly correlated with functional and structural defects. Retinal nerve fiber layer microcirculation measurement using OMAG may help physicians monitor glaucoma.

Repeatability and reproducibility of optic nerve head perfusion measurements using optical coherence tomography angiography.

Optical coherence tomography angiography (OCTA) has increasingly become a clinically useful technique in ophthalmic imaging. We evaluate the repeatability and reproducibility of blood perfusion in the optic nerve head (ONH) measured using optical microangiography (OMAG)-based OCTA. Ten eyes from 10 healthy volunteers are recruited and scanned three times with a 68-kHz Cirrus HD-OCT 5000-based OMAG prototype system (Carl Zeiss Meditec Inc., Dublin, California) centered at the ONH involving two separate visits within six weeks. Vascular images are generated with OMAG processing by detecting the differences in OCT signals between consecutive B-scans acquired at the same retina location. ONH perfusion is quantified as flux, vessel area density, and normalized flux within the ONH for the prelaminar, lamina cribrosa, and the full ONH. Coefficient of variation (CV) and intraclass correlation coefficient (ICC) are used to evaluate intravisit and intervisit repeatability, and interobserver reproducibility. ONH perfusion measurements show high repeatability [CV≤3.7% (intravisit) and ≤5.2% (intervisit)] and interobserver reproducibility (ICC≤0.966) in all three layers by three metrics. OCTA provides a noninvasive method to visualize and quantify ONH perfusion in human eyes with excellent repeatability and reproducibility, which may add additional insight into ONH perfusion in clinical practice.

Optic nerve head perfusion in normal eyes and eyes with glaucoma using optical coherence tomography-based microangiography.

BACKGROUND: To investigate the differences of perfusion in the optic nerve head (ONH) between normal and glaucomatous eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus 5000 HD-OCT-based OMAG prototype system centered at the ONH (Carl Zeiss Meditec Inc, Dublin, CA, USA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. En face OMAG images for preLC were generated using signals with highest blood flow signal intensity. ONH perfusion was quantified as flux, vessel area density, and normalized flux within the ONH. Standard t-tests were performed to analyze the ONH perfusion differences between normal and glaucomatous eyes. Linear regression models were constructed to analyze the correlation between ONH perfusion and other clinical measurements. RESULTS: Twenty normal and 21 glaucoma subjects were enrolled. Glaucomatous eyes had significantly lower ONH perfusion in preLC in all three perfusion metrics compared to normal eyes (P≤0.0003). Significant correlations between ONH perfusion and disease severity as well as structural changes were detected in glaucomatous eyes (P≤0.012). CONCLUSIONS: ONH perfusion detected by OMAG showed significant differences between glaucoma and normal controls and was significantly correlated with disease severity and structural defects in glaucomatous eyes. ONH perfusion measurement using OMAG may provide useful information for detection and monitoring of glaucoma.

Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography.

PURPOSE: To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. DESIGN: Cross-sectional, observational study. SUBJECTS: Twenty-eight normal, 30 POAG, and 31 NTG subjects. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. MAIN OUTCOME MEASURES: Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. RESULTS: Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. CONCLUSIONS: Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for diagnosis and monitoring of glaucoma.