Outer retinal layer thickness in patients with glaucoma with horizontal hemifield visual field defects.

BACKGROUND/AIMS: To determine the effect of glaucoma on outer retinal layer thickness in eyes with horizontal hemifield visual field (VF) defects. METHODS: We conducted a cross-sectional study in glaucomatous eyes with repeatable (in three or examinations) horizontal hemifield VF (programme 24-2) defect defined as: all five nasal VF locations immediately either above or below the horizontal midline abnormal in the pattern deviation plot with p<0.5%; no mirror-image adjacent 5 VF locations abnormal in the pattern deviation plot and no non-edge VF locations in the non-affected hemifield abnormal in the pattern deviation plot with p<1%. We used optical coherence tomography to measure thickness of each retinal layer in the temporal macula (12° horizontally and 24° vertically) and computed the absolute (µm) and relative (%) intraindividual asymmetry between the perimetrically normal and abnormal hemimacula. RESULTS: We included 10 eyes of 8 patients with median age of 67 years and median VF mean deviation of -8.85 dB. The nerve fibre, ganglion cell and inner plexiform layers were significantly thinner in the perimetrically abnormal hemimacula (median asymmetry of -6.4, -11.5 and -3.8 µm, (corresponding to -27.7, -40.5 and -15.7 %), respectively, all p≤0.01). The inner nuclear layer was slightly thicker in the perimetrically abnormal hemimacula (median asymmetry of 1.3 µm (5.0 %), p=0.01). The outer plexiform, outer nuclear and photoreceptor layers asymmetry values were negligible. CONCLUSION: Our study showed no evidence that glaucoma has an effect on the outer retinal layer thickness. In contrast, a large impact was observed in inner layer thickness.

Survey of complementary and alternative medicine use in glaucoma patients.

PURPOSE: To determine the prevalence, types, and associated factors of complementary and alternative medicine (CAM) use in glaucoma patients. PATIENTS AND METHODS: Prospective, multicenter, cross-sectional survey. A total of 1516 consecutive patients attending 2 tertiary glaucoma clinics were surveyed on CAM use. Information gathered on standardized data collection sheets included demographic variables, ophthalmic history, glaucoma treatment history, and details of CAM use. RESULTS: The response rate was 92.5%. A total of 166 patients (10.9%) reported current use of CAM therapy specifically for glaucoma whereas 41 patients (2.7%) reported past use of CAM. Of the patients who reported CAM use, 62.5% had not disclosed the use of CAM to their ophthalmologist and 40.5% believed that the treatments were helping their glaucoma. The most commonly used types of CAM were herbal medications (34.5%), dietary modifications (22.7%), and vitamin/mineral supplements (18.8%). Of the 207 patients who reported current or past CAM use for their glaucoma, 3 (1.4%) indicated that they used conventional glaucoma treatments < prescribed because of their CAM use. CONCLUSIONS: Approximately 1 in 9 glaucoma patients use CAM for their disease. Many of these patients do not disclose the use of CAM to their ophthalmologist, but the vast majority report that they still take conventional glaucoma medications as prescribed.

Computer-assisted image analysis of temporal retinal vessel width and tortuosity in retinopathy of prematurity for the assessment of disease severity and treatment outcome.

PURPOSE: To quantify the severity of retinopathy of prematurity (ROP) through temporal retinal vessel diameter and tortuosity by the use semiautomated analysis and to evaluate the effects of laser treatment on retinal vessel measurements. METHODS: A total of 176 RetCam digital fundus images from 63 infants diagnosed with ROP between January 2005 and December 2008 were retrospectively analyzed with Retinal Vessel Measurement V5.8 software. Patients were classified into 1 of 3 groups: stage 1 and 2 (Group 1), stage 3 not requiring treatment (Group 2), and stage 3 requiring treatment (Group 3). Diameter and tortuosity of the 4 major temporal retinal arteries and veins close to the optic disk were quantified. Tortuosity was measured as central (within 2 disk diameters from the center of the optic disk) and paracentral (from 2 to 4 disk diameters). For Group 3, measurements of vessels immediately before treatment and all follow-up post-treatment measurements of vessels were analyzed. RESULTS: Differences in central and paracentral arteriolar tortuosity were pronounced. The average central arteriolar tortuosities were 1.12 ± 0.018 for Group 1, 1.13 ± 0.018 for Group 2, and 1.32 ± for Group 3; the paracentral arteriolar tortuosities were 1.11 ± 0.019 for Group 1, 1.12 ± 0.019 for Group 2, and 1.31 ± 0.02 for Group 3. In the post-treatment analysis of Group 3 patients, significant reductions in all vascular measurements were observed compared to pre-treatment, except for central and paracentral vein tortuosity. CONCLUSIONS: Computerized systems can be used to objectively assess differences in vascular parameters between ROP stages.

The Toronto epidemiology glaucoma survey: a pilot study.

OBJECTIVE: To evaluate the prevalence of undetected glaucoma in a Toronto population. DESIGN: A cross-sectional survey. PARTICIPANTS: Toronto residents aged 50 years or older. METHODS: Telephone calls were randomly made to Toronto residents. Those who indicated they did not have glaucoma were invited to the Toronto Western Hospital for a comprehensive ophthalmic assessment, including best corrected visual acuity testing, applanation tonometry, pachymetry, gonioscopy, disc assessment, frequency doubling technology, and Heidelberg retinal tomography. Patient suspected to have glaucoma were asked to return for further evaluation, including a 24-2 Humphrey automated visual field test, repeat Heidelberg retinal tomography, repeat disc assessment, and possibly a diurnal tension curve. The diagnosis of glaucoma was made based on standardized criteria modified from those used by the Rotterdam Study and Foster and associates. RESULTS: Among 975 eligible respondents, 73 (7.5%) stated that they had glaucoma. Of the remaining 902 negative respondents, 271 booked clinical appointments, and 180 completed the clinical assessment; their mean age was 61.6 years. Of the participants, 7 (3.9%) were diagnosed with glaucoma: 5 (2.8%) had primary open-angle glaucoma (3 with low-pressure and 2 with high-pressure glaucoma); 1 had (0.6%) chronic angle-closure glaucoma; and 1 (0.6%) had pseudoexfoliation glaucoma. A further 8 (4.4%) participants were classified as probably having open-angle glaucoma and 33 (18.3%) as being suspected to have glaucoma. Narrow angles were found in 27 participants (15%), and 37 (20.6%) had family histories of glaucoma. CONCLUSION: The prevalence of undetected glaucoma appears to be high in Toronto. Further studies involving larger numbers of participants are required to confirm this finding.