Baseline intraocular pressure: an independent risk factor in severe steroid-induced ocular hypertension after intravitreal dexamethasone implant.

PURPOSE: To evaluate the baseline intraocular pressure (IOP)-related risk of severe steroid-induced ocular hypertension (SIOH). We hypothesized that the incidence and severity of SIOH may differ according to baseline IOP in patients who received intravitreal dexamethasone implants. METHODS: A total of 889 eyes treated with intravitreal dexamethasone implants and a baseline IOP of ≤ 23 mmHg were enrolled. Enrolled patients were divided into two groups: the steroid-responders (127 eyes) and the non-steroid-responders (762 eyes). The steroid-responders group was subdivided into post-injection IOP of ≥ 25, > 30, or > 35 mmHg or IOP elevation of ≥ 10 mmHg over the baseline value. The odds ratio of SIOH was calculated using univariable logistic regression analysis, and significant variables were analyzed with a multivariable model. IOP was measured before (baseline IOP) and after dexamethasone implant injection at 1 week and 1, 2, 3, 6, and 12 months. RESULTS: Although baseline IOP was significantly associated with the development of SIOH in logistic regression analysis, the results from the subgroup analysis differed. In the group with IOP elevation of ≥ 10 mmHg over the baseline, SIOH was not significantly associated with baseline IOP, but it was significantly related to higher baseline IOP in the severe SIOH group (IOP > 30 and > 35 mmHg). CONCLUSIONS: Higher baseline IOP is a risk factor for severe SIOH. Clinicians should be aware of the risk of SIOH when administering steroids intravitreally to patients with high baseline IOP (IOP > 19 mmHg).

Clinical utility of aqueous humor polymerase chain reaction and serologic testing for suspected infectious uveitis: a single-center retrospective study in South Korea.

BACKGROUND: This study aimed to assess and compare the clinical value of aqueous humor polymerase chain reaction (PCR) and serologic tests in patients diagnosed with suspected infectious uveitis. METHODS: In this retrospective observational study, data of 358 patients who were diagnosed with suspected infectious uveitis and who underwent aqueous humor PCR testing were analyzed. PCR and serologic test results were compared with the clinical features. RESULTS: The rates of initial diagnoses for infectious uveitis were higher with PCR (99 patients, 28%) compared to those with serologic tests (38 pateints, 11%). The diagnostic positivity of PCR was 29% for anterior uveitis, 0% for intermediate uveitis, 5% for posterior uveitis, and 30% for panuveitis. In particular, PCR was useful in confirming the diagnosis of cytomegalovirus and varicella-zoster virus infections and Toxoplasma gondii-associated uveitis. For PCR test, the sensitivity was 0.431, specificity was 0.985, and the negative and positive predictive values were 0.506 and 0.980, respectively. For IgM test, the sensitivity was 0.151, specificity was 0.970, and the negative and positive predictive values were 0.403 and 0.895, respectively. CONCLUSION: Aqueous humor PCR can be a valuable diagnostic tool for confirming the infectious etiology in patients clinically diagnosed with uveitis. PCR had good predictive and diagnostic value for anterior uveitis and panuveitis compared with that for intermediate and posterior uveitis.

Efficacy and tolerability of preservative-free 0.0015% tafluprost in glaucoma patients: a prospective crossover study.

BACKGROUND: The aim of this work is to evaluate efficacy and tolerability of preservative containing 0.0015% tafluprost and preservative-free 0.0015% tafluprost using a prospective crossover study. METHODS: Primary open angle glaucoma (POAG) and normotensive glaucoma (NTG) patients were randomized enrolled. Group 1 ("NPT to PT") patients used preservative-free 0.0015% tafluprost (NPT) for 6 months and then changed to preservative containing 0.0015% tafluprost(PT) for 6 months. Group 2 ("PT to NPT") patients used preservative containing 0.0015% tafluprost for 6 months and changed to preservative-free 0.0015% tafluprost for 6 months. At 1, 3, 6, 7, 9, and 12 months, we measured intraocular pressure for efficacy and graded corneal erosion, tear break-up time (TBUT), and subjective discomfort. RESULTS: A total of 20 patients and 20 eyes were enrolled. In Group 1 and 2, intraocular pressure was well controlled to approximately 14 mmHg (9.38-18.46% decrease). Generally, subjective satisfaction was improved after changing from PT to NPT (p = 0.03) and TBUT using PT was numerically inferior to that using NPT (p = 0.06) but not when changing from NPT to PT. CONCLUSION: Both preservative containing and preservative-free 0.0015% tafluprost reduced intraocular pressure significantly. In addition, changing medication from PT to NPT might improve subjective satisfaction and tear break up time. TRIAL REGISTRATION: The trial registration number is NCT 03104621 (Apr/1/2017). Retrospectively registered.

Prevalence, Awareness, and Risk Factors of Primary Open-Angle Glaucoma: Korea National Health and Nutrition Examination Survey 2008-2011.

PURPOSE: To investigate the prevalence, awareness, and risk factors for primary open-angle glaucoma (POAG) in the Korean population. DESIGN: The Korea National Health and Nutrition Examination Survey (KNHANES), a population-based cross-sectional study using a complex, stratified, multistage, probability-cluster survey. PARTICIPANTS: A total of 13,831 participants 40 years of age or older were included from the KNHANES database for the years 2008 through 2011. METHODS: Glaucoma diagnosis was based on the International Society of Geographical and Epidemiological Ophthalmology criteria. The prevalence of POAG and the proportion of POAG patients previously informed of the disease were calculated using KNHANES sample weights. Ocular and systemic factors were compared between the POAG and control groups. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors for POAG. MAIN OUTCOME MEASURES: Weighted prevalence, awareness, and risk factors for POAG. RESULTS: The prevalence of POAG in the Korean population was 4.7% (95% confidence interval, 4.2-5.1): 5.5% in men and 3.9% in women, respectively, which increased with age (P < 0.001). The mean intraocular pressure (IOP) in POAG eyes was 15.0±0.4 mmHg, which was higher than that of the control group (14.0±0.1 mmHg; P < 0.001). Multivariate logistic regression analysis revealed that older age (P < 0.001), male gender (P < 0.001), higher IOP (P < 0.001), myopia (P < 0.001), hypertension (P = 0.031), and nonoverweight status (P = 0.017) were associated significantly with POAG in the Korean population. Among the 710 study participants diagnosed with POAG, only 8.0% were aware of the disease. CONCLUSIONS: This was the first study to examine the prevalence, awareness, and risk factors of POAG in the Korean population using 4-year KNHANES data. Koreans with higher IOP, myopia, older age, male gender, hypertension, and nonoverweight status require more attention and support from the glaucoma screening and surveillance systems.

Protective effect of etanercept, an inhibitor of tumor necrosis factor-α, in a rat model of retinal ischemia.

BACKGROUND: To assess the neuroprotective effect of etanercept (Enbrel®) which is a commercialized Tumor necrosis factor-α (TNF-α) inhibitor on axonal injury in an animal model of acute ischemia. METHODS: Acute ischemia was induced by intraocular pressure elevation in 36 rats. The treatment groups underwent subcutaneous injection of etanercept (0.3 or 1.0 mg/kg) three times per week up to 4 weeks. The control groups were treated in the same manner using the same volume of phosphate-buffered saline (PBS). Optic nerve damage was evaluated by counting the number of axons under a transmission electron microscope. Microglial cell activity was assessed using Iba1 and CD68. RESULTS: After induction of ischemia, the ratio of preserved axons was significantly greater in the 2-week 1.0-mg/kg etanercept-treated group than in the PBS-treated group (p = 0.062). The 4-week 0.3-mg/kg and 1.0-mg/kg etanercept-treated groups also showed significantly higher ratios of preserved axons than did the PBS-treated group (p = 0.021 and 0.003, respectively). The expression of Iba1 and CD68 in the optic nerve was lower in the etanercept-treated groups than in the PBS-treated groups. Immunohistochemical staining using rabbit anti-Iba1 antibody showed that the amount of microglia at the optic nerve head was noticeably lower in the etanercept-treated groups than in the PBS-treated groups. CONCLUSIONS: Etanercept significantly suppressed optic nerve injury in this rat model of acute ischemia. This in vivo study suggests that etanercept might be a novel neuroprotective treatment agent for TNF-α-related disease.

Psychological Aspects of Glaucoma.

Glaucoma is a group of optic neuropathies that is more prevalent among the elderly population and commonly associates with comorbidities, including mental disorders in that population. This article reviews the relationship between glaucoma and mental disorders. In it, we discuss the coexistence of glaucoma and mental illnesses, including Alzheimer's disease, depression, and personality disorder. We also focus on the proper treatment approaches for glaucoma patients with mental comorbidity and poor treatment adherence. We summarize some cautiously recommended psychotherapeutic medications, while also discussing the psychologically adverse effects of antiglaucoma medications.

Tear Lipid Layer Thickness Change and Topical Anti-Glaucoma Medication Use.

PURPOSE: To investigate the effects of topical anti-glaucoma medications on tear lipid layer thickness (LLT) and the ocular surface. METHODS: This retrospective study examined ocular surface disease (OSD) subjects who had (n = 34) and who did not have (n = 51) open-angle glaucoma (OAG). OSD was evaluated with lipid layer thickness (using LipiView interferometer), tear breakup time (TBUT), total corneal and conjunctival staining (Oxford grading scale), and Ocular Surface Disease Index (OSDI). Four variables (total duration of anti-glaucoma medication use, duration of current anti-glaucoma medication use, total number of daily anti-glaucoma medication drops applied, and total number of anti-glaucoma medications [bottles]) related to anti-glaucoma medication were used to verify associations with LLT. RESULTS: Among the parameters, only LLT showed significantly lower values in the OAG group. In both groups, total staining showed a significant negative correlation between LLT and TBUT. Only in the OAG group, the OSDI showed significant correlations with number of medications (r = 0.389, p = 0.012) and daily number of drops (r = 0.354, p = 0.02); LLT showed significant correlations with TBUT (r = 0.381, p = 0.026) and total medication duration (r = -0.387, p = 0.013). In multivariate analyses, TBUT and total medication duration showed significant correlations with LLT (p = 0.032 and p = 0.015, respectively) in the OAG group. CONCLUSIONS: Topically medicated OAG subjects with OSD had a lower tear LLT than those with OSD who did not have OAG. Therefore, our results indicate that one should evaluate ocular surface disease status in patients who take anti-glaucoma medications.

Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open-angle glaucoma.

BACKGROUND: The objective of the study is to examine the effect of trabeculectomy on intraocular lens power calculations in patients with open-angle glaucoma (OAG) undergoing cataract surgery. DESIGN: The design is retrospective data analysis. PARTICIPANTS: There are a total of 55 eyes of 55 patients with OAG who had a cataract surgery alone or in combination with trabeculectomy. METHODS: We classified OAG subjects into the following groups based on surgical history: only cataract surgery (OC group), cataract surgery after prior trabeculectomy (CAT group), and cataract surgery performed in combination with trabeculectomy (CCT group). MAIN OUTCOME MEASURES: Differences between actual and predicted postoperative refractive error. RESULTS: Mean error (ME, difference between postoperative and predicted SE) in the CCT group was significantly lower (towards myopia) than that of the OC group (P = 0.008). Additionally, mean absolute error (MAE, absolute value of ME) in the CAT group was significantly greater than in the OC group (P = 0.006). Using linear mixed models, the ME calculated with the SRK II formula was more accurate than the ME predicted by the SRK T formula in the CAT (P = 0.032) and CCT (P = 0.035) groups. CONCLUSIONS: The intraocular lens power prediction accuracy was lower in the CAT and CCT groups than in the OC group. The prediction error was greater in the CAT group than in the OC group, and the direction of the prediction error tended to be towards myopia in the CCT group. The SRK II formula may be more accurate in predicting residual refractive error in the CAT and CCT groups.

Semi-automated counting method of axons in transmission electron microscopic images.

OBJECTIVE: To evaluate the accuracy of a new semi-automated method for counting axons in transmission electron microscopic (TEM) images. PROCEDURES: Optic nerve cross sections were obtained from both eyes of Sprague Dawley rats after unilateral induction of chronic ocular hypertension. TEM images (3000× magnification) of cross sections were evaluated by both semi-automated and manual counting methods. The semi-automated counting method was performed using ImageJ software after simple image optimization, and the resulting estimate of axon damage was compared with semiquantitative damage grading scale from light microscopic (LM) images. RESULTS: Axon counts obtained from the semi-automated method were strongly correlated with those obtained from the manual counting method (Pearson's correlation coefficient r = 0.996, P < 0.001) and from the full manual count from LM images (Spearman's ρ = 0.973, P < 0.001). The semi-automated method measured axonal damage with an error of 0.94 ± 3.16% (mean ± standard deviation), with worse axonal damage associated with greater error. Interobserver and intra-observer variability in axons counts were low (Spearman's ρ = 0.999, P < 0.005). The results of the semi-automated counting method were highly correlated with semiquantitative damage grading scale (Spearman's ρ = 0.965, P < 0.001). CONCLUSION: Results of our semi-automated method for counting axons in TEM images were strongly correlated with those of conventional counting methods and showed excellent reproducibility.

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon's fibroblasts.

BACKGROUND: Brimonidine is a highly selective α2 adrenergic agonist that has been widely used in anti-glaucoma eyedrops. The aim of this study was to investigate its putative anti-fibrotic role in the fibrosis caused by activated Tenon's fibroblasts. METHODS: Primary cultured human Tenon's fibroblasts were exposed to 2.0 ng/mL of transforming growth factor-ß1 (TGF-ß1) for up to 48 h. In the presence of various concentrations of brimonidine (from 0.0 to 10.0 µM), the expression levels of fibronectin, collagen types I and III, and ß-actin were determined by Western immunoblots. The expression of phosphorylated SMAD2/3 (p-SMAD2/3) was then evaluated using immunofluorescence. RESULTS: TGF-ß1 significantly increased the synthesis of fibronectin and collagens in human Tenon's fibroblasts; however brimonidine treatment distinctly attenuated the TGF-ß1-induced production of extracellular matrix (ECM) proteins. TGF-ß1 also changed the cellular morphology to be plump, while brimonidine treatment returned the cells to a spindle shape, similar to control fibroblasts. Regarding p-SMAD2/3, brimonidine treatment did not show any apparent changes in its expression. CONCLUSIONS: Our data revealed that brimonidine reduces TGF-ß-induced ECM synthesis in human Tenon's fibroblasts in vitro. This finding implies that topical administration of brimonidine may be helpful in reducing the fibrosis caused by the long-term use of topical anti-glaucoma medications.

Comparison of three types of images for the detection of retinal nerve fiber layer defects.

PURPOSE: To compare the clinical effectiveness of three types of images for detecting retinal nerve fiber layer (RNFL) defects. METHODS: Three image sets of 100 subjects (9 normal control subjects, 16 glaucoma suspects, and 75 glaucoma patients) were produced using color fundus photography, typical red-free RNFL photography, and blue reflectance RNFL photography with confocal scanning laser ophthalmoscopy (CSLO). A total of 300 images were rated twice in random order by five independent evaluators who were masked to the patient characteristics; each image was rated as normal, having a diffuse RNFL defect, or showing a wedge RNFL defect. Intraobserver and interobserver agreement, sensitivity, specificity, accuracy, and area under the curve were assessed. An additional analysis was performed for identifying differences in two black-and-white RNFL photographs. RESULTS: The results showed high intraobserver agreement, with relatively low interobserver agreements among the five evaluators. Blue reflectance RNFL photography with CSLO demonstrated the best performance in sensitivity, specificity, accuracy, and area under the curve. Blue reflectance RNFL images showed better accuracy than red-free RNFL images especially in subjects with wedge defects and in advanced glaucomatous cases. CONCLUSIONS: The RNFL images produced using blue reflectance with CSLO showed the best performance for the detection of RNFL defects, especially in cases with wedge defects and advanced glaucoma stages.

Disc hemorrhages and their risk factors in an urban South Korean population.

PURPOSE: The aim of this study was to estimate the prevalence of disc hemorrhage (DH) and evaluate its related risk factors in an urban South Korean population. METHODS: This retrospective cross-sectional study included subjects who underwent health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were first reviewed by two ophthalmologists and then by two glaucoma specialists and one retina specialist to determine the presence of DHs. In addition to fundus photographs, each participant completed systemic examination as well as sociodemographic and behavioral questionnaires. RESULTS: Fundus photographs were available for 164,029/168,044 (97.61%) subjects 20 years and older. The prevalence of DH was 226/164,029 (0.14%; 95% confidence interval, 0.12 to 0.16) per subject. A large proportion (61.5%) of eyes with DH had localized wedge-shaped retinal nerve fiber layer defects indicative of glaucoma. There was also a slight increase in DH prevalence with age, but no other statistically significant associations were found. CONCLUSIONS: The prevalence of DH was 0.14% in urban South Korean subjects 20 years and older. Older age and the presence of glaucomatous retinal nerve fiber layer defects were associated with higher prevalence of DH. These findings suggest that the presence of a DH in an eye implies a high likelihood of glaucoma, although its absence does not indicate that glaucoma is absent.

Effect of axial length on diurnal IOP in cataract patients without glaucoma.

PURPOSE: To evaluate the effect of ocular biometrics on intraocular pressure (IOP) and diurnal IOP fluctuation in nonglaucomatous subjects. METHODS: We examined 115 subjects from May to December 2007 in Kangbuk Samsung Hospital, Seoul, Korea. Intraocular pressure was measured with a Goldmann applanation tonometer in habitual positions every 2 hours from 9 am to 11 pm. Ocular biometric values including central corneal thickness, central corneal power, axial length, anterior chamber depth, and lens thickness were measured using an ultrasound biometer and keratometer and the refractive state was determined. RESULTS: Two hundred fourteen eyes of 115 patients were included in this study; the mean (±SD) IOP of all eyes was 12.33 (±2.55) mmHg. The mean (±SD) diurnal IOP fluctuation was 2.72 (±1.43) mmHg. Central corneal thickness was positively correlated with the mean IOP (Pearson correlation, r = 0.217, p = 0.002); however, there was no relationship between central corneal thickness and the diurnal IOP fluctuation. Axial length was not related to the mean IOP (Pearson correlation, r = 0.049, p = 0.476) and the diurnal IOP fluctuation (Pearson correlation, r = 0.058, p = 0.395). The mean IOP or diurnal IOP fluctuation was not related to any of the following values: central corneal power, anterior chamber depth, refractive error, lens thickness, or vitreous chamber depth. CONCLUSIONS: Central corneal thickness is significantly related to the IOP but may not affect diurnal IOP fluctuation. The axial length was not associated with IOP profiles in this study. Our results can contribute to a broader understanding of the effects of ocular biomechanical properties on the IOP profile.

Neuroprotective and neurite outgrowth effects of maltol on retinal ganglion cells under oxidative stress.

PURPOSE: To evaluate the neuroprotective and neurite outgrowth effects of maltol, a natural aroma compound, on retinal ganglion cells (RGCs) under oxidative stress in vitro. METHODS: Mouse primary RGCs were isolated using immunopanning-magnetic separation and exposed to H2O2 in the presence of maltol. The cell viability and apoptosis were determined by using adenosine 5'-triphosphate (ATP) assay and terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL), respectively. Neurite outgrowth was assessed by immunofluorescence for α-tubulin. The activation of nuclear factor-κB (NF-κB) was also evaluated using immunofluorescence. RESULTS: When the RGCs were exposed to 20 µM of H2O2 for 16 h, their viability dropped to 40.3±3.4%. However, the maltol treatment restored the cells in a dose-dependent manner. The viability recovered to 73.9±5.1% with 10 µM of maltol and even reached 175.1±11.3% with 2 mM of maltol, as measured by ATP assay. This oxidative stress significantly increased the number of TUNEL-positive RGCs, but the maltol drastically reduced the proportion of those apoptotic cells. The oxidative stress hampered the neurite outgrowth of the RGCs, whereas maltol restored their ability to sprout neurites. Regarding NF-κB, the active form of phosphorylated NF-κB (pNF-κB) increased the oxidative stress level but the maltol treatment again reduced it to an unstressful level. CONCLUSIONS: Our data revealed that maltol attenuated the oxidative stress-induced injury in the primary mouse RGCs. Its neuroprotective and neurite outgrowth effects seemed to be related to NF-κB signaling. Maltol has potential as a new neuroprotective therapeutic agent for oxidative stress-related ocular diseases, including glaucoma.

Instability of 24-hour intraocular pressure fluctuation in healthy young subjects: a prospective, cross-sectional study.

BACKGROUND: Elevated intraocular pressure (IOP) is a major risk factor for the development and/or progression of glaucoma, and a large diurnal IOP fluctuation has been identified as an independent risk factor of glaucoma progression. However, most previous studies have not considered the repeatability of 24-hour IOP measurements. The aim of this study was to evaluate the instability of 24-hour IOP fluctuations in healthy young subjects. METHODS: Ten healthy young volunteers participated in this prospective, cross-sectional study. Each subject underwent 24-hour IOP and systolic/diastolic blood pressure (SBP/DBP) assessments both in sitting and supine positions every 3 hours, once a week for 5 consecutive weeks. Mean ocular perfusion pressure (MOPP) was then calculated for both positions. The intraclass correlation coefficients (ICCs) of maximum, minimum, and fluctuation parameters were computed for IOP, SBP/DBP, and MOPP. Fluctuation was defined as the difference between maximum and minimum values during a day. RESULTS: Among the serial measurements taken over a 24-hour rhythm, the maximum/minimum values of IOP, as well as BP, showed excellent agreement: regardless of position, all ICC values were over 0.800. Most of the BP fluctuation values also showed excellent agreement. IOP fluctuation, however, did not show excellent agreement; the ICC of sitting IOP fluctuation was just 0.212. MOPP fluctuation also showed poor agreement, especially in the sitting position (ICC, 0.003). CONCLUSION: On a day to day basis, 24-hour IOP fluctuations were not highly reproducible in healthy young volunteers. Our results imply that a single 24-hour IOP assessment may not be a sufficient or suitable way to characterize circadian IOP fluctuations for individual subjects.

Bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma or ocular hypertension: an observational study in the Korean clinical setting.

BACKGROUND: This study evaluates the efficacy and tolerability (ie, occurrence and severity of hyperemia) of bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma (OAG) or ocular hypertension in the Korean clinical setting. METHODS: In this multicenter, open-label, observational study, treatment-naïve patients with OAG, including patients with normal-tension glaucoma (NTG, defined as IOP ≤21 mm Hg), or ocular hypertension received bimatoprost 0.01% once daily. Hyperemia was assessed at baseline and weeks 6 and 12, graded by a masked evaluator using a photonumeric scale (0, +0.5, +1, +2, +3), and grouped as (0 to +1) and (+2 to +3). Shifts between groupings were reported as no change, improved ([+2 to +3] to [0 to +1]), or worsened ([0 to +1] to [+2 to +3]). Other adverse events were monitored. Mean IOP changes from baseline at weeks 6 and 12 were reported. Supplemental analyses were conducted for IOPs >21 versus ≤21 mm Hg. RESULTS: Of 295 treatment-naïve patients included in the intent-to-treat/safety population, 73 (24.7%) had baseline IOP >21 mm Hg (mean, 25.7 ± 5.0 mm Hg) and 222 (75.3%) had baseline IOP ≤21 mm Hg (mean, 16.3 ± 3.0 mm Hg); 96.3% had hyperemia graded none (36.3%) to mild (17.3%). At week 12, hyperemia was graded none to mild in 83.7% (n = 220). Worsening occurred in 12.3% of patients by week 6 and 12.7% by week 12. Small improvements occurred in 0.8% and 0.5% of patients at weeks 6 and 12, respectively. Hyperemia scores were generally low and the majority of patients had no change in severity during the study. Mean IOP at weeks 6 and 12 was reduced to 16.4 ± 4.0 mm Hg (-34.5%; P < 0.0001) and 16.7 ± 3.9 mm Hg (-32.0%; P < 0.001) in the baseline-IOP >21 mm Hg group versus 13.3 ± 2.6 mm Hg (-17.8%; P < 0.001) and 13.7 ± 2.8 mm Hg (-15.9%; P < 0.001) in the baseline-IOP ≤21 mm Hg group, respectively. CONCLUSIONS: In treatment-naïve patients, bimatoprost 0.01% induced low shifts in worsening of hyperemia and significant reductions in IOP, regardless of baseline IOP. CLINICAL TRIAL REGISTRATION NUMBER: NCT01594970.

Adjusted color probability codes for peripapillary retinal nerve fiber layer thickness in healthy Koreans.

BACKGROUND: Though a newly developed spectral domain optical coherence tomography (OCT) is at the center of interests for many ophthalmologic researchers and clinicians, its own characteristics are not fully evaluated yet. The main purpose of this study was to establish the adjusted color probability codes for peripapillary retinal nerve fiber layer (RNFL) thickness in healthy Koreans and to compare them with original color codes provided by spectral domain OCT. METHODS: Two hundred ninety-five healthy Korean eyes were enrolled and their peripapillary RNFL thickness was measured by Cirrus OCT. For each decade of age, the normal thickness reference was determined on the basis of z-scores and the adjusted color probability codes were established. Then the agreements between adjusted and original color codes were calculated using weighted Kappa (Kw) coefficient. RESULTS: On the basis of Kw coefficient, the overall agreement between the adjusted and original probability color codes was not excellent (Kw range of 0.500 to 0.806). If the adjusted probability codes were assumed as a standard of comparison, the original color codes showed the false-negative in 11% of eyes and the false-positive in 0.3% of eyes for average RNFL thickness. CONCLUSIONS: Adjusted color probability codes judged by the Korean normative data showed a discrepancy with original codes. It implies that normal reference and adjusted probability codes for each ethnicity might be needed to determine whether a certain RNFL thickness is within normal range or not.

Prevalence and risk factors of superior segmental optic hypoplasia in a Korean population: the Korea National Health and Nutrition Examination Survey.

BACKGROUND: This study investigated the prevalence and risk factors for superior segmental optic hypoplasia (SSOH) in a Korean population based on the data from the nationwide Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: We performed a retrospective review of the KNHANES dataset covering January 2012 to December 2012. The study population comprised 5,612 subjects (≥19 years of age) who had participated in a medical interview covering demographic and systemic information, been issued a questionnaire regarding associated SSOH risk factors including gender, age, systemic disease, and family history, and had undergone an ophthalmologic examination. Two masked readers evaluated fundus photography, paying special attention to the presence of SSOH. Associations of risk factors (identified in the medical interview portion) with SSOH prevalence were investigated using multivariate logistic regression analysis. RESULTS: SSOH was detected in 16 eyes of 14 subjects, or 0.24% of the 5,612 subjects. All 16 eyes showed a corresponding visual-field defect. In multivariate logistic regression analyses, maternal history of diabetes (Odds ratio (OR), 7.666; 95% Confidence interval (CI), 2.601 ~ 22.593, p < 0.001) and paternal history of ischemic heart disease (IHD) (OR, 11.105; CI, 3.361 ~ 36.686, p < 0.001) were associated with increased risk of SSOH. CONCLUSIONS: This study provides the first representative population-based data on SSOH prevalence in Korea. Additionally, multivariate analyses revealed that a history of maternal diabetes and paternal IHD was the most important factor influencing the prevalence of SSOH.

Visual fields and OCT role in diagnosis of glaucoma.

PURPOSE: To evaluate the clinical performance of visual field (VF) tests and optical coherence tomography (OCT) in diagnosing glaucoma. METHODS: One hundred sets of disc photographs, red-free fundus photographs, VF tests, and OCT images were presented progressively to seven ophthalmologists. Each set was provided in three steps: (1) the disc and red-free fundus photographs were shown first; (2) then, VF tests were also provided; and (3) finally, the OCT results were provided. The same process was repeated on another day. Kappa statistics were used to assess the intraobserver and interobserver agreement, as well as the agreement with the reference standard. RESULTS: The intraobserver agreement was almost perfect in this study and did not change markedly with the addition of diagnostic tools. The interobserver agreement increased from 0.54 to 0.61 when VF was added and increased slightly to 0.63 with OCT. The agreement with the reference standard also increased significantly from 0.48 to 0.61 after adding VF and increased slightly with additional OCT. CONCLUSIONS: An optic disc evaluation and VF test are sufficient to diagnose glaucoma in most cases. However, OCT can play an important role in detecting glaucoma in cases in which it cannot be identified by optic disc examination and VF.