Progressive Macular Vessel Density Loss Observed on Optical Coherence Tomography Angiography in Glaucoma Patients With Single-Hemifield Visual Field Defects.

PRCIS: Faster hemispheric mVD loss was found in the affected hemifield of POAG patients without significant changes in hemispheric thickness. The progression of mVD loss was associated with the severity of VF damage. PURPOSE: To evaluate the changes in macular vessel density (mVD) loss in primary open angle glaucoma (POAG) patients with visual field (VF) defects confined to 1 hemifield. MATERIALS AND METHODS: This longitudinal cohort study used linear mixed models to evaluate the changes in the hemispheric mean total deviation (mTD), mVD, macular ganglion cell complex, macular ganglion cell-inner plexiform layer, and retinal nerve fiber layer between affected hemifields, unaffected hemifields, and healthy controls. RESULTS: Twenty-nine POAG eyes and 25 healthy eyes were followed for an average of 29 months. In POAG eyes, the rates of decline in hemispheric mTD and hemispheric mVD in the affected hemifields were significantly faster than those in the unaffected hemifields (-0.42±1.24 vs. 0.02±0.69 dB/year, P =0.018 and -2.16±1.01 vs. -1.77±0.90% / year, P =0.031, respectively). There were no differences in the rate of hemispheric thickness change between the 2 hemifields. The rate of hemispheric mVD decline in both hemifields of POAG eyes was significantly faster than that of the healthy controls (All P <0.05). An association between the reduced mTD of the VF and the rate of hemispheric mVD loss in the affected hemifield was observed (r=0.484, P =0.008). Faster rates of mVD loss (ß=-1.72±0.80, P =0.050) were significantly related to reduced hemispheric mTD in the multivariate analysis. CONCLUSIONS: Faster hemispheric mVD loss was found in the affected hemifield of POAG patients without significant changes in hemispheric thickness. The progression of mVD loss was associated with the severity of VF damage.

Decreased macular deep capillary plexus is associated with functional progression of normal tension glaucoma patients with unilateral visual field loss.

PURPOSE: To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina are associated with the development of visual field (VF) loss in the fellow eyes of normal tension glaucoma (NTG) patients with unilateral VF loss. METHODS: A longitudinal study was conducted in which 61 eyes with normal VF (mean VF mean deviation -0.7±1.6 dB) from 61 NTG patients were included. All subjects underwent OCTA imaging, spectral-domain-OCT imaging and VF testing. OCTA metrics of superficial capillary plexus and deep capillary plexus (DCP) in the macular region were measured. Relationships between baseline OCTA metrics, demographics and ocular characteristics and the risk of VF glaucoma progression were analysed with a Cox proportional hazards model. RESULTS: During a mean follow-up of 38 months, 11 fellow eyes (18.0%) with normal VF at baseline were determined to have VF progression, while 21.3% of affected eyes had VF progression. After adjustment for potential confounding factors, decreased baseline DCP in the fellow eyes was significantly associated with future VF progression (HR 1.33, 95% CI 1.03 to 1.73, p=0.031). CONCLUSION: Decreased DCP was associated with a higher risk of developing VF damage in NTG patients with unilateral VF loss. Assessments of DCP may help improve the evaluation of the risk of functional deterioration in fellow eyes with an initially normal VF.

Detecting eyes with high risk of angle closure among apparently normal eyes by anterior segment OCT: a health examination center-based model.

BACKGROUND: The main barriers keeping individuals with high-risk of angle closure from seeking eye-care service are the absence of both disease awareness and convenient and low-cost access to the ocular health care system. Present study described the efficacy of a health examination center-based screening model designed to detect eyes with high risk of angle closure (HRAC) among healthy individuals using anterior segment optical coherence tomography (AS-OCT). METHODS: From March 1 to April 30, 2017, consecutive individuals aged ≥ 40 years undergoing routine physical examinations at a health examination center were invited to enroll. Presenting visual acuity (PVA), intraocular pressure (IOP) measurement, non-mydriatic fundus photography and AS-OCT were performed by three trained nurses. Participants with PVA < 6/12 in the better-seeing eye, IOP ≥ 24 mmHg, or abnormal fundus photography in either eye were referred to the outpatient clinic, but not included in the analysis. Eyes with HRAC were defined as having trabecular-iris angle < 12 degrees in ≥ 3 quadrants. Configuration of the iris was classified into flat, bowing, bombe, thick peripheral iris and mixed mechanism. RESULTS: Altogether, 991 participants (77.3%) with readable OCT images (mean age 55.5 ± 9.0 years; 58.4% men) were included. HRAC was diagnosed in 78 eyes (7.9%, 61.3 ± 8.2 years, 41.0% men). The prevalence of HRAC increased with age (p < 0.001) and was much higher among women (11.2%) than men (5.5%) (p = 0.001). The mixed mechanism iris configuration was most common among eyes with HRAC (37/78, 47.4%). CONCLUSION: HRAC is prevalent among asymptomatic Chinese adults undergoing routine health screening. Health examination center-based eye screening with AS-OCT administered by non-specialists may be a good model to screen narrow angles in the population at large.

Cone parameters in different vision levels from the adaptive optics imaging.

ABSTRACT: To investigate the relationship between visual resolution and cone parameters in eyes with different levels of best corrected visual acuity (BCVA).Seventeen eyes of 10 volunteers with BCVA of 20/12.5 or better (group 1) and 16 eyes of 10 volunteers with BCVA of 20/16 (group 2) were investigated in the study. Images of the cone photoreceptors at 1.5° from the fovea were obtained using an adaptive optics (AO) retinal camera. The BCVA was obtained following a subjective refraction using a standardized logMAR visual acuity chart.The mean cone density (29,570.96 ±â€Š2489.94 cells/mm2) at 1.5° from the fovea in group 1 (BCVA ≥ 20/12.5, n = 17) was significantly greater (P < .001) than that (22,963.59 ±â€Š2987.92 cells/mm2) in group 2 (BCVA = 20/16, n = 16). The cone spacing at 1.5° from the fovea in group 1 was 6.45 ±â€Š0.28 µm (mean ±â€ŠSD), which was significantly smaller (P < .001) than 7.36 ±â€Š0.50 µm (mean ±â€ŠSD) in group 2. In the stepwise regression analysis, greater angular cone density (odds ratio [OR], 4.48; P = .005) and smaller angular cone spacing (OR, 0.60; P = .007) at 1.5° from the fovea were significantly associated with the better BCVA.The greater cone density and smaller cone spacing at the parafovea were found in eyes with BCVA of 20/12.5 or better, as compared to that in eyes with BCVA of 20/16. Knowledge of cone distribution for different BCVA levels may be beneficial for different clinical conditions.

Validity and feasibility of a self-administered home vision examination in Yueqing, China: a cross-sectional study.

OBJECTIVE: To investigate the validity and feasibility of a self-administered home vision examination programme in China. DESIGN: Cross-sectional study. SETTING: Yueqing, China. PARTICIPANTS: A two-stage convenience sampling procedure was used to randomly select 600 households from 30 communities participating in the Yueqing Eye Study (YES). The aim of YES is to encourage home-based vision screening, reporting of visual acuity (VA) annually through social media and encouraging people to attend follow-up clinic appointments as a way to improve eye care access for adults with VA ≤+0.5 log of the minimum angle of resolution (logMAR). INTERVENTIONS: Household screeners (one per household) who tested other family members' VA completed a questionnaire on family structure, demographic information and knowledge about screening procedures. Other family members then underwent confirmatory VA testing by researchers. OUTCOME MEASURES: The completion rate of home-based VA screening, its sensitivity and specificity were used to evaluate validity. Factors that determined whether families participated in the self-VA screening were used to evaluate feasibility. RESULTS: 345 (66%) of the 523 (87.2%) households with valid data form their home-based vision examinations also were retested by researchers. There was no statistically significant difference in scores on the family-administerd or researcher-administerd VA test (VA≤+0.5 logMAR, p=0.607; VA >+0.5 logMAR, p=0.612). The sensitivity and specificity of home-based vision screening were 80.5% (95% CI 70.2% to 86.9%) and 95.1% (95% CI 92.6% to 96.8%), respectively. 14.7% (77/523) of tested respondents had VA ≤+0.5 logMAR. Predictors of performing home screening for VA remaining in regression models included higher economic status ('fair and above' vs 'poor': OR 1.74; 95% CI 1.08 to 2.76; p=0.022), age (<45 years vs ≥45 years: OR 0.46; 95% CI 0.25 to 0.85; p=0.014) and living in a nuclear (OR 5.17; 95% CI 2.86 to 9.36; p<0.001) or extended family (OR 8.37; 95% CI 4.93 to 14.20; p<0.001). CONCLUSION: Self-administered home vision screening is reliable and highly accepted by Chinese adults.

Design and baseline data of a population-based metabonomics study of eye diseases in eastern China: the Yueqing Ocular Diseases Investigation.

BACKGROUND: China is undergoing a massive transition toward an urban and industrial economy. These changes will restructure the demographics and economy which will eventually influence the future patterns of disease. The risk factors of vision-impairing eye diseases remain ambiguous and poorly understood. Metabolomics is an ideal tool to understand and shed light on the ocular disease mechanisms for earlier treatment. This article aims to describe the design, methodology and baseline data of the Yueqing Ocular Diseases Investigation (YODI), a developed county population-based study to determine the prevalence and primary causes of visual impairment; also with metabonomics analysis we aimed to identify, predict and suggest some preventive biomarkers that cause blindness. METHODS: A population-based, cross-sectional study. Randomized clustering sampling was used to identify adults aged 50 years and older in Xiangyang Town, Yueqing county-level City. The interviews covered demographic, behavioral, ocular risk factors and mental health state. The ocular examination included visual acuity, autorefraction, intraocular pressure, anterior and posterior segment examinations, fundus photography, retinal tomography and angiography, and visual field testing. Anthropometric measurements included height and weight, waist and hip circumference, blood pressure, pulse rate, electrocardiogram, and abdominal ultrasound scan. A venous blood sample was collected for laboratory tests and metabonomics studies. RESULTS: Of the 5319 individuals recruited for the YODI, 4769 (89.7%) subjects were enrolled for analyses. The median age was 62.0 years, and 45.6% were male. The educational level of illiteracy or semi-illiteracy, primary, middle and high school or above was 29.8%, 45.5%, 20.1%, and 3.3%, respectively. Majority of the participants were female, younger, and less educated when compared with nonparticipants. The average body mass index and waist-hip ratios were 24.4 ± 3.4 kg/m2 and 0.9 ± 0.1 respectively. Blood sample collection reached a sample size of 1909 (479 from subjects with self-reported diabetes and 1430 from one-third of the 4290 subjects without self-reported diabetes). CONCLUSIONS: The YODI provides population-based data with a high response rate (89.7%) on the prevalence and primary causes of major vision-impairing eye diseases in developed county areas in eastern China. Metabonomics analysis from YODI will provide further association of metabolic characteristics with the visual impairment eye diseases. The risk prediction model could be created and has the potential to be generalized to developed eastern areas in China for prevention.

lncRNA CISAL Inhibits BRCA1 Transcription by Forming a Tertiary Structure at Its Promoter.

Cisplatin-based neoadjuvant chemotherapy has been shown to improve survival in patients with squamous cell carcinoma (SCC), but clinical biomarkers to predict chemosensitivity remain elusive. Here, we show the long noncoding RNA (lncRNA) LINC01011, which we termed cisplatin-sensitivity-associated lncRNA (CISAL), controls mitochondrial fission and cisplatin sensitivity by inhibiting BRCA1 transcription in tongue SCC (TSCC) models. Mechanistically, we found CISAL directly binds the BRCA1 promoter and forms an RNA-DNA triplex structure, sequestering BRCA1 transcription factor-GABPA away from the downstream regulatory binding region. Importantly, the clinical relevance of these findings is suggested by the significant association of CISAL and BRCA1 expression levels in TSCC tumors with neoadjuvant chemosensitivity and overall survival. We propose a new model where lncRNAs are tethered at gene promoter by RNA-DNA triplex formation, spatially sequestering transcription factors away from DNA-binding sites. Our study uncovers the potential of CISAL-BRCA1 signaling as a potential target to predict or improve chemosensitivity.

Parapapillary Choroidal Microvasculature Dropout Is Associated With the Decrease in Retinal Nerve Fiber Layer Thickness: A Prospective Study.

Purpose: To explore the correlation between longitudinal changes of peripapillary retinal nerve fiber layer (RNFL) thickness and the presence of parapapillary choroidal microvasculature dropout (MvD). Methods: This is a longitudinal cohort study. All patients with normal-tension glaucoma (NTG) were recruited from the Wenzhou Glaucoma Progression Study. The presence of MvD was determined using optical coherence tomography (OCT) angiography and the RNFL thickness was evaluated by spectral-domain OCT. All assessments were performed both at baseline and at every 3-month follow-up for at least 18 months. Results: Seventy-one eyes were included. The presence of MvD was observed in 23 NTG eyes (32.4%). Eyes with MvD had a thinner RNFL (68.8 ± 9.6 vs. 76.2 ± 16.7 µm, P = 0.016) and a faster rate of RNFL loss (-1.2 ± 1.5 vs. -0.4 ± 1.4 µm/y, P = 0.036) compared with those without MvD. In a univariate analysis of rates of RNFL loss, the presence of MvD at baseline (ß = -0.83 ± 0.38, P = 0.033) was significantly associated with progressive RNFL loss. After adjusting for age, female sex, mean follow-up IOP, axial length, central corneal thickness, and mean deviation, the presence of MvD at baseline (ß = -0.85 ± 0.41, P = 0.041) was significantly associated with faster rates of RNFL loss in the multivariate analysis. Conclusions: There is a significant correlation between the presence of MvD and decrease in RNFL thickness in NTG patients. Our study further supported that the presence of MvD is a predictor of longitudinal RNFL damage in glaucoma.