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).

Axial Length as a Risk Factor for Steroid-Induced Ocular Hypertension.

PURPOSE: In this study, we aimed to assess whether axial length (AXL) is a true risk factor for steroid-induced ocular hypertension (OHT). We hypothesized that the proportion of patients with steroid-induced OHT among individuals who have received intravitreal dexamethasone (DEX) injections would differ according to the AXL of their eyes. MATERIALS AND METHODS: A single-center, cross-sectional, case-control study was conducted on 467 eyes that underwent DEX implant injection owing to various retinal diseases. Intraocular pressure (IOP) was measured before the injection and 1 week and 1, 2, 3, 6, and 12 months after the injection. Enrolled patients were divided into OHT and normal IOP groups. Univariable logistic regression analysis was used to calculate odds ratios of steroid-induced OHT with significant variables being analyzed using a multivariable model. RESULTS: A longer AXL was identified as a risk factor for steroid-induced OHT via both univariable and multivariable analyses, with an odds ratio of 1.216 [95% confidence interval (CI): 1.004-1.472, p=0.0452]. The optimal cut-off value for AXL in terms of steroid-induced OHT was 23.585 mm, with an odds ratio of 2.355 (95% CI: 1.429-3.882, p=0.0008). CONCLUSION: Our findings indicate that a long AXL is a risk factor for steroid-induced OHT. Further, clinicians should be aware of steroid-induced OHT when treating patients with high myopia with steroids.

Risk factors for undergoing surgery in patients with newly diagnosed open-angle glaucoma.

Despite the clinical importance of glaucoma surgery, studies on its prevalence and risk factors are limited. We analyzed a database comprising approximately 1,000,000 Korean residents to investigate the prevalence and risk factors for undergoing glaucoma surgery within 5 years of diagnosis with open-angle glaucoma. Of the 4,303 patients evaluated, 226 (5.3%) underwent glaucoma surgery. Factors associated with the likelihood of glaucoma surgery included the use of two or more eye drops (odds ratio [OR], 30.30; 95% confidence interval [CI], 10.95-83.84), intake of oral carbonic anhydrase inhibitor (OR, 1.79; 95% CI, 1.23-2.61), age > 55 years (55-65 years: OR, 1.71; 95% CI, 1.06-2.76; > 65 years: OR 1.72; 95% CI, 1.10-2.70), female sex (OR, 1.46; 95% CI, 1.10-1.94), middle- and high-income (OR, 2.36; 95% CI, 1.30-4.28, OR, 1.86; 95% CI, 1.03-3.35, respectively), and metropolitan residence (OR, 1.61; 95% CI, 1.14-2.26). Our nomogram for predicting the likelihood of glaucoma surgery showed an acceptable result. In conclusion, older age, female sex, and the intensity of intraocular pressure lowering treatment increased the likelihood of undergoing glaucoma surgery. Our findings indicated that a lower socioeconomic status may forestall receiving this necessary surgery, which requires further attention.

Long-term Intraocular Pressure Fluctuation Is a Risk Factor for Visual Field Progression in Advanced Glaucoma.

PRCIS: Intraocular pressure (IOP) fluctuations increase the risk of visual field progression of primary open-angle glaucoma (POAG) in the advanced stage even when IOP is maintained low on average. PURPOSE: The purpose of this study was to identify risk factors associated with the progression of visual field defect in patients with advanced POAG. MATERIALS AND METHODS: A retrospective review of medical records was conducted to identify patients who met the Hodapp-Parrish-Anderson criteria for advanced POAG. A total of 122 eyes of 122 patients had undergone IOP measurement with Goldmann applanation tonometer, standard automated perimetry, Cirrus optical coherence tomography, and fundus photography at 6-month intervals. Visual field progression was defined as the deterioration of a minimum of 3 visual field locations more than baseline at 5% levels in 4 consecutive visual fields with 24-2 SITA testing. RESULTS: Thirty-six eyes of 122 eyes (29.5%, 51.9±13.9 y old) showed visual field progression during 100.7±44.2 months of follow-up. The progression group showed greater long-term IOP fluctuations (2.6±1.4 mm Hg) than the no progression group (53.5±13.5 y; 2.0±1.0 mm Hg, P=0.008). Disc hemorrhage was detected more frequently in the progression group (40.5% vs. 17.4%, P=0.005). Multivariate Cox regression analysis revealed long-term IOP fluctuations [hazard ratio (HR)=2.567, 95% confidence interval (CI): 1.327-5.370, P=0.012] and disc hemorrhage (HR=2.351, 95% CI: 1.120-4.931, P=0.024) to be independent risk factors of visual field progression. Patients who showed both disc hemorrhage and long-term IOP fluctuations were at greater risks of progression (HR=2.675, 95% CI: 1.072-6.457, P=0.035). CONCLUSIONS: Long-term IOP fluctuations and disc hemorrhage are independent and additive risk factors of visual field progression in advanced glaucoma even at low IOPs. Patients in whom these risk factors are identified require close monitoring and vigorous treatment.

Factors Associated With Differences in the Initial Location of Structural Progression in Normal-Tension Glaucoma.

PRCIS: Different clinical factors are associated with the location of the first structural progression in glaucoma. PURPOSE: The aim was to investigate the underlying clinical parameters affecting the location of the initial structural progression of glaucoma in patients with normal-tension glaucoma (NTG). METHODS: This retrospective study included 228 eyes of 228 patients with NTG. In total, 130 eyes of 130 patients demonstrated structural progression (as determined by event-based guided progression analysis using Cirrus HD-optical coherence tomography) in the peripapillary retinal nerve fiber layer (ppRNFL) or macular ganglion cell inner plexiform layer (mGCIPL). Depending on where the progression occurred first, it was defined as either ppRNFL first progression or mGCIPL first progression. Clinical parameters associated with each first progression were identified using logistic regression. RESULTS: In total, 50 eyes showed ppRNFL first progression and 64 eyes showed mGCIPL first progression. ppRNFL first progression was significantly associated with female sex [odds ratio (OR)=5.705, P=0.015], lack of systemic hypertension (OR=0.199, P=0.014), disc hemorrhage (OR=4.188, P=0.029), higher mean intraocular pressure (OR=1.300, P=0.03), and lower pattern SD (OR=0.784, P=0.028). In contrast, male sex (OR=0.450, P=0.043), lower central corneal thickness (OR=0.987, P=0.032), higher intraocular pressure fluctuation (OR=1.753, P=0.047), lower systolic blood pressure fluctuation (OR=0.839, P=0.002), and higher diastolic blood pressure fluctuation (OR=1.208, P=0.015) were significantly associated with mGCIPL first progression. CONCLUSIONS: Different clinical factors were associated with the initial site of structural glaucoma progression in patients with NTG depending on its peripapillary or macular location, and these findings suggest possible differences in underlying mechanisms of glaucoma damage.

Predicting the safety zone for steroid-induced ocular hypertension induced by intravitreal dexamethasone implantation.

BACKGROUND/AIMS: This study aimed to predict the possibility of steroid-induced ocular hypertension (OHT) after intravitreal dexamethasone (DEX) implantation and to identify a proper safety zone for such injections. METHODS: A cross-sectional observational study was conducted and included 908 patient eyes that underwent DEX implant injection due to various retinal diseases. Intraocular pressure (IOP) was measured before injection, at 1 week, and at 1, 2, 3, 6 and 12 months thereafter. Eyes of enrolled patients were divided into the OHT and normal IOP groups. Univariable logistic regression analysis was used to assess significant associations between steroid-induced OHT and covariates; significant and previously reported significant variables were analysed with a multivariable model, and predictive nomograms were developed. RESULTS: Age, sex, axial length, glaucomatous eye, neovascular glaucoma, secondary glaucoma, uveitis history, hypertension, depression, diabetes mellitus and a history of previous laser-assisted in-situ keratomileusis or laser-assisted subepithelial keratectomy were significantly related to steroid-induced OHT (p<0.05). The calibration plot revealed good prediction under a predicted value of 0.4. Cut-off values for 80%, 86%, 91%, 95% and 98% sensitivity and specificity were offered for the safety zone after intravitreal DEX implantation. CONCLUSION: We developed two nomograms to predict a safety zone for intravitreal DEX implantation. These can be used to identify individuals who may be safely prescribed steroid treatments and for whom extra caution should be exercised.

Effect of red ginseng on visual function and vision-related quality of life in patients with glaucoma.

BACKGROUND: Red ginseng has been found to improve ocular perfusion and dry eye syndrome in glaucomatous eyes; however, its effects on visual function and vision-related quality of life have not been investigated. This study sought to evaluate the effects of red ginseng on visual function and vision-related quality of life in glaucoma patients using contrast sensitivity and a questionnaire. METHODS: Participants were randomly assigned to two groups in this prospective, randomized, double-blind study: in one group, red ginseng was taken first, followed by a placebo, and in the other, placebo was taken first, followed by red ginseng. We measured and compared changes in contrast sensitivity and vision-related quality of life between the two groups. Contrast sensitivity was measured using OPTEC® 6500P, and vision-related quality of life was evaluated using the 25-item National Eye Institute Visual Function Questionnaire. One-way and two-way repeated measure analyses of variance were used for the comparison. Relationships between respective changes in dry eye syndrome and contrast sensitivity were also analyzed. RESULTS: Daytime contrast sensitivity and ocular pain improved after the administration of red ginseng. Nighttime contrast sensitivity was improved in early or moderate glaucoma. Improved contrast sensitivity was not associated with improvement in dry eye syndrome. CONCLUSION: Red ginseng could improve contrast sensitivity and ocular pain in patients with glaucoma. The mechanism underlying improvement in contrast sensitivity appears to be associated with enhanced retinal perfusion or retinal ganglion cell function, but not dry eye syndrome.

Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma.

PURPOSE: To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. METHODS: Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. RESULTS: The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p' = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p' =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p' = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. CONCLUSIONS: Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

High Pulse Wave Velocity Is Associated With Decreased Macular Vessel Density in Normal-Tension Glaucoma.

Purpose: To investigate the relationship between pulse wave velocity (PWV) and retinal vessel density (VD) measured by optical coherence tomography angiography (OCTA) in patients with normal-tension glaucoma (NTG). Methods: This retrospective study included 103 patients with NTG and 109 healthy controls who underwent glaucoma examination and PWV measurements. Each group was classified into two subgroups according to a brachial-ankle PWV of 1400 cm/s. NTG was diagnosed when the maximum untreated intraocular pressure was < 21 mmHg on three repeated measurements obtained at different times in the presence of glaucomatous optic discs (neuroretinal rim thinning and excavation), peripapillary retinal nerve fiber layer defects, and glaucomatous visual field defects. Healthy controls did not have glaucomatous optic discs or visual field defects and exhibited normal retinal nerve fiber layer thickness. The interval between glaucoma examination and PWV measurements did not exceed six months. Univariate and multivariate logistic regression analyses were performed to identify factors associated with high PWV. Results: PWV was higher in the NTG group than in the control group, while peripapillary VD and macular VD (mVD) were lower (all P < 0.05). Stepwise logistic regression analysis revealed that high PWV was significantly associated with age, mean arterial pressure (MAP), and mVD in the NTG group. Meanwhile, high PWV was significantly associated with age, MAP, and low-density lipoprotein cholesterol levels in healthy controls. Conclusions: High PWV is associated with decreased mVD in NTG patients, suggesting that systemic arterial stiffness might be involved in the pathogenesis of NTG.

Glaucoma Progression after Delivery in Patients with Open-Angle Glaucoma Who Discontinued Glaucoma Medication during Pregnancy.

In this retrospective study, clinical characteristics and glaucoma progression of open-angle glaucoma (OAG) patients who discontinued intraocular pressure (IOP)-lowering medication during pregnancy were investigated. Glaucoma progression was determined using either serial visual field tests or optic disc/retinal nerve fiber layer (RNFL) photographs. Age, number of previous pregnancies, diagnosis, average IOP, IOP fluctuation, visual field mean deviation, pattern standard deviation, and RNFL thickness were examined, and their association with glaucoma progression was determined using linear regression analysis. Among 67 eyes (37 patients), 19 eyes (28.4%) exhibited glaucoma progression 13.95 ± 2.42 months after delivery. The progression group showed significantly higher mean IOP than the nonprogression group in the first, second, and third trimesters (p = 0.02, 0.001, and 0.04, respectively). The average IOP in the second, and third trimesters and IOP fluctuation during the entire pregnancy were significantly associated with glaucoma progression according to a univariate analysis (p = 0.04, 0.031, and 0.026, respectively). In conclusion, IOP elevation during pregnancy is associated with glaucoma progression after delivery in patients who had discontinued medication during pregnancy. Therefore, close monitoring of glaucoma is necessary, particularly if patients discontinue medication during pregnancy, and appropriate intervention should be considered in case of increased IOP.

Risk Factors for the Structural Progression of Myopic Glaucomatous Eyes with a History of Laser Refractive Surgery.

As laser refractive surgeries (LRS) have been widely performed to correct myopia, ophthalmologists easily encounter patients with glaucoma who have a history of LRS. It is well known that intraocular pressure (IOP) in eyes with glaucoma is not accurate when measured using Goldmann applanation tonometry. However, risk factors for glaucoma progression, particularly those associated with measured IOP, have rarely been studied. We analysed data for 40 patients with a history of LRS and 50 age-matched patients without a history of LRS. Structural progression was defined as significant changes in thickness in the peripapillary retinal nerve fibre layer as identified using optical coherence tomography event-based guided progression analysis. Risk factors were determined via Cox regression analysis. Disc haemorrhage (DH) was associated with glaucoma progression in both the non-LRS group and LRS group (hazard ratio (HR): 4.650, p = 0.012 and HR: 8.666, p = 0.019, respectively). However, IOP fluctuation was associated with glaucoma progression only in the LRS group (HR: 1.452, p = 0.023). Our results show that DH was a significant sign of progression in myopic glaucoma eyes. When treating patients with myopia and glaucoma, IOP fluctuation should be monitored more carefully, even if IOP seems to be well controlled.

The role of pattern electroretinograms and optical coherence tomography angiography in the diagnosis of normal-tension glaucoma.

In this study, we investigated the correlation between pattern electroretinogram (PERG) and optical coherence tomography angiography (OCTA) parameters for diagnosis in patients with normal-tension glaucoma (NTG). Forty-nine normal individuals (49 eyes) and 60 patients with NTG (60 eyes) were enrolled. OCTA and PERG parameters, such as macular vessel density (VD) and the amplitude of N35-P50 and P50-N95, were measured. Correlation analyses were performed between the parameters, and the area under the curve (AUC) was used to identify their diagnostic ability for NTG. Macular VD and the amplitude of N35-P50 and P50-N95 showed significant differences between the normal individuals and patients with NTG. Correlation between P50 and N95 amplitude and macular VD was significant in the normal and early glaucoma groups. Macular VD showed a higher AUC value (0.730) than that of P50-N95 amplitude (0.645) in the early glaucoma group. In the moderate to severe glaucoma group, the AUC value of the amplitude of P50-N95 (0.907) was higher than that of macular VD (0.876). The results indicate that PERG and OCTA parameters may identify glaucoma in its early stage, based on the severity of glaucomatous damage in patients with NTG.

Investigating the Relationship between Glaucoma Prevalence and Trabecular Meshwork Length.

Glaucoma is one of the most common causes of blindness worldwide, but the risk factors of glaucoma are yet to be fully understood. We investigated the relationship between the prevalence of glaucoma and trabecular meshwork (TM) length by comparing the mean TM length of a South Korean population with that of another ethnic population. We included 250 eyes of 125 patients who underwent anterior segment optical coherence tomography at Yonsei University Gangnam Severance Hospital between January 2015 and December 2017. We measured the distance from the scleral spur to Schwalbe's line in patients with open and closed angles and calculated the TM length using the open- and closed-angle ratios in the general population. The mean TM length of the patients in our study was 752 ± 116 µm. Considering the compensated data, the estimated true mean TM length in the Korean population was 793 ± 76 µm, which was similar to the mean TM length of a previously evaluated Hispanic population, but differed significantly from those of previously evaluated Asian (Chinese), Caucasian, and African-American populations (p < 0.05). Our results support the hypothesis that the development of glaucoma would be affected by TM length.

Effects of Hypoxic Preconditioning and Vascular Endothelial Growth Factor on the Survival of Isolated Primary Retinal Ganglion Cells.

This study aimed to investigate the effect of hypoxic preconditioning (HPC) on primary retinal ganglion cell (RGC) survival and the associated mechanism, including the role of vascular endothelial growth factor (VEGF). Retinas were separated from the enucleated eyeballs of Sprague-Dawley rats on postnatal days 1-4. RGCs were harvested using an immunopanning-magnetic separation system and maintained for 24 h in a defined medium. Hypoxic damage (0.3% O2) was inflicted on the cells using a CO2 chamber. Anti-VEGF antibody (bevacizumab) was administered to RGCs exposed to hypoxic conditions, and RGC survival rate was compared to that of non-anti-VEGF antibody-treated RGCs. HPC lasting 4 h significantly increased RGC survival rate. In the RGCs exposed to hypoxic conditions for 4 h, VEGF mRNA and protein levels were significantly increased. Treatment with high dose bevacizumab (>1 mg/mL) countered HPC-mediated RGC survival. Protein kinase B and focal adhesion kinase levels were significantly increased in 4-h hypoxia-treated RGCs. HPC showed beneficial effects on primary RGC survival. However, only specifically controlled exposure to hypoxic conditions rendered neuroprotective effects. Strong inhibition of VEGF inhibited HPC-mediated RGC survival. These results indicate that VEGF may play an essential role in promoting cell survival under hypoxic conditions.

Progression patterns of normal-tension glaucoma groups classified by hierarchical cluster analysis.

OBJECTIVES: To investigate differences in progression patterns of normal-tension glaucoma (NTG) patients in three clusters classified by hierarchical cluster analysis (HCA). MATERIALS AND METHODS: In a retrospective study, 200 eyes of NTG patients classified by HCA in 2015 who were followed up to the current date were evaluated. Peripapillary retinal nerve fibre layer (RNFL) thicknesses were measured by Cirrus HD-OCT and progression rate was calculated by trend analysis (Guided Progression Analysis [GPA]). VF progression rate was evaluated by linear regression analysis of mean deviation (MD). Progression patterns of three clusters were compared by histograms. RESULTS: In total, 153 eyes of 153 patients were followed up. Mean observation period was 5 years. RNFL reduction rate was -0.83 µm/year in cluster 1, which showed early glaucomatous damage in previous reports; -0.45 µm/year in cluster 2, which showed moderate glaucomatous damage; and -0.36 µm/year in cluster 3, which showed young and myopic glaucomatous damage. The progression pattern of cluster 3 showed a double-peak distribution; RNFL reduction rate was 0.11 µm/year in the non-progressive group and -1.07 µm/year in the progressive group. CONCLUSION: The progression patterns were different among three NTG groups that were divided by HCA. In particular, the group of young and myopic eyes showed a mixture of two different patterns.

Effect of systemic blood pressure on optical coherence tomography angiography in glaucoma patients.

BACKGROUND: The association between retinal microvascular structure and glaucoma has been revealed in multiple studies using optical tomography angiography (OCTA), but limited information on the macular vessel density (mVD) in patients with glaucoma is available. In this study, we tried to identity the factors that affected macular VD (mVD) in glaucomatous eyes. METHODS: This retrospective cross-sectional study evaluated OCT and OCTA images from 92 eyes from 58 healthy subjects and 179 eyes from 103 glaucoma patients using the SD-OCT database from July 2017 to July 2018. Glaucomatous eyes were further divided into two groups according to history of disc haemorrhage (DH). Association between mVD and demographic characteristics, ganglion cell-inner plexiform layer (GCIPL) thickness, visual field mean deviation (MD) and systemic blood pressure was analysed in each group. RESULTS: In both healthy and glaucomatous eyes, mVD was inversely associated with age (ß = -0.035, P = 0.025; ß = -0.039, P = 0.018). In the glaucomatous eyes, mVD was significantly decreased, as the MD value was worse (ß = 0.109, P = 0.002). In glaucomatous eyes with DH, mVD decreased as blood pressure increased (ß = -0.111, P = 0.003) CONCLUSIONS: Reduced mVD is more common in older individuals in both healthy and glaucomatous eyes, and correlates with functional deterioration than structural damage in glaucomatous eyes. In glaucomatous eyes with DH, high systemic BP is associated with a reduction in mVD. This may indicate that glaucoma patients with DH are more susceptible to vascular damage secondary to hypertension.

Relationship between N95 Amplitude of Pattern Electroretinogram and Optical Coherence Tomography Angiography in Open-Angle Glaucoma.

PURPOSE: The pattern electroretinogram (PERG) is useful to detect retinal ganglion cell (RGC) damage in patients with glaucoma. Optical coherence tomography angiography (OCTA) measures retinal vessel density (VD), which is known to be reduced in glaucoma. There may be correlations between parameters of the PERG and OCTA in open-angle glaucoma (OAG). METHODS: In total, 95 eyes of 95 OAG patients and 102 eyes of 102 normal controls were included in this study. N35, P50, and N95 latency along with P50 and N95 amplitude were obtained using the PERG. Retinal VD was measured around the peripapillary and macular area according to the ETDRS grid (concentric circles with diameters of 1, 3, and 6 mm), which is named a center (≤1 mm), an inner (1-3 mm), an outer (3-6 mm), and a full (≤6 mm) area. Pearson correlation analysis was done between parameters, and partial correlation analysis was done after adjusting confounding factors. RESULTS: P50 amplitude, N95 amplitude, and VD of most measured areas were significantly lower in the OAG group compared to the normal group. N95 amplitude showed a statistically significant correlation with parameters of optical coherence tomography and visual field, peripapillary outer and full VD, and macular outer and full VD even after adjusting confounding factors. There was no significant correlation between parameters in the normal group. CONCLUSIONS: N95 amplitude was associated with structural and functional change including VD reduction in OAG. Microvascular alterations may be associated with dysfunctional changes of RGC recorded by the PERG in OAG.

Development of a nomogram using fundus photography to predict glaucoma progression in patients showing disc hemorrhage.

To develop a nomogram to predict the progression of glaucoma by fundus photography in patients with disc hemorrhage. Retrospective review of the medical records of patients with disc hemorrhage, which was detected during follow up with open angle glaucoma, from January 2010 to March 2018. Patients were divided into glaucoma progression (n = 52) or non-progression (n = 38) groups. We assessed proximal location and morphology of disc hemorrhage; relationship to retinal nerve fiber layer defects with disc hemorrhage; and angular extent of disc hemorrhage, between groups using fundus photography. Multiple logistic regression analysis was performed to select prognostic factors, and we constructed a nomogram to predict glaucoma progression. The number of disc hemorrhage at the border of retinal nerve fiber layer defects (P = 0.001) and peripapillary disc hemorrhage (P = 0.008) were significantly higher in the progression group. We used angular extent; location of disc hemorrhage with retinal nerve fiber layer defects; and proximal location of disc hemorrhage to construct the nomogram. The area under the receiver operating characteristic curve of the nomogram was 0.847. We created the nomogram using fundus photography in patients showing disc hemorrhage as a novel and accurate screening method to predict glaucoma progression and aid clinicians to decide on the best treatment plan.