Health anxiety in a non-population-based, pre-publicised glaucoma screening exercise.

OBJECTIVE: To investigate whether anxiety plays a role in self-recruitment for non-population-based glaucoma screening. METHODS: In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma, and also completed the Trait Anxiety Inventory and Shortened Health Anxiety Inventory questionnaires. In pre-publicity for the trial, information on risk factors for glaucoma was given. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. RESULTS: Of the 120 total participants (72 females, 48 males), 12 were considered glaucoma suspects at the screening, although only three (2.5%) were ultimately diagnosed with glaucoma. Health anxiety showed significant correlation with trait anxiety (r=0.525, P<0.001). Trait anxiety was similar for both the genders; this score was significantly below the normal Hungarian population value in women (P<0.001) and at the normal population level in men (P=0.560). In contrast, health anxiety was significantly higher than for both the 'normal' and 'anxious' reference groups (P<0.001), although smaller than that for hypochondriacs (P<0.001). Participants with pre-existing ocular symptoms, and those who attended because of fear of blindness, had significantly higher trait- and health-anxiety scores (P<0.05 for all comparisons). CONCLUSION: In this screening trial, the health anxiety of the self-recruited participants was significantly above normal, whereas the prevalence of glaucoma was within the usual range for a Caucasian population. This suggests that providing pre-publicity information on risk factors for glaucoma does not necessarily increase the prevalence of glaucoma among self-recruited participants in non-population-based screening, as some individuals may participate on account of elevated health anxiety, rather than because of higher potential risk for glaucoma.

Correlation between polarimetric retinal nerve fiber layer thickness and retinal sensitivity determined with frequency-doubling technology.

BACKGROUND AND OBJECTIVE: Correlation between polarimetric retinal nerve fiber layer thickness measured with variable corneal compensation and retinal sensitivity measured with frequency-doubling technology (FDT) and standard automated perimetry (SAP) was investigated. PATIENTS AND METHODS: Twenty-four consecutive patients with chronic open-angle glaucoma and 17 healthy control subjects (1 randomly selected eye for each subject) were evaluated. RESULTS: For all subjects, quadrant scanning laser polarimetry parameters correlated positively with both FDT and SAP mean sensitivity of the opposite hemifield (P< .001). Global scanning laser polarimetry parameters correlated positively with FDT-mean sensitivity, SAP-mean sensitivity, and FDT-mean deviation, and negatively with SAP-mean deviation (in SAP, mean deviation is positive in case of sensitivity loss) (P < or = .02). The nerve fiber indicator also correlated with FDT-pattern standard deviation and SAP-corrected loss variance (P < or = .01). Using un-logged sensitivity values, no further correlations were found. CONCLUSION: Our results show that a similar structure-function relationship exists between polarimetric retinal nerve fiber layer thickness determined with variable corneal compensation and retinal sensitivity measured with SAP and FDT.

Influence of subfoveal choroidal neovascularisation on macular imaging with scanning laser polarimetry of the retinal nerve fibre layer.

PURPOSE: To investigate the influence of subfoveal choroidal neovascularisation (CNV) on macular imaging performed using scanning laser polarimetry (SLP) of the retinal nerve fibre layer. METHODS: SLP was performed on 22 consecutive patients with angiographically verified CNV, and on 23 healthy control subjects. One eye per subject was evaluated using the GDx Nerve Fibre Analyser. Regularity of the corneal retardation on the macular SLP images was assessed according to three criteria: (1) magnitude of the 'macular ratio', defined as the ratio of mean retardation values along two axes (the axis with the maximum retardation and the perpendicular one, corresponding in healthy eyes to minimum retardation); (2) the values of GDx parameters which are independent of quadrant position (ellipse modulation and ellipse average); and (3) the frequency of the regular 'bow-tie' polarisation pattern. RESULTS: 'Macular ratio' was significantly higher in the CNV group than in the control group (P<<0.001). Ellipse modulation did not differ between the groups, but ellipse average was higher in the CNV group (P=0.016). The variance for each of these two parameters was significantly higher for the CNV group (P<<0.001 for both comparisons). A 'bow-tie' pattern polarisation was seen in 23 of the 23 control eyes, but only in 7 of the 22 CNV eyes (P<<0.001). CONCLUSION: The results show that CNV influences the macular image obtained with SLP. This suggests that measurements with SLP may be disturbed for eyes with CNV when the customised corneal compensation method, which makes use of the macular retardation image, is employed.

Comparison between fixed-angle and customised corneal-polarisation compensation methods in scanning laser polarimetric measurement of the retinal nerve fibre layer in glaucoma.

PURPOSE: To investigate the differences between the results of scanning laser polarimetric (SLP) measurements of the retinal nerve fibre layer thickness (RNFLT) made using two different corneal-polarisation techniques; customised (SLP-C), and fixed-angle (SLP-F) compensations. METHODS: Both SLP-C and SLP-F were performed on 37 consecutive phakic patients with chronic open-angle glaucoma, and on 14 healthy control subjects. One randomly selected eye per subject was evaluated. RESULTS: Both SLP-C and SLP-F parameters were able to discriminate between the glaucoma group and the control group, except in the case of the ellipse modulation, which differed significantly between the two groups with SLP-C (P=0.017), but not with SLP-F (P=0.056). When SLP-C and SLP-F values were compared, inferior maximum thickness and ellipse standard deviation were significantly lower with SLP-C in both groups (P<0.05 for each parameter). Superior maximum thickness was significantly lower in glaucoma with SLP-C than with SLP-F (P=0.006) and tended to be lower with SLP-C than with SLP-F in the control group (P=0.053). In the glaucoma group, it was only with SLP-C that a significant (positive) correlation between the superior maximum thickness and the inferior hemifield mean sensitivity (MS) (r=0.653, P<0.001), and between the inferior maximum thickness and the superior hemifield MS (r=0.420, P=0.023) was found. The other global and sectoral SLP parameters showed significant correlation with the corresponding visual field parameters with both techniques. CONCLUSION: Our findings suggest that SLP measurements with customised compensation provide more realistic results for RNFLT than those made with the conventional fixed-angle compensation.

Scanning laser polarimetry of retinal nerve fibre layer thickness after laser assisted in situ keratomileusis (LASIK): stability of the values after the third post-LASIK month.

BACKGROUND: Monitoring the retinal nerve fibre layer thickness (RNFLT) is essential in the diagnosis and treatment of glaucoma. In a previous study we found that a decrease of the polarimetric RNFLT observed in the early period after laser-assisted in situ keratomileusis (LASIK) disappears or tends to disappear by the third post-LASIK month. PURPOSE: To study the stability of the "recovered" polarimetric retardation values between the third and twelfth month after LASIK. METHODS: Scanning laser polarimetry (SLP) with the classic GDx Nerve Fiber Analyzer was performed on 13 consecutive healthy subjects with no eye disease who underwent LASIK for ametropia correction. Measurements were performed preoperatively, then at 3 and 12 months postoperatively. RESULTS: Inferior, temporal and nasal average thickness as well as ellipse average thickness and average thickness showed no difference among the three time points (ANOVA, p > 0.05). Superior average thickness was significantly smaller both at three months (Sheffe test, p =0.008) and 12 months (p =0.006) than before LASIK. However, no difference was seen between the values measured at three months and at 12 months after LASIK (p =0.997). A statistically significant interaction between treatment type (myopic or hyperopic correction) and the change of retardation was found for the superior average thickness (two-way ANOVA, p =0.016). In this quadrant the RNFLT values of the myopic eyes decreased between the baseline and the month 3 measurements but became stable after that; the retardation of the hyperopic eyes remained unchanged throughout. CONCLUSION: RNFLT measured with the classic GDx device after LASIK shows transient changes probably due to the LASIK-induced alteration of the polarization and the healing process. The polarimetric RNFLT values, however, become stable by the third post-LASIK month, and show no further change until the end of the first year after LASIK. Baseline SLP measurements for long-term glaucoma follow-up can be obtained from the third post-LASIK month onwards.

Reduced response of retinal vessel diameters to flicker stimulation in patients with diabetes.

BACKGROUND/AIM: Stimulation of the retina with flickering light increases retinal arterial and venous diameters in animals and humans, indicating a tight coupling between neural activity and blood flow. The aim of the present study was to investigate whether this response is altered in patients with insulin dependent diabetes mellitus. METHODS: 26 patients with diabetes mellitus with no or mild non-proliferative retinopathy and 26 age and sex matched healthy volunteers were included in the study. Retinal vessel diameters were measured continuously with the Zeiss retinal vessel analyser. During these measurements three episodes of square wave flicker stimulation periods (16, 32, and 64 seconds; 8 Hz) were applied through the illumination pathway of the vessel analyser. RESULTS: In retinal arteries, the response to stimulation with diffuse luminance flicker was significantly diminished in diabetic patients compared to healthy volunteers (ANOVA, p<0.0031). In non-diabetic controls flicker stimulation increased retinal arterial diameters by +1.6% (1.8%) (mean, p<0.001 v baseline), +2.8% (SD 2.2%) (p<0.001) and +2.8% (1.6%) (p<0.001) during 16, 32, and 64 seconds of flicker stimulation, respectively. In diabetic patients flicker had no effect on arterial vessel diameters: +0.1% (3.1%) (16 seconds, p = 0.9), +1.1% (2.7%) (32 seconds, p = 0.07), +1.0% (2.8%) (64 seconds, p = 0.1). In retinal veins, the response to flicker light was not significantly different in both groups. Retinal venous vessel diameters increased by +0.7% (1.6%) (16 seconds, p<0.05), +1.9% (2.3%) (32 seconds, p<0.001) and 1.7% (1.8%) (64 seconds, p<0.001) in controls during flicker stimulation. Again, no increase was observed in the patients group: +0.6% (2.4%), +0.5% (1.5%), and +1.2% (3.1%) (16, 32, and 64 seconds, respectively). CONCLUSION: Flicker responses of retinal arteries and veins are abnormally reduced in patients with IDDM with no or mild non-proliferative retinopathy. Whether this diminished response can be attributed to altered retinal vascular reactivity or to decreased neural activity has yet to be clarified.

Influence of LASIK on scanning laser polarimetric measurement of the retinal nerve fibre layer with fixed angle and customised corneal polarisation compensation.

BACKGROUND/AIM: Retinal nerve fibre layer thickness (RNFLT), as measured with scanning laser polarimetry using the fixed angle corneal polarisation compensator (SLP-F), has been found to be reduced after uncomplicated laser assisted in situ keratomileusis (LASIK) compared to the pre-LASIK measurement. Since this virtual RNFLT thinning is attributed to the corneal changes induced by the LASIK, the authors investigated whether customised corneal polarisation compensation (SLP-C), which compensates for the actual corneal polarisation during each measurement, can avoid the LASIK induced, virtual changes of the polarimetric RNFLT values. METHODS: Scanning laser polarimetry using both the SLP-F and SLP-C methods (GDx-Access, software version 5.0) was performed on 15 consecutive healthy subjects with no eye disease who underwent LASIK for ametropia correction. The SLP measurements were performed before the surgery, then on day 1 and day 6 after LASIK. Thickness data from images of one randomly selected eye per subject were analysed using the ANOVA and Scheffe multiple comparison tests. RESULTS: Superior maximum, inferior maximum, normalised superior area, and normalised inferior area (SLP parameters representing the RNFLT at the superior and inferior poles of the optic nerve head) remained unchanged with SLP-C (ANOVA, p>0.05) but decreased (superior maximum, normalised superior area, Scheffe test, p<0.05) or tended to decrease (inferior maximum) after LASIK, when measured using SLP-F. In contrast, certain other parameters-namely, superior ratio and inferior ratio (representing the ratios between the superior or the inferior sector and the temporal sector), maximal modulation, and ellipse modulation decreased with SLP-C (Scheffe test, p<0.05), but remained stable with SLP-F (ANOVA, p>0.05) after LASIK. Superior to nasal ratio, symmetry of the superior and inferior RNFLT as well as the parameter showing the probability of having glaucoma (called "the number") remained unchanged with both types of corneal compensation (ANOVA, p>0.05). With SLP-C the parameter ellipse average thickness increased after LASIK (Scheffe test, p = 0.021). No parameter value altered between day 1 and day 6 after LASIK, for either method. CONCLUSION: The results suggest that the LASIK induced decrease of the polarimetric RNFLT, which is consistently detected with polarimeters when using the fixed angle corneal polarisation compensator, is due to alterations of the corneal polarisation. The use of customised corneal polarisation compensation avoids this virtual decrease of the polarimetric RNFLTHowever, our results suggest an increase of the measured retardation in the temporal quadrant of the SLP-C image after LASIK. Since ratios of parameters using the temporal RNFLT in the denominator are important in the polarimetric glaucoma diagnosis algorithm, their decrease as a consequence of using SLP-C needs further investigation.

Ocuton-S self tonometry vs. Goldmann tonometry; a diurnal comparison study.

PURPOSE: To compare 24-hour diurnal intraocular pressure (IOP) measurements obtained using the Ocuton-S applanation self tonometer and the Goldmann tonometer. METHODS: 24-hour diurnal IOP curves were obtained on 14 eyes of 7 trained patients suffering from medically controlled primary open angle glaucoma. IOP was measured every third hour starting at 9 a.m. with a calibrated Goldmann tonometer; one week later, a similar set of measurements was obtained with Ocuton-S self tonometry by the patients. One week later still, ultrasound corneal pachymetry was performed at the same hours. RESULTS: Overall IOP (24-hour mean) did not differ significantly between the different measuring techniques (ANOVA, p = 0.74), but the IOP differed in a statistically significant manner around the clock (ANOVA, p = 0.00006). The mean Goldmann tonometric readings were up to 2.8 mmHg lower than the Ocuton-S values during the daytime (9 a.m. to 9 p.m.), however, during the night (12 midnight to 6 a.m.) mean IOP measured with Goldmann tonometry was 2.2 to 3.3 mmHg higher than the corresponding average of the self tonometry readings. There was a statistically significant interaction between the type of tonometry and the time of the measurement (p = 0.0007). Central corneal thickness (CCT) showed a significant change during the 24-hour period (p = 0.000001). CONCLUSION: IOP shows a different diurnal curve when measured with the Goldmann tonometer and with the Ocuton-S applanation self tonometer. The instruments' readings might be influenced in different ways by the diurnal changes of the corneal thickness. Since Ocuton-S self tonometry underestimates the IOP in the early morning period, a careful evaluation is necessary when nocturnal and early morning IOP elevation is investigated with this technique.

Does glaucoma medication influence the diameter of the retinal arteriole in the human eye? (A pilot study using the retinal vessel analyser).

PURPOSE: To investigate the potential in vivo influence of different topical glaucoma medications on the diameter of the retinal arterioles of healthy volunteers and glaucoma patients. METHODS: The diameter of one pre-selected retinal arteriole per eye was measured using the Retinal Vessel Analyser (RVA), an instrument developed for non-invasive clinical measurement of the diameter of the main retinal vessels. The instrument contains a video system, and the integrated software recognises the boundaries of the retinal vessels by detecting their light-transmission profile. The vessel diameter (in arbitrary units) is plotted against time (seconds) on a separate display screen. In Study I the vessel diameter was measured in 12 eyes of six healthy volunteers (age 21-26 years, mean age 24.0 years) on six occasions each separated by 14 days. In a double-masked fashion, each subject's right eye was treated with one of 5 glaucoma medications (brinzolamide 1%, timolol 0.5%, betaxolol 0.5%, brimonidine 0.2% or latanoprost 0.005%) and the left eye always received balanced salt solution. In Study II, one randomly selected eye of 16 patients (age 50-79 years, mean age 65.2 years) suffering from primary open-angle glaucoma controlled with topical monotherapy was investigated, in an unmasked fashion. Four patients were on betaxolol 0.5% treatment, six subjects were receiving non-selective topical beta receptor blockers and six subjects were being treated with once daily latanoprost 0.005%. RESULTS: The coefficient of variation for the arteriole diameter in the healthy volunteers was less than 12% in each case. No significant post-treatment change of the diameter of the pre-selected arteriole was found for any topical medication investigated, either in the healthy volunteers (Study I) or in the patients suffering from glaucoma (Study II) (p>0.05, paired t-test). In addition, in Study I no difference was observed in the alteration of the arteriole diameter between the baseline and the hour 2 measurements when the values from the drug-treated and placebo treated eyes were compared (p>0.05, two-way ANOVA). CONCLUSION: In the present investigations it was not possible to detect any statistically meaningful change of the arteriole diameter at two hours after the instillation of any of several topical antiglaucoma drugs widely used in clinical practice. Further investigations are necessary to clarify whether the lack of observed change is due to the lack of retinal vascular effects of the drugs investigated, or is due to an inability of the RVA instrument in practice to detect alterations between time-points separated by several hours.

Cold pressor test and retinal capillary perfusion in vasospastic subjects with and without capsular glaucoma (a preliminary study).

PURPOSE: Using the cold pressor test the authors investigated the change in retinal and neuroretinal capillary perfusion in vasospastic patients suffering from capsular glaucoma (CG) and in vasospastic control subjects. METHODS: Changes in retinal and optic nerve head capillary perfusion induced by the cold pressor test (one hand immersed in 4 degrees C water for 30 seconds, then in 30 degrees C water for 2 minutes) was measured using the Heidelberg Retina Flowmeter in 4 patients with CG and in 5 healthy control subjects. Previously all subjects showed a reduction of cutaneous capillary flow higher than 70% in the cold pressor test (vasospastic reaction). One eye per subject was investigated. Two images were obtained for each phase (baseline, cold phase and warm phase), and the better quality image from each phase was selected for the measurements. One location on the temporal neuroretinal rim and one location on the temporal retina outside the peripapillary area were selected for the HRF measurements. RESULTS: In the CG group neuroretinal rim "Volume" decreased by 26.05%, "Flow" by 25.82% and "Velocity" by 23.91% (p<0.05), retinal "Volume" decreased by 12.30% (p=0.051), and retinal "Flow" by 22.36% (p=0.01) in the cold phase. All these parameters returned to the corresponding baseline values in the warm phase. In the control group a significant decrease was observed in retinal "Volume" (15.96%), "Flow" (17.81%), and "Velocity" (16.11%) in the cold phase (p<0.05), which diminished in the warm phase but remained still significant for "Flow" and "Velocity". CONCLUSION: Cutaneous cold provocation can induce an immediate decrease in retinal and optic nerve head capillary perfusion at least in a part of the vasospastic subjects with or without capsular glaucoma. This decrease diminishes or disappears quickly when the hand is immersed in warm water. To evaluate the potential role of cold-induced retinal and optic nerve head vasoconstriction in the pathogenesis of capsular glaucoma further investigations are necessary since this reaction was also present in the vasospastic control subjects.