Diagnostic ability of retinal nerve fiber layer maps to detect localized retinal nerve fiber layer defects.

PURPOSE: To evaluate and compare the diagnostic ability of spectral domain optical coherence tomography (SD-OCT) for detecting localized retinal nerve fiber layer (RNFL) defects in topographic RNFL maps and circumpapillary RNFL (cpRNFL) thickness measurements. METHODS: Sixty-four eyes with localized RNFL defects in red-free RNFL photographs and 72 healthy eyes were included. All participants were imaged with SD-OCT. The area and angular width of the localized RNFL defects were measured with ImageJ software on RNFL thickness map, significance map (yellow pixels, <5% level), and red-free RNFL photographs. The sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were calculated for cpRNFL thickness, macular inner retina thickness, and RNFL maps (thickness, significance) according to the quantitative measurements and a <5% level of classification to distinguish eyes with localized RNFL defects from healthy eyes. RESULTS: RNFL thickness map (sensitivity 96.9-98.4%, specificity 86.1-98.6%, and AUCs 0.915-0.992) and significance map (sensitivity 96.9-98.4%, specificity 88.9-95.8%, and AUCs 0.937-0.983) showed superior performance in detecting localized RNFL defects compared with other parameters (P-value 0.001-0.024) except for 36 sector cpRNFL thickness (sensitivity 92.2%, specificity 87.5%, and AUCs 0.898; P-value 0.080-0.545). The sensitivity for detecting RNFL defects was related to the angular width, area, and depth of the RNFL defects in the cpRNFL (4 sector, 12 sector) and macular inner retinal measurements. RNFL thickness and significance maps showed a constant sensitivity regardless of variations in angular width, area, and depth of the RNFL defects. CONCLUSION: RNFL thickness and significance maps could be used to distinguish eyes with localized RNFL defects from healthy eyes more effectively than cpRNFL thickness and macular inner retina thickness measurements.

Reduction in intraocular pressure after laser in situ keratomileusis.

PURPOSE: To investigate whether intraocular pressure (IOP) measured on the nasal side is affected after laser in situ keratomileusis (LASIK). SETTING: The Glaucoma Service, Dr. Hong's Eye Clinic, Seoul, Korea. METHODS: In 83 patients, IOP was prospectively measured with the Goldmann tonometer at the central (Tcenter) and nasal (Tnasal) areas of the cornea before and after LASIK. The Tcenter and Tnasal IOP between baseline and 1, 3, and 6 months postoperatively was compared. The correlation between ablation depth, amount of treatment, refractive change, and change in central corneal thickness and Tcenter change was evaluated. RESULTS: Six months after LASIK, Tcenter IOP decreased 3.9 mm Hg (25.2%) and Tnasal IOP decreased 2.0 mm Hg (12.7%) (P < .001, P = .02, respectively). The Tnasal measurement was 1.8 mm Hg higher than the Tcenter measurement (P < .001). Significant correlation between each corneal parameter and the Tcenter reduction at 1 month did not continue to 6 months (P > .05). CONCLUSION: At each follow-up, Tnasal IOP was statistically lower than at baseline, although the reduction was not as great as that of Tcenter IOP. A 2 to 3 mm Hg drop in Tnasal up to 6 months after LASIK should be expected. An alternative would be to measure IOP with the Tono-Pen on the nasal side to fit the tip to the relatively unchanged nasal side of the cornea.

Retinal vessel diameter in normal and primary open-angle glaucoma.

The purpose of this study was to determine how closely peripapillary retinal vessel diameter is related to functional and structural optic nerve damage in primary open-angle glaucoma. Using optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects, the diameters of the superior and inferior temporal retinal arteries and veins were measured at the optic disc border. On the basis of rim/disc area ratio, the glaucoma group was divided into four stages: early, more than 0.61; medium, 0.60-0.41; advanced, 0.40-0.21; far advanced, less than 0.20. In the normal group the diameter of the inferior temporal vein was the largest, followed by that of the superior temporal vein, the inferior temporal artery, and the superior temporal artery. The diameters of the inferior and superior temporal retinal artery were significantly smaller at the early and medium stage, respectively, whereas both inferior and superior temporal retinal vein diameters were significantly smaller at the far advanced stage. The diameters of the inferior and superior temporal retinal arteries correlated significantly with neuroretinal rim area (r > or = 0.48, P = 0.0001), mean deviation (r > or = 0.42, P = 0.0001), vertical cup-to-disc ratio (r < or = -0.33, P = 0.0001), and peripapillary atrophy data (r < or = -0.14, P < 0.04). The results indicate that in primary open-angle glaucoma, vessel diameter becomes less as neuroretinal rim area decreases and visual field defects and peripapillary atrophy increase. Its evaluation can be helpful for the diagnosis of glaucoma and possibly also during follow-up.

Peripapillary atrophy in normal and primary open-angle glaucoma.

This study was undertaken in order to determine the value of measuring peripapillary atrophy for the diagnosis and follow-up of patients with glaucoma, and to evaluate how closely peripapillary atrophy is related to structural and functional optic nerve damage in glaucoma. Magnification-corrected morphometry of photographs using a computer graphic program and automated static threshold perimetry were performed in 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The groups were not significantly different in age, refractive error or disc area. Zones alpha and beta were significantly larger, total peripapillary atrophy was significantly more extensive, and zone beta occurred more often in the glaucoma group than in the normal group. The frequency of zone beta increased with advancing glaucoma stage. The areas of zones alpha and beta and total peripapillary atrophy increased significantly with decreasing rim/disc area ratio, rim area, and mean deviation, and with increasing vertical and horizontal cup-to-disc ratios and cup area. Correlation coefficients were generally higher for zone beta than for zone alpha. Peripapillary atrophy was greater in a sector in which the neuroretinal rim loss was more marked. These findings suggest that increases in the extent of peripapillary atrophy are related to the severity of glaucomatous optic nerve damage and visual field defects, and that peripapillary atrophy is useful for the diagnosis and progression of glaucomatous nerve damage.

Factors associated with the poor final visual outcome after traumatic hyphema.

In order to determine the factors related to the worse final visual outcome following nonperforating traumatic hyphema, the clinical characteristics of 18 patients with visual outcome of 0.1 or worse were compared with those of 166 patients with visual outcome of 0.15 or better. The presence of posterior segment injuries such as macula edema, retinal hemorrhage, epiretinal membrane, and choroidal rupture were significant factors of a poor final visual outcome (P < 0.01). The presence of anterior segment injuries such as corneal blood staining, traumatic mydriasis, iridodialysis, cataract, and lens subluxation had significant predictive factors on a poor final visual outcome and the concurrent posterior segment injuries were more frequent in these patients. Initial visual acuity of 0.1 or worse, glaucoma, vitreous hemorrhage, and eyelid laceration were also significant associations of a poor final visual outcome (P < 0.05). Patients with initially larger hyphema (grade I or more vs microscopic) and older age group (16 years or more vs 15 years or less) tended to have poor final visual acuities. Rebleeding was not associated with significant deterioration in visual prognosis. We conclude that the posterior segment injuries seem to be directly related to a poor visual outcome rather than the occurrence of secondary hemorrhage.

Positive family history of glaucoma is a risk factor for increased IOP rather than glaucomatous optic nerve damage (POAG vs OH vs normal control).

To elucidate the family history of glaucoma (FHG) as a risk factor for ocular hypertension(OH) vs glaucomatous optic nerve damage, we reviewed the clinical records of 361 primary open-angle glaucoma(POAG) patients, 178 OH subjects, and 927 normal controls randomly selected from an urban medical center eye clinic. The prevalence of a positive FHG was 27% in the POAG patients, 47% in the OH subjects, and 11% in the normal controls. Whereas a positive FHG was a significant risk factor for both OH and glaucoma compared to normal control subjects (OR = 7.56, 95% CI: 5.27-10.85, P < .0001 for OH; OR = 3.15, 95% CI: 2.31-4.31, P < .0001), it was a risk factor more significantly for OH than for glaucoma being significantly more prevalent in OH than in POAG (OR = 2.40, 95% CI: 1.65-3.49, P < .0001). These results suggest the importance of additional risk factors other than IOP for glaucomatous optic nerve damage.

Glaucoma risk factors in primary open-angle glaucoma patients compared to ocular hypertensives and control subjects.

To investigate the risk factors for glaucoma, we reviewed the clinical record of 361 primary open-angle glaucoma (POAG) patients, 178 ocular hypertensives (OH), and 927 controls without POAG or OH, randomly selected from an urban medical center eye clinic. Old age defined as > or = 55 year, (odds ratio ratio (OR) = 3.13 95% confidence interval (CI): 2.06-4.76, P < .0001), black race (OR = 2.58, 95% CI: 1.79-3.74, p < .0001), hypertension (OR = 1.709, 95% CI: 1.15-2.51, P < .0108), and diabetes mellitus (OR = 1.83, 95% CI: 1.08-3.09, P = .0308) were identified as significant risk factors in POAG compared to OH. Old Age (OR = 4.94, 95% CI: 3.62-6.76, p < .0001), and black race (OR = 2.04, 95% CI: 1.59-2.61, P < .0001), HTN (OR = 1.63, 95% CI: 1.26-2.11, P = .0002), and DM (OR = 1.40 95% CI: 1.02-1.92 P = .0450) were also significant risk factors when compared to normal controls. However, when the 361 POAG patients were compared to 361 controls matched with respect to age, race, and sex, hypertension and diabetes mellitus did not appear to be independent risk factors. Family history of glaucoma was found to be a risk factors more significantly for OH (OR = 6.79, 95% CI: 4.39-10.50, P < .0001) than for POAG (OR = 2.83, 95% CI: 1.90-4.21, P < .0001) compared to the matched control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)