Glaucoma in myopia: diagnostic dilemmas

2019 ◽  
Vol 103 (10) ◽  
pp. 1347-1355 ◽  
Author(s):  
Nicholas Y Q Tan ◽  
Chelvin C A Sng ◽  
Jost B Jonas ◽  
Tien Yin Wong ◽  
Nomdo M Jansonius ◽  
...  
Keyword(s):  
Nerve Fibre ◽  
Structural Parameters ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Visual Field Defects ◽  
Inner Plexiform Layer ◽  
Diagnostic Dilemma ◽  
Fibre Layer ◽  
Increased Risk ◽  
Nerve Fibre Layer

Myopic eyes have an increased risk of glaucoma. However, glaucomatous changes in a myopic eye are often difficult to detect. Classic structural and functional investigations to diagnose glaucoma may be confounded by myopia. Here, we identify some of the common pitfalls in interpreting these structural parameters, and the possible solutions that could be taken to overcome them. For instance, in myopic eyes, we discuss the limitations and potential sources of error when using neuroretinal rim parameters, and retinal nerve fibre layer and ganglion cell-inner plexiform layer thickness measurements. In addition, we also review new developments and potential adjuncts in structural imaging such as the assessment of the retinal nerve fibre layer texture, and the examination of the microcirculation of the optic nerve head using optical coherence tomography angiography. For the functional assessment of glaucoma, we discuss perimetric strategies that may aid in detecting characteristic visual field defects in myopic glaucoma. Ultimately, the evaluation of glaucoma in myopia requires a multimodal approach, to allow correlation between structural and functional assessments. This review provides overview on how to navigate this diagnostic dilemma.

Relationship between ganglion cell-inner plexiform layer and optic disc/retinal nerve fibre layer parameters in non-glaucomatous eyes

2013 ◽  
Vol 97 (12) ◽  
pp. 1592-1597 ◽  
Author(s):  
Yih-Chung Tham ◽  
Carol Y Cheung ◽  
Victor T Koh ◽  
Ching-Yu Cheng ◽  
Elizabeth Sidhartha ◽  
...  
Keyword(s):  
Ganglion Cell ◽  
Optic Disc ◽  
Nerve Fibre ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Inner Plexiform Layer ◽  
Fibre Layer ◽  
Nerve Fibre Layer

scholarly journals Evaluation of Changes in the Ganglionic Cell Inner Plexiform Layer and Macular Retinal Nerve Fibre Layer in Patients Receiving Hydroxychloroquine

2020 ◽  
Author(s):  
Mouna Al Saad ◽  
Amin Shehadeh ◽  
Mohammed A. Abu Ameerh ◽  
Jehad Meqbil ◽  
Mohammad Qablawi ◽  
...  
Keyword(s):  
Nerve Fibre ◽  
Plexiform Layer ◽  
Retinal Nerve Fibre Layer ◽  
Inner Plexiform Layer ◽  
Control Groups ◽  
Fiber Layer ◽  
Fibre Layer ◽  
Significant Difference ◽  
Ganglionic Cell ◽  
Nerve Fibre Layer

Abstract Backgrounds: To evaluate changes in the thickness of ganglionic cell-inner plexiform layer and macular retinal nerve fiber layer using ocular coherence tomographyin patients exposed to hydroxychloroquine .Methods: This was a retrospective, cross-sectional study of patients on hydroxychloroquine therapy. Ocular coherence tomography images showing of ganglionic cell-inner plexiform cell layer and macular retinal nerve fiber layer thickness were obtained and compared to those of the control groups. The relationship between the thickness of of ganglionic cell-inner plexiform and macular retinal nerve fibre layer and the duration and cumulative dose of hydroxychloroquine was evaluated.Results: In all, 219 patients were included in this study; the mean age was 43.38 (±17.39) years. The study group comprised 100 (20 male and 80 female) patients, with a mean age of 45.28 (± 12.24) years; the control group had 119 patients (44 males and 75 females), with a mean age of 41.79 (± 20.67) years, with no significant difference in age between the groups (p = 0.123). There was a significant difference in mean of ganglionic cell-inner plexiform thickness between the study and control groups (85.6+/- 8 μm ) vs. (88.6+/-6 μm ) (p = 0.006), with a mean difference of 0.31 (95% confidence interval). The average RNFL thickness was similar in the study and control groups, 28.8±2.5 μm (range: 23 – 38) and 29.2±2.8 μm (range: 22 – 35) respectively, (p = 0.389). There was no significant correlation between of ganglionic cell-inner plexiform and macular retinal nerve fibre layer with daily dose (p = 0.229) or cumulative dose of hydroxychloroquine (p = 0.678). Conclusion : The average thickness of ganglionic cell -inner plexiform cell layer was significantly lower in those taking hydroxychloroquine than in controls. Thinning of this layer could be an early indicator of retinal toxicity before the appearance of clinical retinopathy. However, thickness of the macular retinal nerve fibre laye showed no decrease in hydroxychloroquine users and did not correlate with the duration or cumulative doses of hydroxychloroquine. Therefore, macular retinal nerve fibre layer thickness is not a useful biomarker for the early detection of hydroxychloroquine retinal toxicity.

scholarly journals Effect of optic disc–fovea distance on the normative classifications of macular inner retinal layers as assessed with OCT in healthy subjects

2018 ◽  
Vol 103 (6) ◽  
pp. 821-825 ◽  
Author(s):  
Kunliang Qiu ◽  
Binyao Chen ◽  
Jianling Yang ◽  
Ce Zheng ◽  
Haoyu Chen ◽  
...  
Keyword(s):  
Ganglion Cell ◽  
Optic Disc ◽  
Nerve Fibre ◽  
Healthy Subjects ◽  
Retinal Nerve Fibre Layer ◽  
Mean Deviation ◽  
Inner Plexiform Layer ◽  
Retinal Layers ◽  
Fibre Layer ◽  
Nerve Fibre Layer

PurposeTo determine the influence of the optic disc–fovea distance (DFD) on the normative classifications based on thickness measurements of macular inner retinal layers with spectral-domain optical coherence tomography (OCT) in healthy subjects.MethodsA total of 182 eyes from 182 healthy subjects were included (mean (SD) spherical equivalent −0.8 (1.9) dioptres). We performed macula and optic disc imaging with the Topcon 3D OCT 2000. The thickness of the macular inner retinal layers (macular retinal nerve fibre layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL) and both combined (ganglion cell complex; GCC)) and the corresponding classifications based on the built-in normative database were recorded. The occurrence of an abnormal normative classification (occurrence of any thickness variable below the fifth percentile) was related to the DFD and other factors (axial length/refraction, optic disc area, fovea–disc angle, age, gender, image quality, visual field mean deviation and peripapillary retinal nerve fibre layer thickness), using logistic regression.ResultsThe mean (SD) DFD was 4.90 (0.29) mm. A greater DFD was associated with a higher percentage of abnormal normative classification in the OCT parameters describing the thickness of the mRNFL (OR (95%CI) per 0.1 mm increase in DFD: 1.30 (1.13 to 1.50), p<0.001), GCIPL (1.18 (1.02 to 1.38), p=0.023) and GCC measurement (1.29 (1.08 to 1.55), p=0.006).ConclusionsEyes with a greater DFD are prone to false-positive classifications in the thickness assessment of the macular inner retinal layers. The thicknesses should always be interpreted in the context of DFD.

Thinning rates of retinal nerve layer and ganglion cell-inner plexiform layer in various stages of normal tension glaucoma

2019 ◽  
Vol 104 (8) ◽  
pp. 1131-1136
Author(s):  
Hiroko Inuzuka ◽  
Akira Sawada ◽  
Masayuki Inuzuka ◽  
Tetsuya Yamamoto
Keyword(s):  
Ganglion Cell ◽  
Nerve Fibre ◽  
Plexiform Layer ◽  
Normal Tension Glaucoma ◽  
Retinal Nerve Fibre Layer ◽  
Inner Plexiform Layer ◽  
Advanced Stage ◽  
Rates Of Change ◽  
Significant Difference ◽  
Nerve Fibre Layer

AimsTo compare the changes in the macular retinal nerve fibre layer (mRNFL), macular ganglion cell layer and inner plexiform layer (mGCIPL), and circumpapillary retinal nerve fibre layer (cpRNFL) in various stages of normal tension glaucoma (NTG) using spectral domain optical coherence tomography.MethodsEyes with NTG (n=218) were assigned into three groups based on initial mean deviation (MD) as follows: mild (MD>−6 dB), moderate (−6 dB≥MD≥−12 dB) and severe (−12 dB>MD>−20 dB). Annual rates of change in mRNFL, mGCIPL and cpRNFL thickness were calculated by linear regression analysis.ResultsAge, gender, spherical equivalent, and average intraocular pressure during follow-up were not significantly different among the three groups. There were significant differences in the mRNFL, mGCIPL and cpRNFL among the three groups at baseline (p<0.0001 in all sectors except for the mRNFL in the superonasal sector). The average thinning rates of the mRNFL, mGCIPL and cpRNFL were −0.38±0.32 µm/year, −0.62±0.46 µm/year and −0.86±0.83 µm/year, respectively. No significant difference in the rates of change in the mRNFL and mGCIPL were found among the groups in any sector. However, there was a significant difference in the rate of change in the cpRNFL among the groups (in all sectors: p<0.0001).ConclusionsChanges in the mRNFL and mGCIPL can reflect the progression of NTG even in its advanced stage. However, careful interpretation of changes in the cpRNFL in the advanced stage of glaucoma is warranted due to a potential floor effect.

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