Peripapillary sclera exhibits a v-shaped configuration that is more pronounced in glaucoma eyes

2020 ◽  
pp. bjophthalmol-2020-317900
Author(s):  
Xiaofei Wang ◽  
Tin A Tun ◽  
Monisha Esther Nongpiur ◽  
Hla M Htoon ◽  
Yih Chung Tham ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Angle Closure ◽  
Healthy Controls ◽  
Primary Angle Closure Glaucoma ◽  
Line Parallel ◽  
Temporal Side ◽  
And Gender

AimsTo compare the shape of the anterior surface of the peripapillary sclera (PPS) between glaucoma and healthy subjects.Methods88 primary open angle glaucoma (POAG), 98 primary angle closure glaucoma (PACG) and 372 age-matched and gender-matched healthy controls were recruited in this study. The optic nerve head of one randomly selected eye of each subject was imaged with spectral domain optical coherence tomography. The shape of the PPS was measured through an angle defined between a line parallel to the nasal anterior PPS boundary and one parallel to the temporal side. A negative value indicated that the PPS followed an inverted v-shaped configuration (peak pointing towards the vitreous), whereas a positive value indicated that it followed a v-shaped configuration.ResultsThe mean PPS angle in normal controls (4.56±5.99°) was significantly smaller than that in POAG (6.60±6.37°, p=0.011) and PACG (7.90±6.87°, p<0.001). The v-shaped PPS was significantly associated with older age (β=1.79, p<0.001), poorer best-corrected visual acuity (β=3.31, p=0.047), central corneal thickness (β=−0.28, p=0.001), peripapillary choroidal thickness (β=−0.21, p<0.001) and presence of POAG (β=1.94, p<0.009) and PACG (β=2.96, p<0.001). The v-shaped configuration of the PPS significantly increased by 1.46° (p=0.001) in healthy controls for every 10-year increase in age, but not in glaucoma groups.ConclusionsThe v-shaped configuration of the PPS was more pronounced in glaucoma eyes than in healthy eyes. This posterior bowing of the PPS may have an impact on the biomechanical environment of the optic nerve head.

Glaucoma

2012 ◽  
Author(s):  
Julie Huntbach ◽  
Amar Alwitry
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Clinical Skills ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Acute Angle ◽  
Angle Closure ◽  
Pigmentary Glaucoma ◽  
Open Angle

The chapter begins by discussing optic nerve head anatomy and aqueous fluid dynamics, before covering the key clinical skills, namely optic nerve head assessment in glaucoma, tonometry and pachymetry , gonioscopy, and perimetry. It also covers the key areas of clinical knowledge, including ocular hypertension, primary open-angle glaucoma, acute angle closure, normal-tension glaucoma, steroid-induced glaucoma, traumatic glaucoma, inflammatory glaucomas, pseudoexfoliative and pigmentary glaucoma, neovascular glaucoma, malignant glaucoma, iridocorneal endothelial syndrome and iridocorneal dysgenesis, ocular hypotensive agents, laser therapy for glaucoma, and glaucoma surgery. The chapter concludes with three case-based discussions, on open-angle glaucoma, angle closure glaucoma, and steroid glaucoma.

scholarly journals Corneal Segmentation Analysis Increases Glaucoma Diagnostic Ability of Optic Nerve Head Examination, Heidelberg Retina Tomograph’s Moorfield’s Regression Analysis, and Glaucoma Probability Score

2015 ◽  
Vol 2015 ◽  
pp. 1-8
Author(s):  
F. Saenz-Frances ◽  
L. Jañez ◽  
C. Berrozpe-Villabona ◽  
L. Borrego-Sanz ◽  
L. Morales-Fernández ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Open Angle Glaucoma ◽  
Characteristic Curve ◽  
Corneal Thickness ◽  
Cross Sectional Study ◽  
Receiver Operator Characteristic Curve ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Segmentation Analysis

Purpose. To study whether a corneal thickness segmentation model, consisting in a central circular zone of 1 mm radius centered at the corneal apex (zone I) and five concentric rings of 1 mm width (moving outwards: zones II to VI), could boost the diagnostic accuracy of Heidelberg Retina Tomograph’s (HRT’s) MRA and GPS.Material and Methods. Cross-sectional study. 121 healthy volunteers and 125 patients with primary open-angle glaucoma. Six binary multivariate logistic regression models were constructed (MOD-A1, MOD-A2, MOD-B1, MOD-B2, MOD-C1, and MOD-C2). The dependent variable was the presence of glaucoma. In MOD-A1, the predictor was the result (presence of glaucoma) of the analysis of the stereophotography of the optic nerve head (ONH). In MOD-B1 and MOD-C1, the predictor was the result of the MRA and GPS, respectively. In MOD-B2 and MOD-C2, the predictors were the same along with corneal variables: central, overall, and zones I to VI thicknesses. This scheme was reproduced for model MOD-A2 (stereophotography along with corneal variables). Models were compared using the area under the receiver operator characteristic curve (AUC).Results. MOD-A1-AUC: 0.771; MOD-A2-AUC: 0.88; MOD-B1-AUC: 0.736; MOD-B2-AUC: 0.845; MOD-C1-AUC: 0.712; MOD-C2-AUC: 0.838.Conclusion. Corneal thickness variables enhance ONH assessment and HRT’s MRA and GPS diagnostic capacity.

scholarly journals Referral parameters for diagnosis of glaucoma in general eye clinic at Tilganga Institute of Ophthalmology

2019 ◽  
Vol 11 (1) ◽  
pp. 33-39
Author(s):  
Pratibha Lama Joshi ◽  
Bhaskar Jha ◽  
Indira Paudyal ◽  
Suman Shamsher Thapa
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Normal Group ◽  
Intra Ocular Pressure ◽  
Glaucoma Diagnosis ◽  
Ocular Pressure ◽  
The Mean ◽  
Eye Clinic

Objective: To find out the most common referral parameter among the glaucoma suspects patients from general eye clinic and to establish glaucoma diagnosis. Methods: This study is a retrospective cohort hospital based study. Two hundred patients from January to February 2017 sent to glaucoma clinic as glaucoma suspects were re-evaluated meticulously by glaucoma specialist and were diagnosed as glaucoma, non glaucoma, suspects and ocular hypertension. Results: Out of the 200 patients referred to glaucoma clinic as glaucoma suspects only19% were diagnosed to have glaucoma. The mean age at which glaucoma diagnosed was 55.29(14.4) compared to 41.6(15.1) in normal group. One hundred and sixty five patients were referred on the basis of suspicious optic nerve head, among them 14.5% (24/165) had glaucoma. This study showed that, open angle glaucoma (OAG) 28.9% was the most common type of total glaucoma diagnosed. The mean vertical cup discratio in the OAG group was 0.69±0.1 (0.4 -0.9) compared to 0.56 ± 0.11((0.2-0.8)(p=0.00) normal. The mean intra ocular pressure (IOP) in OAG group was 19.73 ±4.95(11-32) mmHg compared to 16.74± 3.36(10-30) mmHg (p=0.00) in normal group. The mean central corneal thickness (CCT) in OAG group was 533.05 ± 31.24μm (467-606) compared to normal was 534.9±33.6 μm (432-696) (p=0.670). Conclusions: Suspicious optic nerve head is the most common referral parameter between the general ophthalmologist and residents, but this study shows only few of them were diagnosed with glaucoma. This gives us a clue that the ophthalmologists and residents are to be trained better to help them identify the signs of glaucoma on the optic nerve head beside its size, which will reduce unnecessary burden to the resources of patients and hospital.

Glaucoma

2016 ◽  
Author(s):  
Andrew Tatham ◽  
Peng Tee Khaw
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Open Angle Glaucoma ◽  
Clinical Skill ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Normal Tension Glaucoma ◽  
Aqueous Fluid ◽  
Angle Closure ◽  
Pigmentary Glaucoma

This chapter explores glaucoma. It starts off with an outline of optic nerve head anatomy and then describes aqueous fluid dynamics and the pathogenesis of glaucoma. It then goes on to discuss the clinical skill areas of optic nerve head assessment in glaucoma, glaucoma imaging devices, tonometry and tachymetry, gonioscopy, and perimetry. The chapter also details ocular hypertension, primary open-angle glaucoma, primary angle closure, and secondary angle closure. In addition, it discusses normal tension glaucoma, steroid-induced glaucoma, traumatic glaucoma, inflammatory glaucomas, pseudoexfoliative glaucoma, pigmentary glaucoma, and neovascular glaucoma. It then covers aqueous misdirection, iridocorneal endothelial syndrome and iridocorneal dysgenesis, ocular hypotensive agents, laser therapy for glaucoma, and glaucoma surgery.

scholarly journals Contribution and significance of Heidelberg retinal tomography II in diagnostics of ocular hypertension and its conversion into primary open-angle glaucoma

2009 ◽  
Vol 66 (4) ◽  
pp. 283-289
Author(s):  
Vujica Markovic ◽  
Djordje Kontic ◽  
Paraskeva Hentova-Sencanic ◽  
Marija Bozic ◽  
Ivan Marjanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Optic Nerve ◽  
Ocular Hypertension ◽  
Optic Nerve Head ◽  
Structural Changes ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Significant Loss ◽  
Open Angle

Background/Aim. A term 'ocular hypertension' is used when IOP is found to be > 21 mmHg on two consecutive occasions, in the absence of detectable glaucomatous damage. The aim of this study was to determine the significance and contribution of Heidelberg Retinal Tomography II (HRT II) results that show very early, subtle changes in retinal neurofibre layers (RNFL) in the optic nerve head that are specific for glaucoma itself (the loss of neuroretinal rim area and an increase of Cup/Disc ratio), but are not possible to register by an ophthalmoscope. Also, when the results of the functional tests remain unchanged, that confirms the conversion of ocular hypertension into glaucoma. Methods. During a 5-year study period (2002-2007), 29 patients with ocular hypertension were examined. The frequency of control examinations, based on the presence of risk factors for glaucoma development, was 3-6 months. The examination also included IOP measurements with Goldmann Applanation Tonometry (GAT), central corneal thickness (CCT) determination by pachymetry, the examination of chamber angle using indirect gonioscopy, visual field tests by computerized perimetry and also papillae nervi optici (PNO) examination by using HRT II. The application of HRT II enables a great number of stereometric parameters of optic disc, the most important being the rim area and Cup/Disc (C/D) ratio, which was followed during the control examination by each segment, as well as PNO in global. Results. In the examination period, three cases of conversion of ocular hypertension into a primary open-angle glaucoma were found. In the group of patients with ocular hypertension, HRT II results after six months did not show a significant increase in C/D ratio. No significant loss of rim area or rim volume was found either. In three cases of conversion, HRT II results after 3 months showed an increase of C/D ratio and also a significant loss in rim volume at first examination (0.413) comparing to the last one. Conclusion. In diagnosing ocular hypertension and its conversion to glaucoma, HRT II is used for quantitative evaluation of retinal topography and for quantitative monitoring of topographical changes, especially regarding the increase of C/D ratio and loss of rim volume tissue, which enables to see and register subtle structural changes in optic nerve head and RNFL that are so characteristic for glaucoma, which cannot be seen by an ophthalmoscope. With these results, according to risk factors for glaucoma, one can confirm the diagnosis of ocular hypertension and its conversion to primary open-angle glaucoma. In this study HRT II revealed conversion of ocular hypertension into glaucoma in 10% of the patients.

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