Risk factors for microcystic macular oedema in glaucoma

Background/aimsTo identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG).MethodsWe included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss.Results25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and −9.8 (±5.7) versus −4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49).ConclusionsMore severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.

Download Full-text

Role of Central Corneal Thickness on Baseline Parameters and Progression of Visual Fields in Open Angle Glaucoma

European Journal of Ophthalmology ◽

10.1177/112067210701700411 ◽

2007 ◽

Vol 17 (4) ◽

pp. 545-549 ◽

Cited By ~ 14

Author(s):

H. Shah ◽

C. Kniestedt ◽

A. Bostrom ◽

R. Stamper ◽

S. Lin

Keyword(s):

Visual Field ◽

Central Corneal Thickness ◽

Open Angle Glaucoma ◽

Corneal Thickness ◽

Visual Fields ◽

Negative Relationship ◽

Significant Risk ◽

Mean Deviation ◽

Open Angle ◽

Visual Field Progression

Purpose To evaluate the relationship of central corneal thickness (CCT) to baseline visual field parameters and visual field progression in patients with primary open-angle glaucoma (POAG). Methods Charts of consecutive patients with POAG were reviewed to obtain visual field data. Visual field was measured by standard threshold static perimetry. Variables analyzed included mean deviation (MD) and pattern standard deviation (PSD). Results A total of 121 eyes examined over 4 years were evaluated. A significant negative relationship between CCT and PSD (correlation coefficient: −0.02, p<0.05) was found. Analyses comparing CCT to change in PSD and MD (visual field progression) were statistically not significant. Conclusions Patients with thinner corneas initially present with a greater visual field defect, indicating that thin corneas may contribute to advanced glaucomatous damage at the time of diagnosis. However, CCT does not seem to be a significant risk factor for progression of the disease.

Download Full-text

Changes in Peripapillary and Macular Vessel Densities and Their Relationship with Visual Field Progression after Trabeculectomy

Journal of Clinical Medicine ◽

10.3390/jcm10245862 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5862

Author(s):

Jooyoung Yoon ◽

Kyung Rim Sung ◽

Joong Won Shin

Keyword(s):

Visual Field ◽

Linear Regression ◽

Open Angle Glaucoma ◽

Linear Regression Analysis ◽

Reduction Rate ◽

Vessel Density ◽

Mean Deviation ◽

Factors Associated ◽

Significant Difference

The aim of this study was to determine the factors associated with visual field (VF) deterioration after trabeculectomy, including the peripapillary vessel density (pVD) and macular vessel density (mVD) changes assessed by optical coherence tomography angiography (OCT-A). Primary open-angle glaucoma patients with more than two years of follow-up after trabeculectomy were included. pVD was calculated in a region defined as a 750 μm-wide elliptical annulus extending from the optic disc boundary. mVD was calculated in the parafoveal (1–3 mm) and perifoveal (3–6 mm) regions. VF deterioration was defined as the rate of mean deviation (MD) worse than −1.5 dB/year. The change rates of pVD and mVD were compared between the deteriorated VF and non-deteriorated VF groups. The factors associated with the rate of MD were determined by linear regression analyses. VF deterioration was noted in 14 (21.5%) of the 65 eyes that underwent trabeculectomy. The pVD (−2.26 ± 2.67 vs. −0.02 ± 1.74%/year, p ≤ 0.001) reduction rate was significantly greater in the deteriorated VF group than in the non-deteriorated VF group, while that of parafoveal (p = 0.267) and perifoveal (p = 0.350) VD did not show a significant difference. The linear regression analysis showed that the postoperative MD reduction rate was significantly associated with the rate of pVD reduction (p = 0.016), while other clinical parameters and preoperative vascular parameters did not show any association. Eyes with greater loss of peripapillary retinal circulation after trabeculectomy tended to exhibit VF deterioration. The assessment of peripapillary vascular status can be an adjunctive strategy to predict visual function after trabeculectomy.

Download Full-text

Assessing glaucoma deterioration using Spaeth/Richman contrast sensitivity test

Therapeutic Advances in Ophthalmology ◽

10.1177/2515841420977412 ◽

2020 ◽

Vol 12 ◽

pp. 251584142097741

Author(s):

Parul Ichhpujani ◽

Tanu Singh ◽

Sahil Thakur ◽

Rohan Bir Singh ◽

Suresh Kumar

Keyword(s):

Contrast Sensitivity ◽

Correlation Coefficient ◽

Open Angle Glaucoma ◽

Visual Fields ◽

Correlation Coefficients ◽

Sensitivity Test ◽

Mean Deviation ◽

Fiber Layer ◽

Floor Effect ◽

Significant Difference

Purpose: To assess changes in the central and peripheral contrast sensitivity in severe primary open-angle glaucoma (POAG) patients using a computer-based Spaeth/Richman contrast sensitivity test (SPARCS) over a period of 24 months. Methods: Our pilot, observational study included 15 patients (30 eyes) with severe POAG. Visual acuity, intraocular pressure, number of anti-glaucoma drugs, visual fields, and SPARCS score were recorded at first visit and at 12 and 24 months. Results: We observed changes in mean deviation (MD) from −19.37 ± 5.04 to −20.63 ± 4.07, mean pattern standard deviation (PSD) from 11.49 ± 2.61 to 11.35 ± 2.01, and mean SPARCS score from 54.97 ± 15.66 to 53.50 ± 16.42. We found no statistically significant difference between visual field parameters and SPARCS scores associated with the number or type of prescribed anti-glaucoma drugs. Spearman’s correlation coefficient of SPARCS at baseline (SPARCS1) versus MD at baseline (MD1) was 0.274 ( p = 0.142) and SPARCS1 versus PSD at baseline (PSD1) was −0.163 ( p = 0.389). The correlation coefficient between SPARCS at 12 months (SPARCS2) versus MD (MD2) at the same time point was computed to be 0.391 ( p = 0.03), whereas SPARCS2 versus PSD at 12 months was −0.212 ( p = 0.262). Similarly, we found the coefficient to be 0.336 ( p = 0.069) for SPARCS3 (SPARCS at 24 months) versus MD3 (MD at 24 months) and −0.242 ( p = 0.197) for SPARCS3 versus PSD3 (PSD at 24 months). Correlation coefficients between SPARCS1/2, SPARCS1/3, MD1/2, MD1/3 PSD1/2, and PSD1/3 were 0.856, 0.865, 0.748, 0.722, 0.497, and 0.562, respectively ( p < 0.001). MD changed by 9.46% ± 12.73%, PSD by 0.64% ± 14.03%, and average SPARCS by 3.31% ± 12.73% over 24 months. Conclusion: The data from our study indicate the utilitarian application of SPARCS, an inexpensive and readily available tool for monitoring functional deterioration in cases with advanced glaucomatous damage, especially in resource-poor settings. Furthermore, it is a useful and reliable alternative to the imaging modalities where retinal nerve fiber layer measurement can be erroneous in advanced cases secondary to the floor effect.

Download Full-text

Tolerable rates of visual field progression in a population-based sample of patients with glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310635 ◽

2017 ◽

Vol 102 (7) ◽

pp. 916-921 ◽

Cited By ~ 3

Author(s):

Angeliki Salonikiou ◽

Panayiota Founti ◽

Vassilis Kilintzis ◽

Antonis Antoniadis ◽

Eleftherios Anastasopoulos ◽

...

Keyword(s):

Visual Field ◽

Visual Impairment ◽

Open Angle Glaucoma ◽

Visual Fields ◽

Field Tests ◽

Population Based ◽

European Population ◽

Mean Deviation ◽

Cross Sectional ◽

Rate Of Progression

AimsTo provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG).MethodsParticipants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than −12dB and blindness as MD equal to or worse than −24dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis.ResultsAmong 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was −3.65±5.28dB. Among those, 69.1% would have a maxTRoP_VI slower than −1dB/year and 18.7% would have a maxTRoP_VI between −1 and −2dB/year. Also, 72.4% would have a maxTRoP_BL slower than −2dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than −2dB/year.ConclusionsThe majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than −1dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed.

Download Full-text

The effect of mirtogenol towards the changes in retinal nerve fiber layer thickness and visual field in primary open angle glaucoma

Ophthalmologica Indonesiana ◽

10.35749/journal.v43i1.134 ◽

2019 ◽

Vol 43 (1) ◽

pp. 28

Author(s):

Astriviani Widyakusuma ◽

Widya Artini ◽

Virna Dwi Oktariana ◽

Joedo Prihartono

Keyword(s):

Visual Field ◽

Nerve Fiber ◽

Retinal Nerve Fiber Layer ◽

Open Angle Glaucoma ◽

Visual Fields ◽

Mean Deviation ◽

Fiber Layer ◽

Nerve Fiber Layer ◽

Rnfl Thickness ◽

Retinal Nerve Fiber

Objective: To evaluate the effect of Mirtogenol towards the changes in retinal nerve fiber layer (RNFL) thickness and visual field in patients with primary open angle glaucoma (POAG) with controlled IOP. Methods: This is a prospective, double blind, randomized study. Forty one POAG patients with IOP ≤ 18 mmHg were randomly assigned to receive either Mirtogenol or placebo. Changes in RNFL thickness and mean deviation of visual fields were evaluated before the treatment, as well as 4 weeks and 8 weeks after the treatment. Patients were asked for any side effects during the treatment period. Result: The average RNFL thickness in the Mirtogenol group decreased -0.70±1.63 μm from 87.29±19.39 μm before the treatment to 86.58±19.43 μm after 8 weeks of treatment, however the change was not significant (p=0.121). The average RNFL thickness in the placebo group decreased -1.74±1.79 μm from 97.14±17.19 μm before the treatment to 95.40±18.56 μm after 8 weeks of treatment, the change was statistically significant (p< 0.001). The average MD of visual field in the Mirtogenol group increased 0.542±1.93 dB after 8 weeks of treatment while the MD of visual field in the placebo group decreased -0.083±1.36 dB after 8 weeks of treatment. Hoewever the changes in MD of visual field was not significant (p>0.05). No side effect was found throughout the study. Conclusion: Mirtogenol seemed to maintain retinal nerve fiber layer thickness and increased mean deviation of visual fields.

Download Full-text

Factors Associated with Lamina Cribrosa Displacement After Trabeculectomy Measured by Optical Coherence Tomography in Advanced Primary Open Angle Glaucoma

10.20944/preprints201802.0152.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Ali Efatizadeh ◽

Azadeh Doozandeh ◽

Mehdi Yaseri ◽

Nils A. Loewen

Keyword(s):

Optical Coherence Tomography ◽

Regression Coefficient ◽

Open Angle Glaucoma ◽

Biomechanical Properties ◽

Lamina Cribrosa ◽

Mean Deviation ◽

Optical Coherence ◽

Open Angle ◽

Factors Associated ◽

Corneal Biomechanical Properties

Purpose: To investigate the relationship of lamina cribrosa displacement to corneal biomechanical properties and visual function after mitomycin C-augmented trabeculectomy. Method: Eighty-one primary open angle eyes were imaged before and after trabeculectomy using an enhanced depth spectral-domain optical coherence tomography (SDOCT). Corneal biomechanical properties were measured with the Ocular Response Analyser before the surgery. The anterior lamina cribrosa (LC) was marked at several points in each of six radial scans to evaluate LC displacement in response to Intraocular pressure (IOP) reduction. A Humphrey visual field test (HVF) was performed before the surgery as well as three and six months postoperatively. Results: Factors associated with a deeper baseline anterior lamina cribrosa depth (ALD) were cup-disc ratio (P=0.04), baseline IOP (P= 0.01), corneal hysteresis (P= 0.001), and corneal resistance factor (P= 0.001). After the surgery, the position of LC became more anterior (negative), posterior (positive) or remained unchanged. The mean LC displacement was -42 μm (P= 0.001) and was positively correlated with the magnitude of IOP reduction (regression coefficient: 0.251, P=0.02), and negatively correlated with age (regression coefficient: - 0.224, P= 0.04) as well as baseline cup-disk ratio (Regression coefficient: -0.212,P= 0.05) Eyes with a larger negative LC displacement were more likely to experience an HVF improvement of more than 3 dB gain in mean deviation (P= 0.002). Conclusion: A lower SDOCT cup-disc ratio, younger age, and a larger IOP reduction were correlated with a larger negative LC displacement and improving HVF. Corneal biomechanics did not predict LC displacement.

Download Full-text

Comparitive study between normal tension glaucoma and primary open-angle glaucoma

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.110 ◽

2021 ◽

Vol 7 (3) ◽

pp. 562-567

Author(s):

Sowmya Shree B V ◽

Bharathi N ◽

Shwetha Kumari C ◽

Ranjitha C Sadananda ◽

Madhura M Khanapur

Keyword(s):

Open Angle Glaucoma ◽

Visual Fields ◽

Normal Tension Glaucoma ◽

Cross Sectional Study ◽

Mean Deviation ◽

Cross Sectional ◽

Neuroretinal Rim ◽

Significant Difference ◽

Independent Risk Factors ◽

Work Up

The study is conducted to determine the functional and structural differences between NTG and POAG, to assess the rate of conversion of NTG into POAG and its early intervention. It is a hospital based prospective, cross-sectional study of 56 NTG and 56 POAG patients. History was taken and comprehensive ophthalmic examination with glaucoma work up was done.Majority of the patients belonged to the age group between 51 and 60 years i.e. 48.2% in NTG and 62.5% in POAG. Majority of the NTG patients i.e. 33 (58.9%) were females while 41(73.2%) were males in POAG. 40% of NTG patients had systemic association like bronchial asthma, diabetes, hypertension, ischemic heart disease and migraine. There was no significant difference in CDR between two groups. Inferior & temporal neuroretinal rim thinning was more common in NTG. While bipolar thinning & superior rim thinning was more common in POAG. There is significantly more thinning of RNFL in POAG than NTG. The mean deviation (MD) & pattern standard deviation (PSD) in visual fields between NTG & POAG showed no significant difference. Whereas the field loss was near centre of fixation in NTG group compared to POAG which was diffuse. These differences between NTG and POAG suggest that the pathogenesis of NTG includes IOP and IOP independent risk factors, while IOP is the main risk factor in POAG. The parameters assessed determine the risk and progression of NTG to POAG.

Download Full-text

Visual status in primary open-angle glaucoma: A hospital-based report from Nepal

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v3i2.11226 ◽

2014 ◽

Vol 3 (2) ◽

pp. 49-57 ◽

Cited By ~ 1

Author(s):

Suraj Shakya Vaidya ◽

Umesh Raj Aryal ◽

Andrej M Grjibovski ◽

Alexandra Krettek

Keyword(s):

Primary Open Angle Glaucoma ◽

Early Stage ◽

Open Angle Glaucoma ◽

Visual Fields ◽

Mean Deviation ◽

P Value ◽

Continuous Variables ◽

Open Angle ◽

Visual Damage ◽

Visual Status

Background: Primary open-angle glaucoma (POAG) is the commonest cause of irreversible blindness. Most hospitals in Nepal are carrying out opportunistic glaucoma screening for those attending hospitals for any eye consultation. However, there are no reports detailing the visual damage at the time of diagnosis confirming the early detection of cases.Objectives: This study aimed to investigate the clinical features and visual status at the time of diagnosis of POAG in the Nepalese population.Methods: We evaluated 173 newly diagnosed consecutive cases of POAG from three hospitals across Nepal. Glaucoma evaluation was carried out detailing the findings of visual acuity and visual fields. Continuous data were presented as means and standard deviations (SD) and categorical data as proportions (95% CI). Unpaired t-tests compared continuous variables with p value set at a 5% level of significance.Results: Out of total patients, 82.1% were diagnosed incidentally while they visited the hospital for symptoms not expected to be for glaucoma. Only 9.8% of cases were aware of them being at risk of developing glaucoma and thus attended hospitals for regular check-up. Visual field examination revealed mean scores of mean deviation (MD) as low as-13.24 dB and pattern standard deviation of 7.34 dB. Glaucoma hemifield test was outside normal limits in 61.5% of eyes tested. Additionally, 4.7% patients were blind.Conclusion: POAG cases presented late with significant visual damage. Existing opportunistic screening for glaucoma in Nepal needs to be combined with community-based glaucoma awareness programs to bring more people to hospital at the early stage of the disease.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11226Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page : 49-57

Download Full-text

Younger age of onset and uveitis associated with HLA-B27 and delayed diagnosis in Thai patients with axial spondyloarthritis

Scientific Reports ◽

10.1038/s41598-021-93001-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Naphruet Limsakul ◽

Praveena Chiowchanwisawakit ◽

Parichart Permpikul ◽

Yubolrat Thanaketpaisarn

Keyword(s):

Regression Analysis ◽

Multiple Regression Analysis ◽

Axial Spondyloarthritis ◽

Age At Onset ◽

Delayed Diagnosis ◽

Musculoskeletal Symptom ◽

Hla B27 ◽

Delay In Diagnosis ◽

Factors Associated ◽

Younger Age

AbstractTo identify characteristics associated with HLA-B27, and to identify factors associated with delayed diagnosis in Thai patients with axial spondyloarthritis (axSpA). This cross-sectional study included Thai patients were diagnosed with axSpA by a rheumatologist at Siriraj Hospital. Clinical data were collected. Regression analyses were employed to identify factors associated with study outcomes. Of total 177 patients, 127 (72%) were positive HLA-B27. Uveitis [Odds ratio (OR) 4.0], age at onset of the first musculoskeletal symptom of ≤ 28 years [OR 3.5], female [OR 0.4], and psoriasis [OR 0.4] were significantly associated with HLA-B27 in multiple regression analysis. Those with positive HLA-B27 had less spinal flexibility. Elevated C-reactive protein (p = 0.012) was associated with shorter delay in diagnosis, while uveitis (p < 0.001) and younger age at onset of the first symptom (p = 0.002) were associated with longer delay in diagnosis in multiple regression analysis. Younger age at onset of the first musculoskeletal symptom and uveitis were associated with HLA-B27 and delayed diagnosis in axSpA patients. Young people with musculoskeletal symptom and uveitis should be referred to a rheumatologist to rule out or make a timely diagnosis of axSpA.

Download Full-text

Activities and risk factors associated with fall-related injuries among US Army soldiers

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001564 ◽

2020 ◽

pp. bmjmilitary-2020-001564

Author(s):

Raina D Brooks ◽

T Grier ◽

B H Jones ◽

M C Chervak

Keyword(s):

Risk Factors ◽

Cross Sectional Study ◽

Cross Sectional ◽

Physically Active ◽

Us Army ◽

Factors Associated ◽

Younger Age ◽

Near Falls ◽

Independent Risk Factors ◽

Army Soldiers

IntroductionFalls/near falls are the second leading cause of hospitalisation and outpatient visits among US Army soldiers. While numerous studies have evaluated fall-related or near fall-related injuries among elderly adults, few have evaluated this association among young adults. The objective of this study is to describe the characteristics and risk factors associated with fall-related or near fall-related injuries among male US Army soldiers.MethodsThis is a cross-sectional study of male US Army Airborne Division soldiers (n=5187). Electronic surveys captured demographic, lifestyle, physical training (PT), fitness and injury data during spring/summer of 2016. Multiple logistic regression was used to identify independent risk factors of fall-related or near fall-related injuries, adjusting for potential confounders.ResultsPrimary findings indicated that activities and risk factors associated with fall-related or near fall-related injuries among soldiers included younger age (≤35 years), holding a job that required minimal lifting activities, slower 2-mile run times and not running during personal PT.ConclusionsThe findings from this study suggest that male US Army soldiers and other physically active men may benefit from (1) obtaining and/or maintaining higher aerobic endurance and muscular strength, and (2) training focused on preventing fall-related injuries during PT, road marching and sports/recreational activities. Moreover, prevention strategies and education should further target younger soldiers (≤35 years old), as younger age is not modifiable.

Download Full-text