A personalized approach to preclinical diagnosis and initial therapy of primary glaucoma based on a comprehensive structural and functional examination. A clinical case

The principles of personalized approach to early diagnosis and monitoring of primary glaucoma are shown by a clinical example. We analyzed the potentials of contemporary electrophysiological tests for preclinically diagnosing glaucoma optic neuropathy and monitoring drug treatment. For the first time, we demonstrated the experience of using a new fixed combination of brinzolamide + brimonidine by a clinical case from our practice. The test results confirm the hypotensive effect of the medication (IOP reduction by 36.2 %) so that it can be recommended for the treatment of patients with glaucomatous optic neuropathy and that combined with vascular pathology.

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Faculty Opinions recommendation of Differentiation of compressive from glaucomatous optic neuropathy with spectral-domain optical coherence tomography.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718348640.793499331 ◽

2014 ◽

Author(s):

K Sheng Lim

Keyword(s):

Optical Coherence Tomography ◽

Optic Neuropathy ◽

Spectral Domain ◽

Glaucomatous Optic Neuropathy ◽

Optical Coherence

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Parapapillary atrophy in optic neuropathies: Histology and clinical relevance

European Journal of Ophthalmology ◽

10.1177/11206721211060655 ◽

2021 ◽

pp. 112067212110606

Author(s):

Ana Banc ◽

Stefania Bianchi Marzoli

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Optic Nerve Head ◽

Clinical Findings ◽

Age Related Macular Degeneration ◽

Glaucomatous Optic Neuropathy ◽

Age Related ◽

High Resolution Images ◽

Parapapillary Atrophy ◽

Optic Nerve Disorders

Parapapillary atrophy is one of the parameters of the optic nerve head area which are assessed during the ophthalmoscopic examination particularly useful to characterize glaucomatous optic neuropathy. Optical coherence tomography evaluation provides high-resolution images of the optic nerve head and surrounding area, and can be used to study parapapillary atrophy. Different parapapillary atrophy zones were described depending on their histological features and research has been conducted to investigate the possible association between the presence and/ or size of parapapillary atrophy zones and several optic nerve disorders. In this review we discuss the histology and the clinical findings related to parapapillary atrophy in patients with glaucomatous optic neuropathy, non-glaucomatous optic neuropathies (e.g. arteritic and non-arteritic anterior ischemic optic neuropathies; suprasellar and parasellar tumors), and other ocular conditions (e.g. high myopia; age-related macular degeneration). Two different histologic classifications were identified. Parapapillary atrophy was demonstrated in glaucoma and glaucoma-like neuropathies, but not in other types of optic nerve disorders.

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Modern methods for assessing morphometric and functional indicators in primary glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-83-87 ◽

2021 ◽

pp. 83-87

Author(s):

N.R. Sharvadze ◽

◽

A.L. Shtilerman ◽

D.P. Skachkov ◽

Y.A. Drovnyak ◽

...

Keyword(s):

Open Angle Glaucoma ◽

Diagnostic Methods ◽

High Tech ◽

Glaucomatous Optic Neuropathy ◽

Static Perimetry ◽

Functional Changes ◽

Modern Methods ◽

Analytical Review ◽

Primary Glaucoma ◽

Key Words Glaucoma

In the article are presented analytical review of scientific articles devoted to the study of modern methods of diagnostics of primary glaucoma. On the basis of scientific articles, a review material was collected and systematized on diagnostic methods for studying morphometric and functional changes in primary glaucoma, which are used in modern ophthalmic practice. In recent years, the improvement and implementation of new high-tech modern diagnostic methods open up new opportunities for researchers and clinicians. Optical coherence tomography, OCT angiography, static perimetry make it possible, by comparing morphometric and functional parameters, to give a more complete, comprehensive assessment of pathological changes in the optic nerve head, in the macular region and at the level of the choriocapillaries. Prevention of glaucoma blindness largely depends on its early diagnosis based on the use of modern organizational and medical technologies. Key words: glaucoma, open-angle glaucoma, intraocular pressure, glaucomatous optic neuropathy, diagnostic methods.

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An Experimental Basis for Implicating Excitotoxicity in Glaucomatous Optic Neuropathy

Survey of Ophthalmology ◽

10.1016/s0039-6257(99)00017-x ◽

1999 ◽

Vol 43 ◽

pp. S142-S150 ◽

Cited By ~ 65

Author(s):

Christian K Vorwerk ◽

Madhu S.R Gorla ◽

Evan B Dreyer

Keyword(s):

Optic Neuropathy ◽

Glaucomatous Optic Neuropathy ◽

Experimental Basis

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Electrophysiological markers of preclinical diagnosis of glaucomatous optic neuropathy

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2021-14-1-35-41 ◽

2021 ◽

Vol 14 (1) ◽

pp. 35-41

Author(s):

M. O. Kirillova ◽

M. V. Zueva ◽

I. V. Tsapenko ◽

A. N. Zhuravleva

Keyword(s):

Optic Neuropathy ◽

Ganglion Cells ◽

Open Angle Glaucoma ◽

Statistical Significance ◽

Photopic Negative Response ◽

Glaucomatous Optic Neuropathy ◽

Functional Changes ◽

Bright Flash ◽

Pattern Size ◽

Group 2

Purpose: to evaluate the changes in electrophysiological indicators reflecting various aspects of the function of retinal ganglion cells (RGC) and their axons in the early diagnosis of glaucomatous optic neuropathy (GON).Material and methods. Two clinical groups, (1) 35 patients (60 eyes) aged 49 to 70 with suspected glaucoma and (2) 16 patients (30 eyes) aged 43–68 with initial primary open-angle glaucoma (POAG), and a comparison group of 38 relatively healthy subjects (45 eyes) aged 42–70 were tested for pattern-reversed visual evoked potentials (PVEP), transient and stationary pattern-ERGs (PERG) according to ISCEV, and photopic negative response (PhNR).Results. The P100 amplitudes in both clinical groups differed significantly from the norm in PVEP on small and large patterns. The elongation of peak latency (T) of P100 compared with norm was significant for the stimulus 1° in group 2. In both groups of patients, increased variability of the temporal parameters of PERG and PVEP for small patterns was found. In groups 1 and 2, a decrease in the amplitude of P50 and N95 peaks of transient PERG for all stimuli was revealed, which was the most significant for the 0.3° pattern. In group 1, the N95 peak was significantly delayed in PERG for large patterns. A statistically significant reduction in the steady-state PERG's amplitude was found in the groups of suspected glaucoma and initial POAG. The sharpest changes were found for small (0.8° and 0.3°) patterns. The elongation of T compared to the norm was most pronounced for PERG at 0.3°, but due to the high variability of temporary indicators within the group, it had no statistical significance. The amplitude of PhNR was significantly different from the norm in the ERG for a flash of 3.0 cd·sec/m2.Conclusion. In patients with suspected glaucoma, a decrease in the P100 VEP amplitude with the simultaneous elongation of T may be considered as a criteria for the plastic stage at the level of lateral geniculate nucleus. Markers of functional changes in RGCs are the decrease in the amplitude of PhNR in response to bright flash, and P50 and N95 of PERG for pattern size 0.3°. The results indicate a greater vulnerability of the parvocellular system to early events in the development of GON.

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Glaucoma Optic Neuropathy Progression: the Results of Long-Term Follow-Up

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-1s-96-101 ◽

2019 ◽

Vol 16 (1S) ◽

pp. 96-101

Author(s):

N. I. Kurysheva ◽

V. N. Trubilin ◽

E. O. Shatalova ◽

L. V. Lepeshkina

Keyword(s):

Risk Factors ◽

Optic Neuropathy ◽

Glaucomatous Optic Neuropathy ◽

Progression Rate ◽

Channel Blockers ◽

Fiber Layer ◽

Glaucoma Progression ◽

Prostaglandin Analogues ◽

Long Term Follow Up

Purpose: to investigate the average speed and risk factors for the glaucomatous optic neuropathy (GON) progression during longterm observation. Patients and methods. The 10-year data of 750 patients were analyzed. The average GON progression rate was calculated on the basis of perimetry and optical coherent tomography data. Further, according to inclusion and exclusion criteria 128 patients were included into the group of retrospective analysis. Resultes. The following risk factors were established: initial cornealcompensated IOP (IOPcc) > 23.6 mm Hg (AUC 0.7), IOPcc after 5 years > 19.8 mm Hg (AUC 0.83), age > 69.5 years (AUC 0.6), corneal hysteresis < 9.9 mm Hg (AUC 0.6) and retinal nerve fiber layer < 92 μm (AUC 0.6). Patients with pseudoexfoliation syndrome, and patients taking systemic calcium channel blockers (p = 0.01) also had the higher risk of GON progression. Its rate was lower in patients with arterial hypertension (p = 0.015), and in patients who received prostaglandin analogues (risk was 5 times reduced, p = 0.04) and fixed combinations (risk was 2 times reduced, p = 0.018). IOPcc of higher than 17.6 mm Hg in the long-term period is the most pronounced risk factor for the progression of GON. It was determined that the average ROP of glaucoma progression among the patients was 0.6 dB/year for ROP1, 0.62 ± 1.09 μm/year for ROP2 and 0.95 ± 3.28 μm/year for ROP3, also each 1 dB/year decrease in photosensitivity (in group with glaucoma progression) was associated with further loss of RNFL (3.9 µm/year). Conclusion. The use of prostaglandin analogues and fixed combinations reduces this risk.

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