Dataset Information

Defects Along Blood Vessels in Glaucoma Suspects and Patients.

ABSTRACT: To examine the relationship between small hypodense regions ("holes") in the retinal nerve fiber layer (RNFL) seen on circumpapillary optical coherence tomography (OCT) images of glaucoma patients and suspects and the paravascular inner retinal defects (PIRDs) seen with OCT line scans near blood vessels in individuals without optic nerve disease but with high myopia and/or epiretinal membranes (ERMs).Based upon the availability of wide-field, swept-source OCT scans, 19 eyes from 15 glaucoma patients or suspects were selected from a larger group of eyes with holes on circumpapillary frequency-domain OCT scans. Paravascular defects (PDs) were identified using en face slab images generated (ATL 3D-Suite) from 52-?m slabs just below the vitreal border of the inner limiting membrane by averaging reflective intensity. Paravascular defects were confirmed with B-scans from these images.For 13 of the 19 eyes, the appearance of the PDs fit the previously described PIRDs and extended well beyond the circumpapillary region. In the other 6 eyes, the PDs were restricted to a small region and did not fit the previously described appearance of PIRDs. In these eyes, the holes were associated with an arcuate defect of the RNFL. Of the 13 with PIRDs, 9 had ERMs and/or high myopia previously associated with PIRDs in otherwise healthy eyes.Holes seen on circumpapillary OCT scans of glaucoma patients and suspects are associated with local glaucomatous damage, as well as with PIRDs associated with high myopia and ERMs.

SUBMITTER: Hood DC

PROVIDER: S-EPMC4829107 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Defects Along Blood Vessels in Glaucoma Suspects and Patients.

Hood Donald C DC De Cuir Nicole N Mavrommatis Maria A MA Xin Daiyan D Muhammad Hassan H Reynaud Juan J Ritch Robert R Fortune Brad B

Investigative ophthalmology & visual science 20160401 4

<h4>Purpose</h4>To examine the relationship between small hypodense regions ("holes") in the retinal nerve fiber layer (RNFL) seen on circumpapillary optical coherence tomography (OCT) images of glaucoma patients and suspects and the paravascular inner retinal defects (PIRDs) seen with OCT line scans near blood vessels in individuals without optic nerve disease but with high myopia and/or epiretinal membranes (ERMs).<h4>Methods</h4>Based upon the availability of wide-field, swept-source OCT scan ...[more]

PMID: 27054521

Similar Datasets

Project description:PurposeCompare the ability of peripapillary and macular structural parameters, vascular parameters, and their integration to discriminate among glaucoma, suspected glaucoma (GS), and healthy controls (HCs).MethodsIn this study, 196 eyes of 119 patients with glaucoma (n = 81), patients with GS (n = 48), and HCs (n = 67) underwent optical coherence tomography (OCT) and OCT angiography to measure peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses, radial peripapillary capillary perfusion density (RPC-PD), and macular GCIPL perfusion density (GCIPL-PD). Parameters were integrated regionally with logistic regression and globally with machine learning algorithms. Diagnostic performances were evaluated with area under the receiver operating characteristic (AUROC) curves.ResultsPatients with glaucoma had mild to moderate damage (median, -3.3 dB; interquartile range, -6.5 to -1.4). In discriminating between patients with glaucoma and the HCs, pRNFL thickness had higher AUROC curve values than RPC-PD for average (0.87 vs. 0.62; P < 0.001), superior (0.86 vs. 0.54; P < 0.001), inferior (0.90 vs. 0.71; P < 0.001), and temporal (0.65 vs. 0.51; P = 0.02) quadrants. mGCIPL thickness had higher AUROC curve values than GCIPL-PD for average (0.84 vs. 0.68; P < 0.001), superotemporal (0.76 vs. 0.65; P = 0.016), superior (0.72 vs. 0.57; P = 0.004), superonasal (0.70 vs. 0.56; P = 0.01), inferotemporal (0.90 vs. 0.72; P < 0.001), inferior (0.87 vs. 0.69; P < 0.001), and inferonasal (0.78 vs. 0.65, P = 0.012) sectors. All structural multisector indices had higher diagnostic ability than vascular ones (P < 0.001). Combined structural-vascular indices did not outperform structural indices. Similar results were found to discriminate glaucoma from GS.ConclusionsCombining structural and vascular parameters in a structural-vascular index does not improve diagnostic ability over structural parameters alone.Translational relevanceOCT angiography does not add additional benefit to structural OCT in early to moderate glaucoma diagnosis.

Project description:PurposeIdentify factors predicting worse or better than expected visual field (VF) performance.MethodsA total of 10,262 VFs from 1538 eyes of 909 subjects with manifest or suspected glaucoma were analyzed. Linear mixed-effects models predicted mean deviation (MD) at each timepoint. Differences between observed and predicted MD (?MD) were calculated and logistic regression identified factors predicting lower than expected (?MD <-1 dB) or higher than expected (?MD >1 dB) sensitivity.ResultsBoth higher and lower than expected sensitivity were more likely in VFs with severe compared with mild damage (relative risk [RR] >1.3, P < 0.05). Higher than expected sensitivity was more likely in VFs with moderate damage (RR = 2.57, P < 0.001). False-positive (FP) errors increased the likelihood of higher than expected sensitivity at all disease stages (RR >2.1 per 10% increase, P < 0.001), whereas false-negative (FN) errors increased the likelihood of lower than expected sensitivity in mild and moderate disease (RR >1.19 per 10% increase, P < 0.05). Fixation loss errors slightly increased the likelihood of higher than expected VF sensitivity in moderate and severe disease (RR >1.1 per 10% increase, P < 0.01). Longer test duration increased likelihood of lower than expected sensitivity at all disease stages (RR >1.36 per minute increase, P < 0.001). Lower than expected sensitivity was more likely in late afternoon tests (RR = 1.27, P < 0.01). A total of 26.6% of VFs had higher or lower than expected sensitivity in the absence of FPs, FNs, or fixation losses.ConclusionsFPs, test duration, and FNs are the primary measures predicting if a VF is likely to be reliable, although tests with normal reliability measures may still be unreliable. Our results help clinicians judge VF reliability and highlight the need to integrate reliability measures with other clinical data when making treatment decisions.Translational relevanceThis likelihood model derived from a large dataset helps clinicians identify VFs that may either falsely suggest disease progression or mask true worsening, thereby improving the utility of VFs in clinical practice.

Project description:SIGNIFICANCE:This article shows that self-tonometry can provide robust measures of diurnal intraocular pressure (IOP) and also detect changes to IOP in response to treatment within a short period of monitoring. These advances in IOP monitoring may contribute to improved management of glaucoma patients and suspects. PURPOSE:The aim of this study was to prospectively investigate the utility of rebound self-tonometry performed over several weeks for detecting diurnal IOP fluctuations in glaucoma patients and suspects and also initial response to topical treatment in glaucoma patients. METHODS:Forty patients were recruited following glaucoma-specific examination. Subsequent to successful training with the iCare HOME tonometer, patients were instructed to measure IOP, in a sitting position, four times a day over 4 to 6 weeks. Date, time, laterality, and IOP downloaded from the tonometer and clinical examination data, including applanation IOP and corneal thickness, were analyzed. A user satisfaction survey was also administered at study completion. t Test and analysis of variance were used to compare groups and IOP across days. Pearson correlation was used to compare measurements to Goldmann applanation tonometry and IOP measurements from the first day/s to the overall mean IOP. RESULTS:Twenty-seven patients (18 suspects and 9 glaucoma patients) completed data collection. Patients self-measured IOP on 118 (±29) occasions for 40 (±7.4) days. Two dominant patterns of fluctuation were revealed: peak IOP upon awakening (n = 11) and at midday (n = 13). Diurnal IOP measured in the first 7 days showed strong correlation to diurnal IOP across the entire study period (r = 0.82, P < .0001). Within 24 hours of treatment commencement (latanoprost 0.005% ophthalmic solution), IOP reduced from 23.9 (±5.2) to 16.1 (±2.6) mmHg. Overall, patients rated the instrument as easy to use, although difficulties with correct alignment were expressed. CONCLUSIONS:Rebound self-tonometry demonstrated utility for measuring diurnal IOP fluctuations in most patients, hence enhancing management of patient with or at risk of developing glaucoma.

Project description:ObjectiveBecause uncertainty exists about which glaucoma suspects should be treated, this study sought to identify the glaucoma suspects who an expert panel could agree would be appropriate or inappropriate to treat.DesignThe RAND/UCLA appropriateness method, a well-established procedure to synthesize the scientific literature with expert opinion to resolve uncertainty on a health topic.ParticipantsEleven-member panel composed of recognized international leaders in the field of glaucoma.MethodsBased on a systematic review of the literature on potentially important factors to consider when deciding to initiate treatment, more than 1000 scenarios of glaucoma suspects initially were created. The panel formally rated the appropriateness of initiating treatment for glaucoma suspects through a 2-round modified Delphi method, a technique that preserves the confidentiality of individual panelists'ratings but allows panelists to compare their own ratings with those of the entire panel.Main outcome measuresFinal ratings for scenarios were categorized as appropriate, uncertain, or inappropriate to treat according to typical prespecified statistical criteria previously used in projects using the RAND/UCLA appropriateness method. Tools were developed to help clinicians to approximate the panel ratings of glaucoma suspects.ResultsThe panel chose age, life expectancy, intraocular pressure (IOP), central corneal thickness, cup-to-disc ratio, disc size, and family history as the variables to consider when deciding whether to treat glaucoma suspects. Permutations of these variables created 1800 unique scenarios. The panel rated 587 (33%) scenarios as appropriate, 585 (33%) as uncertain, and 628 (35%) as inappropriate for treatment initiation. Analysis of variance determined that IOP had greater impact than any other variable on panel ratings. A point system was created with 96% sensitivity and 93% specificity for predicting panel ratings of appropriateness for a glaucoma suspect.ConclusionsAn expert panel can reach agreement on the appropriateness and inappropriateness of treatment for glaucoma suspects.

Dataset Information

Defects Along Blood Vessels in Glaucoma Suspects and Patients.

Publications

Defects Along Blood Vessels in Glaucoma Suspects and Patients.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets