Cognitive Impairment in Primary Open Angle Glaucoma: A Case-Control Study.

Glaucoma patients had a reduction in the inner annulus peripapillary choroidal microvascular density (PCMD) that became worse as the glaucoma severity progressed, which might provide new evidence supporting the vascular theory. To compare PCMD among normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and healthy controls using optical coherence tomography (OCT) angiography (OCTA). The study included 40 POAG, 25 NTG, and 33 healthy controls. All subjects underwent OCT and OCTA testing. The inner annulus and outer annulus PCMD, as well as peripapillary vessel density (VD), were calculated. One-way analysis of variance was used to compare the vascular parameters of the 3 groups. Pearson correlation analysis or Spearman correlation test was used to evaluate the correlation between PCMD and glaucomatous severity factors. The spatial positional relationship between PCMD and corresponding peripapillary retinal nerve fiber layer (RNFL) thickness and visual field (VF) mean deviation (MD) was also assessed. The average and 4 quadrants of the inner annulus PCMD and peripapillary VD in the 2 glaucomatous groups were significantly lower than in normal eyes ( P <0.05). Strong correlations were found between inner annulus PCMD and VF MD, peripapillary VD, and RNFL in POAG patients. Similarly, the inner annulus PCMD in NTG patients was strongly correlated with peripapillary VD and RNFL (all r >0.5). Strong positional correlations were found between inner superior quadrantal PCMD and RNFL thickness in both POAG and NTG patients ( r =0.566 and 0.731, respectively). Likewise, inner inferior quadrantal PCMD exhibited a strong correlation with RNFL thickness in POAG patients ( r =0.608). Strong positional correlations were also found between inner superior PCMD and VF MD in both POAG and NTG patients ( r =0.589 and 0.622, respectively). Inner inferior PCMD exhibited a moderate correlation with VF MD in both POAG and NTG patients ( r =0.487 and 0.440, respectively). The study found that the inner annulus PCMD decreased to varying degrees in NTG and POAG patients. The inner annulus PCMD was closely related to the structural and visual function parameters of glaucoma in both NTG and POAG. Furthermore, inner PCMD demonstrated a spatial correlation with corresponding RNFL thickness and VF MD.

To evaluate macular thickness and peripapillary retinal nerve fibre (pRNFL) layer thickness in primary open angle glaucoma (POAG) patients using optical coherence tomography (OCT) in semi-urban population of eastern U.P. : Cross-sectional observational study carried out on 72eyes of 42 POAG patients and 72 eyes of 36 normal individuals above 40 years from January 2023 – August 2023 in eye OPD of Hind Institute of Medical Sciences, Barabanki. Best corrected visual acuity, anterior segment examination, Gonioscopy, tonometry, Central corneal thickness, perimetry, fundoscopy, peripapillary RNFL and macular thickness using OCT was done in all patients. POAG patients had significantly lower mean pRNFL quadrant measurements in superior, inferior and temporal quadrants when compared with controls. 83.68 ± 13.55 vs.140.01 ± 4.53; p=0.001 for superior quadrant; 76.33 ± 12.96 vs. 141.99 ± 4.51; p=0.001 for inferior quadrant; 52.31 ± 8.67 vs. 74.36 ± 3.56; p=0.001 for temporal quadrant. Mean pRNFL thickness in the nasal quadrant was not found significant in our study (55.53±7.08 vs. 80.85±5.24; p=0.295). Significant differences in thickness in foveal, inferior outer, temporal inner and nasal inner sector between POAG and control patients (p&amp;#60;0.05) were found. Superior, inferior and temporal pRNFL quadrants thickness and foveal, inferior outer, temporal inner and nasal inner macular thickness were found to be the best parameters to diagnose POAG at early stage.

Purpose To evaluate platelet parameters in primary open-angle glaucoma (POAG) patients and to explore the association between platelet parameters and POAG severity. Methods A total of 402 consecutive POAG patients and 408 healthy control subjects from the Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Fudan University, were consecutively recruited between January 2016 and October 2018. Detailed ophthalmological and systematic examinations were performed. Blood samples for platelet parameters, including platelet count (PLT), platelet distribution width (PDW), plateletcrit (PCT), mean platelet volume (MPV), and platelet large cell ratio (P-LCR), were analyzed using an automated hematology analyzer in the department of clinical laboratory science of the hospital. The POAG subgroups were classified according to age (<50, ≥50), gender, and visual field mean deviation (MD): mild (MD ≤ 6 dB), moderate (6 dB < MD ≤ 12 dB), and severe (MD > 12 dB). Results In POAG patients, PLT counts (207.08 ± 54.70 ∗ 109/L) were significantly lower (p=0.001) than those of the control group (220.46 ± 55.85 ∗ 109/L). In the POAG group, PDW (13.76 ± 3.16 fL) and MPV (10.46 ± 1.32 fL) values were significantly higher (all p < 0.001) than those of the control group (PDW 11.82 ± 2.44 fL, MPV 10.13 ± 1.10 fL). PDW and MPV values were highest in the severe POAG group (PDW 14.49 ± 2.99 fL; MPV 10.74 ± 1.39 fL), followed by the moderate group (PDW 12.50 ± 3.14 fL; MPV 10.02 ± 1.08 fL) and then the mild group (PDW 11.82 ± 2.44 fL; MPV 9.92 ± 0.76 fL), with statistically significant differences observed between mild-severe POAG and moderate-severe POAG groups by LSD post hoc test. Multiple linear regression analyses showed a significant association between PDW and MD (β = 0.430, p < 0.001) and MPV and MD (β = 0.363, p=0.001). Logistic regression analyses revealed that PDW (OR = 1.297, 95% CI = 1.011–1.663) was associated with the severity of POAG. Conclusions PDW and MPV values were significantly elevated in POAG patients, and PDW was positively associated with disease severity, which suggested the possibility that platelet activation be involved in pathomechanisms of POAG.

BackgroundThere are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG in other Asian countries.MethodsThis prospective cross-sectional study was performed in two hospitals with glaucoma service in Malaysia from 2010 to 2012. Seventy-seven patients of Malay ethnicity were enrolled in this study, including 32 NTG patients and 45 POAG patients. Using the Heidelberg Retinal Tomograph III, we measured optic disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area.ResultsThe eyes for NTG patients had significantly larger optic disc areas (2.65 [standard deviation, 0.41] vs 2.40 [standard deviation, 0.36] mm2, respectively; P=0.006) and cup areas (1.54 [standard deviation, 0.43] vs 1.32 [standard deviation, 0.40] mm2, respectively; P=0.027) compared with the eyes of POAG patients. Comparison of the other parameters between the two groups revealed no significant difference (P>0.050). The moderate and severe NTG patients showed significantly deeper cups and larger disc and cup areas when compared with the moderate and severe POAG patients (P<0.050).ConclusionThe NTG patients in this study have notably larger optic disc and cup areas than the POAG patients. Our observations are consistent with those reported in studies of NTG and POAG patients in Korea. The deeper cups and larger disc and cup areas may serve as indicators of severity when comparing NTG with POAG. However, these findings require verification with IOP and visual field results.

Progression of Primary Open-Angle Glaucoma in Diabetic and Nondiabetic Patients

To observe the diurnal variations of intraocular pressure (IOP) measured with dynamic contour tonometer (DCT) in primary open angle glaucoma (POAG) patients, normal tension glaucoma (NTG) patients, and healthy controls, and to compare the differences of diurnal variation curves between the two eyes of each subject and define the distribution of the peak of IOP; to analyze the diurnal variation range of ocular pulse amplitude (OPA) and compare the differences among the POAG and NTG patients and healthy controls. DCT was used to measure the diurnal variations of IOP and OPA in the two eyes of 18 POAG patients, 17 NTG patients and 30 normal controls at 5:00, 7:00, 10:00, 14:00, 18:00, and 22:00 and the distribution of the peak IOP was observed. The range of the diurnal variation of OPA was identified. The diurnal variation curves of IOP were different among the POAG patients, NTG patients, and normal people, and also between the two eyes of each subject. Four right eyes (13.3%) and 6 left eyes (20.0%) of the healthy controls, 4 right eyes (23.5%) and 5 left eyes (29.4%) of the NTG patients, and 5 right eyes (27.8%) and 4 left eyes (22.2%) of the POAG patients reached the peak IOP values in out-office period. Diurnal variation of OPA was detected in both the patients and controls, and the variation curves were different within different groups sampled and between the two eyes of each subject. The diurnal OPA range of the right and left eyes of the POAG group were (2.1 +/- 1.3) mm Hg, and (2.4 +/- 1.9) mm Hg respectively, significantly larger than those of the normal controls [(1.1 +/- 0.5) mm Hg and 1.2 +/- 0.5) mm Hg respectively], and those of the NTG group [(1.1 +/- 0.8) mm Hg and (1.0 +/- 0.5) mm Hg) respectively] (all P < 0.01). OPA has diurnal variation. The diurnal variation of the POAG patients is the largest. NTG patients and normal controls have asymmetric IOP and OPA diurnal variations. The two eyes of the same individual cannot always be treated as the same. The value of IOP measured in the office-time cannot completely represents the 1 d IOP.

The purpose of the study was to compare radial peripapillary capillary (RPC) density between normal subjects and patients with early primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCT-A). A total of 24 patients with early POAG and age-matched 52 normal subjects underwent scanning with OCT-A imaging (RTVue XR-100, Avanti OCT). The enface angioflow images obtained were analyzed qualitatively for the RPC network, and RPC capillary density (CD) was measured in 8 sectors within a 3.45-mm-diameter circle around the optic disc, using the Bar-Selective Combination of Shifted Filter Responses (B-COSFIRE) method. CD and retinal nerve fiber layer (RNFL) thickness were compared between corresponding sectors with the Mann-Whitney U test. Correlations between CD and Humphrey visual field parameters and optic disc structural parameters were calculated by linear regression analysis. In the normal eyes, RPC bed was clearly visible on OCT-A as a dense microvascular network around the optic disc, whereas in POAG patients it was focally attenuated. RPC CD was lower in the inferotemporal (P=0.002) and superotemporal (P=0.008) sectors with corresponding focal RNFL defect in POAG patients when compared with normal controls. The average CD correlated with visual field mean deviation (P=0.01) and pattern standard deviation (P=0.02) in glaucomatous eyes. OCT-A demonstrated reproducible, focal loss of RPCs in patients with early POAG when compared with normal controls. The results of our study suggest that the RPC density measurements may have a value in the diagnosis and monitoring of glaucoma.

To assess the association between the serum levels of uric acid (UA) and primary open-angle glaucoma (POAG). In this pilot study, 46 eyes of 23 patients with a clinical history of POAG and 30 eyes of 15 healthy subjects were included. All patients underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA), intraocular pressure (IOP), and gonioscopy. Visual field parameters, such as mean deviation (MD) and pattern standard deviation (PSD), and optical coherence tomography (OCT) values of the optic nerve head, including retinal nerve fiber layer (RNFL) thickness and vertical cup/disc ratio (VCDR), were noted. A blood sample was collected from each subject for serum UA measurement. IOP, MD, PSD, RNFL thickness, and VCDR resulted significantly different in POAG patients, when compared with controls (p < 0.05). POAG patients showed significantly lower levels of mean serum UA than healthy controls (4.00 ± 0.66 mg/dL vs 4.95 ± 0.86 mg/dL, respectively, p < 0.0001). Furthermore, severe POAG patients showed mean serum levels of UA lower than mild POAG patients (3.36 ± 0.70 mg/dL vs 4.22 ± 0.51 mg/dL, respectively, p = 0.01). Visual field and OCT parameters were statistically correlated with the mean serum levels of UA in POAG eyes (p < 0.05). Results suggest that in POAG patients, serum UA levels may be decreased and correlated with visual field and OCT parameters worsening. Further larger multi-center prospective studies are necessary to confirm our findings and establish the role of UA in glaucoma.

PurposeTo establish and validate a formula to predict spectral domain (SD)-optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness from time domain (TD)-OCT RNFL measurements and other factors.MethodsSD-OCT and TD-OCT scans were obtained on the same day from healthy participants and patients with glaucoma. Univariate and multivariate linear regression relationships were analyzed to convert average Stratus TD-OCT measurements to average Cirrus SD-OCT measurements. Additional baseline characteristics included age, sex, intraocular pressure, central corneal thickness, spherical equivalent, anterior chamber depth, optic disc area, visual field (VF) mean deviation, and pattern standard deviation. The formula was generated using a training set of 220 patients and then evaluated on a validation dataset of 105 patients.ResultsThe training set included 71 healthy participants and 149 patients with glaucoma. The validation set included 27 healthy participants and 78 patients with glaucoma. Univariate analysis determined that TD-OCT RNFL thickness, age, optic disc area, VF mean deviation, and pattern standard deviation were significantly associated with SD-OCT RNFL thickness. Multivariate regression analysis using available variables yielded the following equation: SD-OCT RNFL = 0.746 × TD-OCT RNFL + 17.104 (determination coefficient [R2] = 0.879). In the validation sample, the multiple regression model explained 85.6% of the variance in the SD-OCT RNFL thickness.ConclusionsThe proposed formula based on TD-OCT RNFL thickness may be useful in predicting SD-OCT RNFL thickness. Other factors associated with SD-OCT RNFL thickness, such as age, disc area, and mean deviation, did not contribute to the accuracy of the final equation.

Pseudoexfoliation glaucoma eyes had a similar level of peripapillary and superficial macular vessel densities compared with primary open-angle glaucoma eyes matched for age and glaucoma severity when assessed by optical coherence tomography angiography (OCT-A). To compare vessel density (VD) measured by OCT-A between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) in the peripapillary and macular areas. The circumpapillary (cpVD), parafoveal (pfVD), and perifoveal vessel densities (perifVD) were obtained using OCT-A (AngioVue/RTVue-XR) in 98 eyes from 98 subjects [age, visual acuity, visual field (VF) mean deviation (MD) matched 49 POAG and 49 PXG eyes]. Global and 8 sectoral VDs in the peripapillary capillary layer were compared. In the macula, the superficial and deep layers of the pfVD and perifVD were analyzed globally and in 4 quadrants. Univariate and multivariate linear regression models were built using cpVD, pfVD, and perifVD as dependent variables and covariates [age, intraocular pressure (IOP), axial length, signal strength index (SSI), and retinal nerve fiber layer (RNFL) thickness] were considered independent variables. In the peripapillary region, none of the VDs differed between groups both before and after adjustment. When we adjusted superficial and deep layer macular VDs for age, IOP, SSI, axial length, and RNFL thickness, all of which could affect measurements, the 2 groups did not differ in any sector. The cpVD in POAG eyes significantly correlated with VF MD and RNFL thickness, whereas IOP, VF MD, and RNFL thickness affected cpVD in PXG. The macular VD in the deep layer was associated with only SSI in both groups. Age-matched and glaucoma severity-matched PXG and POAG did not significantly differ in cpVD or in most of the superficial macular VD parameters.

Purpose: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA).Methods: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed.Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects.Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness, mean deviation, nocturnal dip, blood pressure variability) were analyzed.Results: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study.Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients.In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness.In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length.Conclusions: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients.Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness.In POAG patients, significant factors influencing choroidal thickness were age and axial length.

Objective To measure RNFL thickness by Frequency-domain optical coherence tomography (OCT) in patients with different stages of primary glaucoma (CACG and POAG),to evaluate the correlation between RNFL thickness and visual field mean defect (MD),to detect RNFL thickness change of early stage primary glaucoma,and to discuss the clinical significance in the early diagnosis of primary glaucoma objectively. Methods Ninety-two subjects of 40 normal and 52 with different stages of primary glaucoma were enrolled in this study.RNFL thickness was measured by Zeiss Cirru HD-OCT,and visual field was tested by Zeiss Humphrey-750.The association between visual field MD and RNFL thickness was evaluated with Pearson correlation coefficients. Results In the normal group,mean RNFL thickness was 112.91±9.36μm; the early period glaucoma group 94.43±7.67μm; the middle period glaucoma group 80.82±10.36μm; the later period glaucoma group 67.86±8.01μm.Visual field MD in each group was-0.88±1.53dB,-4.26±1.83dB,-7.43±2.64dB and -17.06±5.85dB.The differences in mean RNFL thickness and visual field MD between normal and each stage glaucoma group were significant (P ＜0.05) by independent sample t-test.In each stages of glaucoma group,mean RNFL thickness and visual field MD (early period:r =-0.537,middle period:r =-0.615,later period:r=-0.804) correlated significantly (P ＜0.05).In the early period glaucoma group,superior RNFL thickness was 116.32±11.65μm,inferior RNFL thickness 105.58±9.73μm,nasal RNFL thickness 75.40±10.91μm,and temporal RNFL thickness 70.28±13.08μm.In group B,superior RNFL thickness was 140.15±8.79μm,inferior RNFL thickness 137.29±10.07μm,nasal RNFL thickness 90.20±14.19μm,and temporal RNFL thickness 88.43±10.85μm.The difference of superior and inferior RNFL thickness between group A1 and group B had statistical significance tested by independent sample t-test,P ＜0.05; nasal and temporal RNFL thickness between group A1 and group B was tested by independent sample t-test,P ＞0.05,there was no statistical significance difference. Conclusions Frequency-domain OCT detected that the average of RNFL thickness become thinning with the progression of disease in the primary glaucoma patients,have negative correlation with vision MD,it is able to objectively reflect the degree of glaucomatous optic nerve damage.Frequency-domain OCT can show significantly decreased superior and inferior RNFL thickness of the early period primary glaucoma,which shows good ability in distinguishing normal from early period primary glaucomatous eyes. Key words: Optical coherence tomography (OCT); Retinal nerve fiber layer (RNFL); Mean defect (MD); Early diagnosis primary glaucoma

Objective To investigate the affect of medication compliance on retinal nerve fiber layer thickness acquired by stratus OCT in primary open angle glaueoma （POAG） patients. Methods 100 eyes of 53 POAG outpatients from 2007 to 2010 were recruited in outpatient service. All the patients were sorted into 2 groups according to their medication compliance： high medication compliance （group A） and low medication compliance （group B）. Both global and retinal nerve fiber layer （RNFL） thickness in the four quadrants （superior, inferior, nasal and temporal） were detected by OCT in both groups during 1 year follow-up and the changes were statistically analyzed. Results The changing value of RNFL thickness in global average and in the four quadrants （ superior, inferior, nasal and temporal） is （ 3.13 ± 6.64） μm, （ - 4.7 ± 12.95 ）μm, （ -2.54±9.75）μm, （ -3.28 ±14.86） μm, （ - 1.84 ± 11.94） μm in group A, and （7.74 ± 8.14） μm, （15.82±22.10）μm, （4.94±13.96）μm, （8.42±13.64）μm, （ 4. 38 ±19. 63 ）μm in group B. The data presented striking difference between group A and group B in average, in the superior and in the nasal （ t = 7.32, 5. 663, 4. 10 ; P 〈 0. 001 ）, as while as in the inferior （ t = 3. 105, P 〈 0. 05 ）, while not showed statistical difference in the temporal （ t = 1. 914, P 〉0. 05 ）. Conclusions OCT was a test method with objective, specific, sensitive and quantitative characteristics. OCT can be used to evaluate the medication compliance of POAG patient which facilitate monitoring RNFL lesion. Key words: Primary open angle glaucoma; Retina; Retinal nerve fiber layer; Medication compliance; Optical coherence tomography

This study aimed to assess vascular endothelial function in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) by measuring: (a) endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery, and (b) circulating endothelial progenitor cells, which are believed to support the integrity of the vascular endothelium. We enrolled 25 patients with OHT, 23 with POAG and 26 control subjects, all of whom were aged < 65 years and had no medical history of cardiovascular disease or cardiovascular risk factors. All subjects underwent a complete ophthalmological examination, biochemistry study, assessment of cardiovascular parameters, brachial artery ultrasound assessment of endothelium-dependent FMD, generic circulating progenitor cell (CPC) and circulating endothelial progenitor cell (EPC) count with the use of flow cytometry. Flow-mediated vasodilation values differed significantly in OHT (4.5 +/- 1.1%; p = 0.021) and POAG (4.0 +/- 0.9%; p = 0.003) patients compared with controls (7.7 +/- 0.8%). The CD34(+) KDR(+) EPC count was markedly lower in OHT (28.0 +/- 5.0; p < 0.001) and POAG (24.3 +/- 3.4; p < 0.001) patients compared with controls (73.1 +/- 8.1). Neither FMD not EPCs differed significantly between OHT and POAG patients. No significant differences in CPC count or cardiovascular parameters were found among OHT or POAG patients and controls. The levels of CD34(+) KDR(+) EPCs were directly correlated (p = 0.043) with FMD, and inversely correlated (p = 0.032) with baseline intraocular pressure in OHT and POAG patients. Both OHT and POAG patients without cardiovascular risk factors have previously unreported severely reduced circulating EPCs and reduced FMD, both of which are indicators of endothelial dysfunction and increased risk of cardiovascular events.

Objectives:The aim of this study was to investigate the magnitude of diurnal fluctuation in the superficial parafoveal vessel density (pfVD) and radial peripapillary capillary-peripapillary vessel density (RPC-ppVD) in exfoliative glaucoma (XFG) patients using optical coherence tomography angiography (OCTA) and to compare the findings with those of primary open-angle glaucoma (POAG) patients with glaucomatous damage of comparable severity.Methods:A total of 50 patients with XFG and 48 with POAG were examined in this retrospective cross-sectional study. The OCTA readings and intraocular pressure (IOP) values were obtained at 9 am, 11 am, 2 pm, and 4 pm on the same day. The maximal change in the IOP and vessel density (VD) values was evaluated to determine the magnitude of diurnal variation.Results:No significant difference was found in the magnitude of the average diurnal superficial-pfVD, RPC-ppVD and IOP change between the XFG and POAG groups. Comparison of the diurnal variation of sub-sector VD revealed that the magnitude of the diurnal variation in the VD of the inferonasal peripapillary and superior parafoveal regions was greater in the XFG group than that of the POAG group (p=0.004 and p=0.021, respectively). Furthermore, the differences persisted after correcting for the confounding factors of IOP, mean deviation (MD), and global retinal nerve fiber layer (RNFL) values. The magnitude of the average superficial-pfVD and the average RPC-ppVD was not correlated with the MD, total ganglion cell complex, global RNFL, or the magnitude of IOP values in either group.Conclusion:The eyes of XFG patients demonstrated more significant diurnal fluctuation in VD (including the superior superficial-pfVD as well as the inferonasal RPC-ppVD) when compared with POAG patients, despite no statistical significance between groups in the IOP variation.