Patients with early-stage POAG exhibit reduced pupillary responses to moderate and high irradiances of blue and red lights. This wavelength-independent functional alteration correlates with structural thinning of the RNFL and could be the consequence of dysfunction or loss of melanopsin expressing ipRGCs in the early stages of the disease.

A major complication of hypertension is microvascular damage and capillary rarefaction is a known complication of hypertensive end-organ damage which confers a higher risk of systemic disease such as stroke and cardiovascular events. Our aim was to study the effect of hypertension on the retinal microvasculature using non-invasive optical coherence tomography angiography (octA). We performed a case-control study of 94 eyes of 94 participants with systemic hypertension and 46 normal control eyes from the Singapore chinese eye Study using a standardized protocol to collect data on past medical history of hypertension, including the number and type of hypertensive medications and assessed mean arterial pressure. Retinal vascular parameters were measured in all eyes using octA. in the multivariate analysis adjusting for confounders, compared to controls, eyes of hypertensive patients showed a decrease in the macular vessel density at the level of the superficial [OR 0.02; 95% CI, 0 to 0.64; P 0.027] and deep venous plexuses [OR 0.03; 95% CI, 0 to 0.41; P 0.009] and an increase in the deep foveal avascular zone. this shows that hypertension is associated with reduced retinal vessel density and an increased foveal avascular zone, especially in the deep venous plexus, as seen on octA and there is a potential role in using octA as a clinical tool to monitor hypertensive damage and identifying at risk patients Hypertension is a major cause of morbidity and mortality globally 1,2 , affecting 29.2% men and 24.8% women in 2012 3. A major complication of hypertension is microvascular damage, related partly to abnormal vasomotor tone and increased wall-to-lumen ratio in relation to higher blood pressure 4,5. It has also been suggested that vascular rarefaction may due to either functional alterations such as microvessel constriction resulting in non-perfusion or anatomical alterations resulting in actual non-perfusion and vessel loss 4. There have been many previous studies on the association between hypertension and retinal vasculature. Retinal fundus photo changes seen in response to hypertension include classic hypertensive retinopathy signs such as arteriovenous (AV) nicking, generalized or focal arteriolar narrowing, microaneurysms, intraretinal hemorrhages, cotton wool spots and papilloedema 6. These changes have been shown to confer a higher risk of systemic disease such as stroke and cardiovascular events 6-9. Other studies have also looked at larger retinal vessels (200-300 µm) using color fundus photos and demonstrated a correlation between narrower arteriolar diameter in hypertension 10-13. The impact of hypertension on capillary microvasculature is less clear. Historically, invasive fundus fluorescein angiography (FFA) was needed to evaluate perfusion and the structure of capillary microvasculature. Previous studies using FFA have shown that in patients with hypertension, there is an increase in perifoveal inter-capillary area and decrease in capillary blood velocity 14. However, FFA is not suitable for use in larg...

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Purpose: To assess 5-year cumulative incidence and risk factors of fellow eye involvement in Asian neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy.Methods: In a prospective cohort study of Asian nAMD and polypoidal choroidal vasculopathy, the fellow eyes were evaluated for exudation. The 5-year incidence of exudation was compared between nAMD and polypoidal choroidal vasculopathy.Results: A total of 488 patients were studied. The 5-year incidence of exudation in fellow eyes was 16.2% (95% confidence interval: 12.0-20.2). Polypoidal choroidal vasculopathy compared with nAMD in the first eye was associated with lower fellow eye progression (9.8% [95% confidence interval: 5.1-14.3]) vs. 22.9% [95% confidence interval: 15.8-29.3], P , 0.01). Drusen (hazards ratio 2.11 [95% confidence interval: 1.10-4.06]), shallow irregular retinal pigment epithelium elevation (2.86 [1.58-5.18]), and pigment epithelial detachment (3.01 [1.27-7.17]) were associated with greater progression. A combination of soft drusens and subretinal drusenoid deposits, and specific pigment epithelial detachment subtypes (multilobular, and sharp peaked) were associated with progression. Pigment epithelial detachment, shallow irregular retinal pigment epithelium elevation, and new subretinal hyperreflective material occurred at 10.4 6 4.2 months, 11.1 6 6.0 months, and 6.9 6 4.3 months, respectively, before exudation. Conclusion:The 5-year incidence of fellow eye involvement in Asian nAMD is lower than among Caucasians because of a higher polypoidal choroidal vasculopathy prevalence. Drusens, shallow irregular retinal pigment epithelium elevation, and pigment epithelial detachment are risk factors for fellow eye progression.