OCT-3 RNFL and macular thickness measurements are reproducible in normal eyes. These results should be validated in ocular hypertensive and glaucomatous eyes.

To assess the internal reflectivity of the retinal nerve fiber layer in normal, ocular hypertensive, and glaucomatous eyes using optical coherence tomography. Methods: All patients underwent complete ophthalmic examination and achromatic automated perimetry. Intraocular pressure was 21 mm Hg or less for low-tension glaucoma and normal eyes and at least 25 mm Hg on 2 separate occasions in ocular hypertensive and high-tension glaucoma eyes. All glaucomatous eyes had characteristic glaucomatous optic neuropathy and associated achromatic automated perimetry defect. Relative retinal nerve fiber layer internal reflectivity was measured on optical coherence tomography images using a software program of our own design. Results: We enrolled 98 eyes (19 normal, 34 ocular hypertensive, 17 high-tension glaucoma, and 28 lowtension glaucoma). Relative internal reflectivity was less in eyes with glaucoma than in normal (PϽ.001, t test) and ocular hypertensive eyes (PϽ.001, t test). There was no difference in relative internal reflectivity between normal and ocular hypertensive eyes (P=.32) and between eyes with high-tension glaucoma and low-tension glaucoma (P = .43). Internal reflectivity correlated with mean deviation on achromated automatic perimetry (r 2 = 0.49, PϽ.001, quadratic regression analysis). Conclusion: Relative retinal nerve fiber layer internal reflectivity may provide useful information about the extent of retinal nerve fiber layer injury in glaucoma.

Aim: To evaluate the effect of a tight necktie on intraocular pressure (IOP) measurement using Goldmann applanation tonometry. Methods: 40 eyes of 20 normal subjects and 20 open angle glaucoma patients (all male) were enrolled. IOP was measured with an open shirt collar, 3 minutes after placing a tight necktie, and 3 minutes after loosening it. All measurements were made by the same examiner. Results: Mean IOP in normal subjects increased by 2.6 (SD 3.9) mm Hg (p=0.008, paired t test; range −3 to +14 mm Hg) and in glaucoma patients by 1.0 (1.8) mm Hg (p=0.02, paired t test; range −2 to +4.5 mm Hg). In normal subjects, IOP in 12 eyes was increased by >2 mm Hg and in seven eyes by >4 mm Hg. In glaucoma patients, IOP in six eyes was increased by >2 mm Hg and in two eyes by >4 mm Hg. Conclusion: A tight necktie increases IOP in both normal subjects and glaucoma patients and could affect the diagnosis and management of glaucoma. E levated intraocular pressure (IOP) remains the most important known risk factor for the development and progression of glaucomatous damage. 1 Accurate measurement of IOP remains crucial in decisions regarding management. Many patients wear tight neckties throughout the day and continue wearing them during IOP measurements. We hypothesised that this may elevate IOP by increasing episcleral venous pressure. During routine examination, if a patient were to be wearing a tight necktie, the increased IOP could lead to an erroneous diagnosis of ocular hypertension or even glaucoma.Moreover, if the patient consistently were to wear a tight necktie as a normal preference in daily life, this could lead to a sustained increase in IOP and could predispose to the development of glaucomatous optic neuropathy, thereby rendering a tight necktie a risk factor as well as a confounder of accurate IOP measurement. We evaluated the effect of tight neckties on IOP measurement by Goldmann applanation tonometry. METHODSNormal subjects and open angle glaucoma patients were enrolled in this prospective study. Informed consent was obtained from each subject using a consent form approved by the institutional review board for human research of the New York Eye and Ear Infirmary. All subjects were male, had best corrected visual acuity of 20/60 or better, and wore collared shirts. Subjects were excluded if they had current infection or inflammation in either eye, any abnormality preventing reliable applanation tonometry in either eye, strabismus, previous incisional glaucoma filtration surgery, or other nonglaucomatous disease affecting the visual field.All normal subjects had IOP <21 mm Hg by Goldmann applanation tonometry, normal optic disc appearance based upon clinical examination, and normal achromatic automated perimetry. Normal optic disc appearance was defined as vertical cup to disc asymmetry <0.2, cup/disc ratio <0.6, and an intact neuroretinal rim without peripapillary haemorrhages, notches, localised pallor, or nerve fibre layer defect. Achromatic automated perimetry indices showed a mean defect (MD) and cor...

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