Central Visual Field Damage and Parapapillary Choroidal Microvasculature Dropout in Primary Open-Angle Glaucoma

Lee, Eun Ji; Kim, Tae Woo; Kim, Ji Ah; Kim, Jeong Ah

doi:10.1016/j.ophtha.2017.10.036

Cited by 83 publications

(65 citation statements)

References 33 publications

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“…In agreement with previous studies, we found focal loss of vessels in the inner and outer annuli in POAG eyes compared with control eyes. 10,11,19 Although focal loss of vessels suggests that impairment in parapapillary choroidal perfusion may primarily cause vascular damage to the axons, it may be a simple secondary effect of glaucomatous damage. To address this question, we compared superficial (within RNFL) and deep vessel densities of two optic neuropathies (NAION and POAG) with similar RNFL loss, allowing us to evaluate the relationship between neural loss and vascular damage.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, OCT-A studies have shown choroidal microvascular dropout immediately around the optic disc in glaucomatous eyes using manual assessment. [7][8][9][10][11] Choriocapillaris flow also was reported to be qualitatively impaired in NAION eyes studied by OCT-A, 12 although another study did not find such changes. 13 We used a new automated image processing method of choroidal microvessel quantification and compared the parapapillary choroidal microvascular changes in remote NAION and POAG to elucidate their roles in the pathogenesis of these two diseases.…”

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confidence: 99%

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Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma

Fard

Salabati

Mahmoudzadeh

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Citation: Aghsaei Fard M, Salabati M, Mahmoudzadeh R, et al. Automated evaluation of parapapillary choroidal microvasculature in ischemic optic neuropathy and open angle glaucoma. Invest Ophthalmol Vis Sci. 2020;61(3):35. https://doi.org/10.1167/iovs.61.3.35 PURPOSE.To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between nonarteritic anterior ischemic optic neuropathy (NAION) and primary open angle glaucoma (POAG). METHODS.Thirty-seven eyes with chronic NAION, 34 unaffected fellow eyes with NAION, 47 moderate and severe POAG eyes, and 54 healthy control subjects were evaluated. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial retinal vessels. RESULTS.Linear models showed no difference in peripapillary retinal nerve fiber layer between NAION and POAG eyes. Mean peripapillary superficial small vessels in the NAION and POAG groups were 36.62 ± 7.1% and 39.72 ± 8.18% without a statistically difference between them (P = 0.16). Mean inner and outer annular region PPCMv densities in the NAION group were 26.55 ± 9.2% and 17.81 ± 6.9%, which were not different from unaffected fellow eyes and the control group. However, the POAG group had significantly reduced PPCMv density in both inner and outer annuli with values of 15.84 ± 6.5% and 12.80 ± 5.0%, respectively, compared with normal subjects (both P < 0.001). Inner and outer circle PPCMv densities were also significantly reduced in the POAG group compared with the NAION group. CONCLUSIONS. ReducedPPCMv density in POAG eyes shows that deep optic nerve head ocular blood flow may contribute to axonal damage in patients with glaucoma.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma

Fard

Salabati

Mahmoudzadeh

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…The disappearance of the b-PPA area in the multivariate analysis appears to be due to the association between b-PPA and cMvD, with cMvD found exclusively within the bor c-PPA region in both the present (Table 4) and previous studies. 24,31,48,49 This finding further suggests that cMvD has a stronger influence on the rate of RNFL thinning than b-PPA does. Although the precise relationship between cMvD and b-PPA remains to be clarified, the significant influence of b-PPA on glaucoma progression may be due to the higher likelihood of the presence of cMvD in those eyes.…”

Section: Discussionmentioning

confidence: 82%

Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma

Lee

Kim

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To determine which groupings of prognostic factors best explain the rapid progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). METHODS. Optic nerves of 111 POAG patients who were followed for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain optical coherence tomography (OCT) were included. Eyes were imaged using enhanced depth-imaging spectraldomain OCT and swept-source OCT angiography to determine the lamina cribrosa curvature index (LCCI), and the presence of a choroidal microvasculature dropout (cMvD), respectively. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements. A regression tree model was used to find groupings of factors that best explain the rate of future RNFL thinning. RESULTS. Disc hemorrhage, larger LCCI, and presence of cMvD were associated with faster global RNFL thinning in the multivariate regression analysis. The regression tree analysis revealed three stratified groups based on the rate of RNFL thinning, divided by the LCCI and the presence of cMvD. Eyes with LCCI ‡11.87 had the fastest RNFL thinning (À2.4 6 0.8 lm/ year, mean 6 SD). Among eyes with LCCI <11.87, the presence of cMvD was the strongest factor influencing faster RNFL thinning (À1.5 6 0.8 lm/year). Eyes with LCCI <11.87 and without a cMvD exhibited the slowest RNFL thinning (À0.8 6 0.9 lm/year). CONCLUSIONS. Our regression tree model demonstrated that larger LCCI, and then the presence of cMvD were the first and second strongest prognostic factors for faster progressive RNFL thinning. Further studies may be needed to confirm these findings.

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“…Focal defects (or ‘dropout’) of the choriocapillaris adjacent to the optic nerve head can be detected by OCT‐A and have been shown to occur more frequently in advanced glaucoma and to be associated with lamina cribrosa abnormalities on structural OCT scans . This form of microvascular defect is also reported to be very strongly associated with perifoveal visual field scotomas . Longitudinal studies are also needed to determine whether such microvascular defects contribute to axon damage or rather only a parallel manifestation of the connective tissue (lamina cribrosa and peripapillary scleral) deformations at the root of the glaucomatous disease process.…”

Section: Oct Angiography (Oct‐a)mentioning

confidence: 99%

Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma

Fortune

2019

Clinical and Experimental Optometry

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Clinical examination of the optic disc is a fundamental component of any ophthalmic evaluation, but it is especially important for diagnosis and management of glaucoma. The purpose of this article is to: (1) review the limitations inherent to clinical examination; (2) outline the rationale for adopting into clinical practice quantitative measures of the optic nerve head neuro-retinal rim tissue integrity derived from current optical coherence tomography imaging approaches; (3) describe recent developments in this area; and (4) highlight a few avenues of active research that hold promise for future translation to clinical practice.

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Central Visual Field Damage and Parapapillary Choroidal Microvasculature Dropout in Primary Open-Angle Glaucoma

Abstract: The presence of MvD in the parapapillary choroid was a strong predictor for IPFS.

Cited by 83 publications

References 33 publications

Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma

Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma

Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma

Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma

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