Influence of intraocular pressure reduction on progression of normal-tension glaucoma with myopic tilted disc and associated risk factors

Seol, Bo Ram; Kim, Soa; Kim, Dong‐Myung; Park, Ki Ho; Jeoung, Jin Wook; Kim, Seok Hwan

doi:10.1007/s10384-017-0508-y

Cited by 15 publications

(10 citation statements)

References 27 publications

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“…The Advanced Glaucoma Intervention Study 24 , Collaborative Normal-Tension Glaucoma Study Group 25,26 , and others 27 have demonstrated that IOP reduction, even when damage has occurred at low IOP, reduces the rate of progressive visual field loss. Yet the absolute level of baseline, unmedicated IOP does not statistically distinguish which patients with OAG will ultimately suffer progressive optic neuropathy, even though patients with the greatest therapeutic IOP reduction ultimately suffer less glaucoma progression 28 . About 20% of such patients experience progressive optic neuropathy five years after 30% IOP reduction from normal baseline levels 3 , even sometimes to such deeply subnormal IOP that ocular hypotension then poses a separate risk of vision loss 29 .…”

Section: Introductionmentioning

confidence: 99%

Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure

Demer

Clark

Suh

et al. 2019

Current Eye Research

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Purpose/Aim: We used magnetic resonance imaging (MRI) to investigate effects of intraocular pressure (IOP), race, and other factors on optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in open angle glaucoma (OAG). Materials and Methods:Thirty-five patients with OAG (26 with maximal untreated IOP ≤21mmHg, 9 with IOP >21mmHg) and 48 controls underwent axial and quasi-coronal MRI in central gaze and large (27-33°) abduction and adduction. Some underwent MRI at smaller ductions (21-28°). Effects of presence vs. absence of OAG; within OAG whether maximum IOP level was ≤21mmHg vs. >21mmHg; adduction angle; race; age; and gender on ON path length and globe translation were analyzed using generalized estimating equations to account for possible intereye correlations of individual subjects.Results: Average visual field mean deviation (±standard error of mean, SEM) was −8.2±1.2 dB in OAG with normal IOP, and −6.1±1.4 in high IOP. In central gaze, ON path in OAG was significantly more redundant than in controls but in both groups the ON became significantly and almost equally straighter in small (~21°) or large (~27°) adduction than in central gaze. With progressive adduction only, globes retracted in OAG (P<0.005) but not in controls; this was only weakly related to globe size and not to IOP elevation. Globe retraction in adduction was significant only in OAG, and in that group was significantly greater in Asian than white patients (P<0.02). Conclusions:Although ON tethering in adduction is normal, progressive adduction is associated with abnormal globe retraction, in OAG regardless of IOP level. This phenomenon is more prominent in Asians who have OAG. Traction in adduction may cause repetitive strain injury

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Section: Introductionmentioning

confidence: 99%

Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure

Demer

Clark

Suh

et al. 2019

Current Eye Research

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“…Multiple studies have failed to establish statistical relationship of IOP to POAG 22,29 or to progressive ON damage [30][31][32] . Even when reduced by treatment, IOP level does not statistically predict progressive ON damage 31,33 , and around 20% of patients develop such damage 5 years after 30% IOP reduction from levels already statistically normal 24 , even when extremely low IOP itself begins to cause visual loss 34 . Clearly, other sources of stress on the ON besides IOP deserve consideration.…”

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confidence: 99%

Finite element modeling of effects of tissue property variation on human optic nerve tethering during adduction

Park

Shin

Demer

2022

Sci Rep

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Tractional tethering by the optic nerve (ON) on the eye as it rotates towards the midline in adduction is a significant ocular mechanical load and has been suggested as a cause of ON damage induced by repetitive eye movements. We designed an ocular finite element model (FEM) simulating 6° incremental adduction beyond the initial configuration of 26° adduction that is the observed threshold for ON tethering. This FEM permitted sensitivity analysis of ON tethering using observed material property variations in measured hyperelasticity of the anterior, equatorial, posterior, and peripapillary sclera; and the ON and its sheath. The FEM predicted that adduction beyond the initiation of ON tethering concentrates stress and strain on the temporal side of the optic disc and peripapillary sclera, the ON sheath junction with the sclera, and retrolaminar ON neural tissue. However, some unfavorable combinations of tissue properties within the published ranges imposed higher stresses in these regions. With the least favorable combinations of tissue properties, adduction tethering was predicted to stress the ON junction and peripapillary sclera more than extreme conditions of intraocular and intracranial pressure. These simulations support the concept that ON tethering in adduction could induce mechanical stresses that might contribute to ON damage.

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“…The relationship between disc tilt or torsion and visual field defect progression is controversial. Some studies did not find any significant association (98)(99)(100)(101). Other studies suggested that the presence of disc tilt and a larger vertical disc tilt angle are protective factors against visual field progression (102, 103).…”

Section: Longitudinal Studiesmentioning

confidence: 99%

Myopic tilted disc: Mechanism, clinical significance, and public health implication

2023

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Myopic tilted disc is a common structural change of myopic eyes. With advancing ocular imaging technology, the associated structural changes of the eye, particularly the optic nerve head, have been extensively studied. These structural changes may increase patients’ susceptibility to axonal damage and the risk of developing serious optic neuropathies including glaucoma. They also lead to diagnostic difficulties of disease suspects and treatment dilemmas of patients, which implicate clinical practice and subsequently the health care system. In the context of the mounting prevalence of myopia worldwide and its implications to irreversible visual impairment and blindness, it is essential to gain a thorough understanding of the structural changes of myopia. Myopic tilted disc has been extensively investigated by different study groups. However, generalizing the knowledge could be difficult because of the variable definitions of myopic tilted disc utilized in these studies and the complexities of the changes. The current review aimed to clarify the concepts and discuss various aspects of myopic tilted disc, including the definitions, association with other myopia-related changes, mechanism of tilted disc development, structural and functional changes, and clinical implications.

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Influence of intraocular pressure reduction on progression of normal-tension glaucoma with myopic tilted disc and associated risk factors

Abstract: Lower-percent reduction in IOP was associated with NTG progression in eyes with myopic tilted discs, and the presence of disc hemorrhage was a risk factor for NTG progression.

Cited by 15 publications

References 27 publications

Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure

Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure

Finite element modeling of effects of tissue property variation on human optic nerve tethering during adduction

Myopic tilted disc: Mechanism, clinical significance, and public health implication

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