The Spatial Pattern of Neuroretinal Rim Loss in Ocular Hypertension

Strouthidis, Nicholas G.; Gardiner, Stuart K.; Sinapis, Christos; Burgoyne, Claude F.; Garway-Heath, David F.

doi:10.1167/iovs.08-2844

Cited by 23 publications

(21 citation statements)

References 28 publications

(21 reference statements)

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“…Scanning laser ophthalmoscopy has been used for more than 20 years and longitudinal studies have explored its potential for detection of glaucoma progression. Although topography of rim area change has been found to be consistent with what is expected in glaucoma,29 30 rim area change has not always been associated with evidence of functional change 31 32. A study by our group found only fair correlation between functional and structural rates of change in a group of patients with suspected or definite glaucoma 32.…”

Section: Introductionsupporting

confidence: 50%

Measuring rates of structural and functional change in glaucoma

Nouri‐Mahdavi

2014

Br J Ophthalmol

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Glaucoma is a progressive optic neuropathy. Hence, most glaucomatous eyes demonstrate signs of deterioration over time despite what may appear to be adequate treatment. The main goal of glaucoma treatment is to slow the rate of disease so that patients can prolong their functional vision. Therefore, it is important for clinicians caring for patients with glaucoma to be able to estimate rates of change with structural and functional outcomes in their patients. Various trend analysis models have been previously used to estimate rates of decay in glaucoma. The authors discuss the relevant issues and the inherent caveats related to estimating structural and functional rates of change in glaucoma. Patterns of deterioration, testing frequency, and combing structural and functional rates of change are also addressed.

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Section: Introductionsupporting

confidence: 50%

Measuring rates of structural and functional change in glaucoma

Nouri‐Mahdavi

2014

Br J Ophthalmol

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“…This discrepancy may stem from several differences in study design. First, in previous studies, 7,20 eyes with ocular hypertension or glaucoma with high IOP were mainly enrolled, whereas in the present study 80% of the patients with mild glaucoma and 60% of the patients with 20 the spatial pattern of rim change was assessed longitudinally, whereas RNFL and rim were cross-sectionally evaluated in the present study. Third, the differences in rim detection methodology should also be considered; cup margin and disc margin as determined by Cirrus HD-OCT may differ from those detected by disc photograph or HRT.…”

Section: Discussionmentioning

confidence: 92%

“…Jonas et al 7 reported that glaucomatous rim loss assessed by disc photographs occurred in all sectors with regional preferences depending on the stage of the disease. Strouthidis et al 20 investigated the spatial pattern of longitudinal rim area decline by using the HRT and reported that the slopes of changes in nasal and temporal areas were less than those in superior and inferior areas. On the other hand, a study utilizing serial disc photographs reported that the main pattern of cup extension in eyes with ocular hypertension was generalized expansion, 6 which agrees with the present results; presently, the relative amount sectorial rim area and thickness loss showed even topographic distribution throughout all areas without spatial preference.…”

Section: Discussionmentioning

confidence: 99%

Glaucoma Diagnostic Ability of Quadrant and Clock-Hour Neuroretinal Rim Assessment Using Cirrus HD Optical Coherence Tomography

Hwang

Kim

2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The aim of this study was to investigate the glaucoma diagnostic ability of quadrant and clock-hour neuroretinal rim assessment by Cirrus HD spectral-domain optical coherence tomography (OCT).METHODS. Eighty eyes of 80 glaucoma patients and 80 eyes of 80 healthy subjects were enrolled. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Cirrus HD-OCT. Quadrant and clock-hour rim areas and thicknesses were obtained from optic nerve head images and 3608 circumferential rim thickness curve of Cirrus HD-OCT, respectively. Area under receiver operating characteristic curves (AUCs) and sensitivities of RNFL thicknesses, rim areas, and rim thicknesses at a 90% specificity level were calculated.RESULTS. Quadrant and clock-hour rim area and thickness showed good diagnostic ability for glaucoma in all areas (AUCs, 0.877-0.969; sensitivities, 67.5%-96.3%). When the AUCs of RNFL thicknesses, rim areas, and rim thicknesses were compared, no significant difference was found in global area and superior and inferior quadrants (P > 0.05). However, in nasal and temporal quadrants, rim area and thickness had greater AUCs (AUCs, 0.919-0.945; sensitivities, 82.5%-86.3%) than RNFL thickness (AUCs, 0.749-0.776; sensitivities, 12.5%-33.8%; P < 0.001). Eyes with moderate to advanced glaucoma (mean deviation < -6 dB) had thinner RNFL than mild glaucoma (mean deviation ‡ -6 dB) in global area, superior, inferior, and temporal quadrants (P < 0.003); rim area and thickness showed no significant difference in all areas (P > 0.003).CONCLUSIONS. Neuroretinal rim assessment in nasal and temporal areas by Cirrus HD-OCT may enhance glaucoma diagnostic ability. RNFL and rim changes measured by Cirrus HD-OCT may be different according to the stages of glaucomatous damage. (Invest Ophthalmol Vis Sci.

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“…These techniques, including confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography, have improved the identification of early disease and also enhanced the observation of progressive optic nerve fiber loss over time (Figure 4). 30–34 …”

Section: Methodsmentioning

confidence: 99%

The Pathophysiology and Treatment of Glaucoma

Weinreb

Aung

Medeiros

2014

JAMA

3,098

2,485

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IMPORTANCE Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. OBJECTIVE To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. EVIDENCE REVIEW A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. FINDINGS The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. CONCLUSIONS AND RELEVANCE Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.

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The Spatial Pattern of Neuroretinal Rim Loss in Ocular Hypertension

Cited by 23 publications

References 28 publications

Measuring rates of structural and functional change in glaucoma

Measuring rates of structural and functional change in glaucoma

Glaucoma Diagnostic Ability of Quadrant and Clock-Hour Neuroretinal Rim Assessment Using Cirrus HD Optical Coherence Tomography

The Pathophysiology and Treatment of Glaucoma

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