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      Assessment of Open-Angle Glaucoma Peripapillary and Macular Choroidal Thickness Using Swept-Source Optical Coherence Tomography (SS-OCT)

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          Abstract

          Objective

          To compare peripapillary and macular choroidal thickness (PCT and MCT) between open-angle glaucoma (OAG) and normal controls using swept-source optical coherence tomography (SS-OCT), and to evaluate global and localized relationships between choroidal thickness and various factors in OAG, also using SS-OCT.

          Methods

          In this cross-sectional comparative study, 134 OAG patients and 73 normal controls were examined. PCT (global, 12 clock-hour sectors), MCT (global, six sectors) were measured by SS-OCT. The difference in choroidal thickness between the OAG patients and the normal controls was analyzed. The relationships between choroidal thickness and various factors including age, sex, spherical equivalent (SE), axial length (AXL), central corneal thickness (CCT), intraocular pressure (IOP), peripapillary retinal nerve fiber layer thickness (pRNFLT), visual field mean deviation (MD), ganglion cell-inner plexiform layer thickness (GCIPLT), and disc area were analyzed by univariate and multivariate linear regression. Global and regional analyses were performed in 12 segments of the peripapillary circle and in six sectors of the macula.

          Results

          There were significant differences in global PCT and MCT between the OAG patients and the normal controls (115.22±41.17 vs. 138.89±44.70, P<0.001), (184.36±57.15 vs. 209.25±61.11, P = 0.004). The difference in global PCT remained, both after adjusting for age, AXL (117.08±3.45 vs. 135.47±4.70, P = 0.002) and also after adjusting for age, AXL, disc area (117.46±3.46 vs. 135.67±4.67, P = 0.002). But the difference in global MCT did not remain after adjusting for age, AXL, SE (188.18±4.46 vs. 202.25±6.08, P = 0.066). PCT showed significant differences between the groups in all of the 12 clock-hour sectors. These differences remained after adjusting for age, AXL and for age, AXL, disc area, with the exception of the 10 o’clock (o/c) sector. MCT in six sectors showed differences between the two groups, but they did not remain after adjusting for age, AXL, SE. In a multivariate regression analysis of the OAG patients, global PCT showed correlations with age (β = -1.18, P = 0.001), AXL (β = -14.01, P<0.001), and disc area (β = -16.67, P = 0.026). Global MCT, meanwhile, showed a significant correlation with age (β = -1.92, P<0.001), AXL. (β = -21.97, P<0.001). Choroidal thickness did not show any global or localized relationship with glaucoma severity in the OAG patients.

          Conclusions

          The global and all 12 clock-hour PCT, with the exception of the 10 o/c sector, were thinner in OAG; however, they did not show any correlation with glaucoma severity. Possible roles of PCT in glaucoma pathogenesis should be investigated further.

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          Most cited references21

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          Choroidal thickness measured by spectral domain optical coherence tomography: factors affecting thickness in glaucoma patients.

          To measure choroidal thickness and to determine parameters associated with it. Cross-sectional study. Seventy-four glaucoma patients and glaucoma suspects. Spectral domain optical coherence tomography (SD-OCT) scans were obtained to estimate average choroidal thickness in a group of glaucoma suspects and glaucoma patients. The average thickness was calculated from enhanced depth SD-OCT images and manually analyzed with Image J software. Open-angle glaucoma, open-angle glaucoma suspect, primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspect were defined by published criteria. Glaucoma suspects had normal visual fields bilaterally. Glaucoma was defined by specific criteria for optic disc damage and visual field loss in ≥1 eye. The most affected eye was analyzed for comparisons across individuals, and right/left and upper half/lower half comparisons were made to compare thickness against degree of visual field damage. Average macular and peripapillary choroidal thickness measured using SD-OCT. The choroidal-scleral interface was visualized in 86% and 96% of the macular and peripapillary scans, respectively. In multivariable linear regression analysis, the macular choroid was significantly thinner in association with 4 features: Longer eyes (22 μm per mm longer [95% confidence interval (CI), -33, -11]), older individuals (31 μm thinner per decade older [95% CI, -44, -17]), lower diastolic ocular perfusion pressure (26 μm thinner per 10 mmHg lower [95% CI, 8, 44]), and thicker central corneas (6 μm per 10 μm thicker cornea [95% CI, -10, 0]). The choroid was not significantly thinner in glaucoma patients than in suspects (14 μm [95% CI, -54, 26]; P = 0.5). Peripapillary choroidal thickness was not significantly different between glaucoma and suspect patients. Thickness was not associated with damage severity as estimated by visual field mean deviation or nerve fiber layer thickness, including comparisons of right with left eye or upper with lower values. Age, axial length, CCT, and diastolic ocular perfusion pressure are significantly associated with choroidal thickness in glaucoma suspects and glaucoma patients. Degree of glaucoma damage was not consistently associated with choroidal thickness. Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            The blood supply of the optic nerve head and the evaluation of it - myth and reality.

            Evidence has gradually emerged that there is vascular insufficiency in the optic nerve head (ONH) in both anterior ischemic optic neuropathy (AION) and glaucomatous optic neuropathy (GON); thus both represent ischemic disorders of the ONH. Together these diseases constitute a major cause of blindness or seriously impaired vision in man. Consequently there has recently been great interest in the ONH circulation in health and disease and in how to evaluate it. Many studies of the subject have been published, with conflicting interpretations and claims. The basis of the inconsistent information seems to be confusion on some fundamental issues concerning the ONH circulation itself. The objective of this paper is to differentiate myths and misconceptions from reality about the ONH blood supply; to elucidate the reasons for disagreement on the blood supply of the ONH; and to evaluate the reliability and validity of various methods currently used to measure ONH blood flow.
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              • Article: not found

              Ocular hemodynamics and glaucoma prognosis: a color Doppler imaging study.

              To evaluate the effect of optic nerve circulation, using color Doppler imaging (CDI), on the progression of visual field damage in primary open-angle glaucoma. The relationship between the results of retrobulbar CDI, performed shortly after the diagnosis of primary open-angle glaucoma, and the progression of visual field loss for 7 years was evaluated in 44 glaucoma patients. Color Doppler imaging variables in patients with a stable and deteriorating clinical course were compared, and the pattern of increasing risk for different CDI values was analyzed using an additive logistic model. Based on this nonparametric analysis, we arrived at a discriminant CDI value identifying glaucoma patients with a poor prognosis. On the basis of the discriminant value, patients were divided into 2 groups, and the odds ratio of visual field loss for each group was then estimated. Patients with a stable visual field had a higher diastolic velocity and a lower resistivity index in the ophthalmic artery (P<.001 for both) compared with those with a deteriorating visual field during the study. The odds of visual field deterioration in patients with an ophthalmic artery resistivity index of 0.78 or higher was about 6 times that of patients with an ophthalmic artery resistivity index lower than 0.78. Color Doppler imaging variables of the ophthalmic artery correlate with the risk of visual field deterioration in patients with primary open-angle glaucoma.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 June 2016
                2016
                : 11
                : 6
                : e0157333
                Affiliations
                [001]Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
                Charité University Medicine Berlin, GERMANY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YJS KHP. Performed the experiments: YJS YKK KHP. Analyzed the data: YJS YKK KHP. Contributed reagents/materials/analysis tools: YJS YKK JWJ KHP. Wrote the paper: YJS KHP.

                Article
                PONE-D-15-35920
                10.1371/journal.pone.0157333
                4911141
                27309734
                2b278b28-1439-4108-aece-d395488e5a79
                © 2016 Song et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 August 2015
                : 29 May 2016
                Page count
                Figures: 2, Tables: 5, Pages: 12
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Ophthalmology
                Eye Diseases
                Glaucoma
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
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                Ocular System
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                Ocular System
                Ocular Anatomy
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                Anatomy
                Ocular System
                Ocular Anatomy
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                Diagnostic Medicine
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