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Purpose: To identify the role of systemic arterial stiffness and choroidal microvascular insufficiency on structural progression of normal-tension glaucoma (NTG)., Design: Retrospective cohort study., Methods: A total of 107 early NTG eyes of 88 patients, who underwent pulse wave velocity (PWV) measurements and optical coherence tomography (OCT) angiography (OCT-A) at baseline, were categorized depending on the presence of peripapillary choroidal microvasculature dropout (MvD) and PWV. Differences in glaucomatous progression were analyzed. Structural progression rates were determined using the trend-based analysis of Cirrus OCT., Results: Thirty-two eyes displayed choroidal MvD (62.7 [95% CI 58.4-67.0] years old, 53.6% males), and 70 eyes did not show any MvD (59.9 (95% CI 57.1-62.6) years old, 53.3% males) at baseline. Patients were followed for 48.4 (95% CI 40.0-56.8) months. When they were further divided based on PWV (high PWV ≥ 1400 cm/sec), those with choroidal MvD and high PWV showed significantly faster thinning in macular ganglion cell-inner plexiform layer (GCIPL; P = .023). In comparison to those with low PWV and no MvD, eyes with high PWV and MvD in the peripapillary area were likely to show fast structural progression (≤-1.2 µm/year) in the macular GCIPL by odds of 6.019 (95% CI 1.619-38.531, P = .025)., Conclusions: In NTG eyes, GCIPL thinning was faster when choroidal MvD and high systemic arterial stiffness were present. The simultaneous presence of regional and systemic vascular insufficiency may be associated with rapid glaucoma structural progression in eyes with low baseline intraocular pressure., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Disclosure: The authors declare no conflict of interest.

Aims: In this study, we tested the hypothesis that intraocular pressure (IOP) parameters measured by dynamic contour tonometry (DCT) would be more relevant in progression of glaucoma when there is a history of laser refractive surgery (LRS) than the IOP parameters measured by Goldmann applanation tonometry (GAT) or calculated by correction formulae., Methods: Ninety-eight eyes in 54 patients with open-angle glaucoma and a history of LRS were included in this retrospective study. IOP was measured by both GAT and DCT during follow-up. Baseline, mean, and peak IOP, IOP fluctuation, and IOP reduction were measured by each tonometry method. Corrected IOP parameters using central corneal thickness and mean keratometry values were also analysed. Clustered logistic regression was used to identify variables correlated with progression of glaucoma. Areas under the curve (AUCs) for correlated variables were also compared., Results: The mean DCT value (OR 1.36, p=0.024), peak DCT value (OR 1.19, p=0.02) and pattern SD (OR 1.10, p=0.016) were significant risk factors for progression. There was a significant difference in the predictive ability of the mean DCT and GAT values (AUC 0.63 and 0.514, respectively; p=0.01) and of the peak DCT and GAT values (0.646 and 0.503, respectively, p=0.009). The AUCs for corrected IOP did not exceed those of DCT., Conclusions: IOP measurements were more associated with progression of glaucoma when measurements were obtained by DCT than by GAT or correction formulae in eyes with a history of LRS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To categorize the structural progression pattern of glaucoma, as detected by optical coherence tomography guided progression analysis, with respect to the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL)., Methods: One hundred sixty-four eyes with primary open-angle glaucoma were studied. The structural progression pattern evaluated by optical coherence tomography guided progression analysis was classified using hierarchical cluster analysis. The clinical parameters, patterns of structural progression, and visual field (VF) changes were compared among the groups., Results: Three groups were included: stable, progressive peripapillary RNFL thinning without macular GCIPL involvement, and progressive thinning of both the peripapillary RNFL and macular GCIPL. The third group, those with progressive peripapillary RNFL and macular GCIPL thinning, showed more progressive peripapillary RNFL thinning in the inferotemporal area and VF progression in the parafoveal area. Conversely, the 12 and 6 o'clock areas were the most common locations of progressive peripapillary RNFL thinning in the group without macular GCIPL involvement., Conclusions: Structural progression patterns of glaucoma can be categorized into three groups. The location of progressive peripapillary RNFL thinning is associated with progressive macular GCIPL thinning and pattern of VF changes in the affected area. Our results indicate that the use of only macular GCIPL analysis is inadequate for analyzing the structural progression of glaucoma., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2020 The Korean Ophthalmological Society.)

The purpose of this study was to identify risk factors associated with progressive retinal nerve fiber layer(RNFL) thinning of open-angle glaucoma(OAG) in patients whose intraocular pressure(IOP) was maintained low with medical treatment. Based on a retrospective review of medical records, OAG patients with ≥60 months of follow-up and mean IOP below 15 mmHg were recruited. All eyes underwent IOP measurement with Goldmann applanation tonometer(GAT), standard automated perimetry(SAP), and cirrus optical coherence tomography(cirrus OCT) at 6 month or 1 year intervals. RNFL thinning was assessed using the Guided Progression Analysis(GPA) software. Forty-one eyes of 41 patients (mean age 54.9 ± 13.5) were followed up for 77.8 ± 7.8 months. GPA detected 20 eyes (48.8%) with progressive RNFL thinning(-1.5 ± 0.5 um/year), who were subsequently classified as the 'rapid progression group.' Those whose rate of change in RNFL thickness was slower than -1.00 µm/year was classified as the 'slow progression group' (n = 21, -0.0 ± 0.4 um/year, P < 0.001). Mean IOP after initiating therapy was 13.2 ± 1.1 mmHg in the rapid progression group and 13.1 ± 1.3 mmHg in the slow progression group (P = 0.300; 14.8 ± 10.0% vs. 19.6 ± 12.4% reduction, P = 0.155). Disc hemorrhage was found to more frequently occur in the rapid progression group (P = 0.001). Multivariate logistic regression analysis showed that patients with disc hemorrhage were at a higher risk for progressive RNFL thinning in OAG (OR 37.529 95% CI 2.915-483.140) after adjusting for baseline co-variates (P = 0.005). In conclusion, disc hemorrhage is associated with progressive RNFL thinning in OAG with well-maintained IOP. Factors other than IOP appear to also play a role in OAG progression.

The utility of Goldmann applanation tonometry (GAT) for monitoring intraocular pressure (IOP) in open-angle glaucoma (OAG) patients with a history of laser refractive surgery was investigated by comparing IOP fluctuations measured using GAT and dynamic contour tonometry (DCT) on the same day. In this retrospective study, patients were divided into one of two subgroups according to IOP fluctuation values using GAT: 43 eyes in the low IOP fluctuation group (LIFG [GAT fluctuation ≤1.7 mmHg]); and 55 eyes in the high IOP fluctuation group (HIFG [GAT fluctuation >1.7 mmHg]). IOP fluctuation was defined as the standard deviation of all IOP values during follow-up. IOP parameters using GAT were compared with those of DCT. Correlation analyses were performed among IOP parameters, and between IOP fluctuation and associated factors including central corneal thickness, corneal curvature, and axial length. All IOP parameters demonstrated significantly high values in the HIFG compared with those in the LIFG. Mean and peak IOP using DCT were significantly higher than those using GAT in both groups. However, there were no significant differences in IOP fluctuation and reduction using both tonometry methods in the HIFG (p = 0.946 and p = 0.986, respectively). Bland-Altman analysis revealed similar fluctuations using GAT and DCT. In multivariate analyses, there was a significant correlation between fluctuations using GAT and DCT in the HIFG (p = 0.043). These results suggest that IOP monitoring using GAT is a reliable method of monitoring IOP change in glaucoma patients with a history of laser refractive surgery, especially those exhibiting high IOP fluctuation. Nevertheless, several factors, including central corneal thickness, corneal curvature, and axial length, should be considered when using GAT for IOP monitoring.

Purpose: To evaluate and compare the frequency, type and cause of imaging artifacts incurred when using swept-source optical coherence tomography (SS OCT) and Cirrus HD OCT in the same patients on the same day., Materials and Methods: From left eye OCT results of 72 patients, disc area and macular area data could be compared between the two types of OCT. For each scan, the final printout report and source data were examined. For comparison between the two types of OCT, only source image data were used because of differences in the final printout report format., Results: There were no significant differences in the artifact frequencies between the two groups in either area (disc area: 35.9% of SS OCT, 42.2% of Cirrus OCT, p = 0.523; Macular area: 24.2% of SS OCT, 22.7% of Cirrus OCT, p = 1.00). The overall results of artifact comparison between the two types of OCTs also showed no significant differences. Boundary misidentification was the most common type of artifact observed, and ocular pathology was the most common cause of artifact in both types of OCTs. Among ocular pathologies, the epiretinal membrane (ERM) was the most common cause of OCT artifact production in both types of OCTs., Conclusions: There was no significant difference in the frequency, type and cause of artifacts between SS OCT and Cirrus HD OCT. Artifacts in OCT can influence the interpretation of OCT results. In particular, ERM around the optic disc could contribute to OCT artifacts and should be considered in glaucoma diagnosis or during patient follow-up using OCT.

Background: To investigate the association between estimated trans-lamina cribrosa pressure difference (TLCPD) and prevalence of normal tension glaucoma (NTG) with low-teen and high-teen intraocular pressure (IOP) using a population-based study design., Methods: A total of 12,743 adults (≥ 40 years of age) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2012 were included. Using a previously developed formula, cerebrospinal fluid pressure (CSFP) in mmHg was estimated as 0.55 × body mass index (kg/m2) + 0.16 × diastolic blood pressure (mmHg)-0.18 × age (years)-1.91. TLCPD was calculated as IOP-CSFP. The NTG subjects were divided into two groups according to IOP level: low-teen NTG (IOP ≤ 15 mmHg) and high-teen NTG (15 mmHg < IOP ≤ 21 mmHg) groups. The association between TLCPD and the prevalence of NTG was assessed in the low- and high-teen IOP groups., Results: In the normal population (n = 12,069), the weighted mean estimated CSFP was 11.69 ± 0.04 mmHg and the weighted mean TLCPD 2.31 ± 0.06 mmHg. Significantly higher TLCPD (p < 0.001; 6.48 ± 0.27 mmHg) was found in the high-teen NTG compared with the normal group. On the other hand, there was no significant difference in TLCPD between normal and low-teen NTG subjects (p = 0.395; 2.31 ± 0.06 vs. 2.11 ± 0.24 mmHg). Multivariate logistic regression analysis revealed that TLCPD was significantly associated with the prevalence of NTG in the high-teen IOP group (p = 0.006; OR: 1.09; 95% CI: 1.02, 1.15), but not the low-teen IOP group (p = 0.636). Instead, the presence of hypertension was significantly associated with the prevalence of NTG in the low-teen IOP group (p < 0.001; OR: 1.65; 95% CI: 1.26, 2.16)., Conclusions: TLCPD was significantly associated with the prevalence of NTG in high-teen IOP subjects, but not low-teen IOP subjects, in whom hypertension may be more closely associated. This study suggests that the underlying mechanisms may differ between low-teen and high-teen NTG patients.

As laser refractive surgeries (LRS) have been widely performed to correct myopia, ophthalmologists easily encounter patients with glaucoma who have a history of LRS. It is well known that intraocular pressure (IOP) in eyes with glaucoma is not accurate when measured using Goldmann applanation tonometry. However, risk factors for glaucoma progression, particularly those associated with measured IOP, have rarely been studied. We analysed data for 40 patients with a history of LRS and 50 age-matched patients without a history of LRS. Structural progression was defined as significant changes in thickness in the peripapillary retinal nerve fibre layer as identified using optical coherence tomography event-based guided progression analysis. Risk factors were determined via Cox regression analysis. Disc haemorrhage (DH) was associated with glaucoma progression in both the non-LRS group and LRS group (hazard ratio (HR): 4.650, p = 0.012 and HR: 8.666, p = 0.019, respectively). However, IOP fluctuation was associated with glaucoma progression only in the LRS group (HR: 1.452, p = 0.023). Our results show that DH was a significant sign of progression in myopic glaucoma eyes. When treating patients with myopia and glaucoma, IOP fluctuation should be monitored more carefully, even if IOP seems to be well controlled. [ABSTRACT FROM AUTHOR]