No abstract

This condensed report may help the clinician assess glaucomatous damage.

The AO-SLO images revealed details of glaucomatous damage that are difficult, if not impossible, to see with current OCT technology. Adaptive optics SLO may prove useful in following progression in clinical trials, or in disease management, if AO-SLO becomes widely available and easy to use.

No abstract

Caucasian race and the presence and magnitude of myopia were found to be significantly associated with the presence of PFS in glaucomatous eyes with DH. Our results may help clinicians in the identification and surveillance of these eyes at higher risk of central VF loss.

Purpose To classify the appearance of the optic disc seen on fundus photographs of healthy subjects and patients with or suspected glaucoma whose diagnosis was based upon visual fields (VF) and spectral domain optical coherence tomography (sdOCT) results. Patients and Methods One eye of 100 patients with or suspected glaucoma and 62 healthy subjects were prospectively tested with 24-2 and 10-2 VF and macular and disc sdOCT cube scans. All eyes with or suspected glaucoma had a 24-2 mean deviation (MD) better than −6.0 dB and an abnormal appearing disc on stereophotographs. The retinal ganglion cell plus inner plexiform layer (RGC+) from the macular scans and the retinal nerve fiber layer (RNFL) from the macular and disc scans were segmented and converted to probabilities plots. An eye was considered “glaucoma” if the sdOCT probability plots showed an abnormality in a region that corresponded to a defect seen on the 24-2 and/or 10-2 VF total deviation plot. Similarly, an eye was considered “suspect” only if both the sdOCT and VF plots were normal. Healthy subjects (normal VFs and sdOCT) were classified as “controls” and used as reference for comparisons. Glaucoma specialists reviewed the stereophotographs and classified eyes based on the presence of signs suggestive of glaucomatous optic neuropathy (GON). Results The pattern of clinical signs of GON seen on stereophotographs was statistically different between glaucoma (P<0.001) and suspects (P<0.001) vs. controls and explained up to 68% of the total variance of the diagnosis based upon sdOCT and VFs. Vertical cup-to-disc (VCDR)>0.6, focal neuroretinal rim thinning, focal RNFL loss, and violation of the ISNT rule had the best performance to differentiate glaucoma and suspects from controls. Compared to the suspect group, glaucoma eyes (abnormal sdOCT and VF tests) were more likely to have VCDR>0.6 (92 vs. 69%, P=0.003), diffuse rim (53 vs. 9%, P<0.001) and RNFL (61 vs. 26%, P<0.001) thinning, and beta-zone parapapillary atrophy (68 vs. 17%, P<0.001). Conclusions Focal and diffuse signs of glaucoma damage seen on stereophotographs often match damage shown on VFs and sdOCT. In addition, damage shown on VFs and sdOCT is often missed during clinical evaluation. Longitudinal studies ought to differentiate focal signs of glaucoma damage seen on stereophotography from false-positives or very early loss.

Précis: Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype.Purpose: Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH). Patients and Methods:In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP ≥ 16 mm Hg) and LTDH (IOP < 16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups.Results: One hundred thirty-three DH patients were included (LTDH = 66 eyes; HTDH = 67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P = 0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P = 0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P = 0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index (P = 0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P < 0.001), and tended to have thinner central corneas (P = 0.066).Conclusions: Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.

No abstract