Are large optic nerve heads susceptible to glaucomatous damage at normal intraocular pressure?

Burk, Reinhard; Rohrschneider, Klaus; Noack, Herbert; Völcker, H. E.

doi:10.1007/bf00181778

Cited by 86 publications

(43 citation statements)

References 38 publications

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“…Burk et al's observation of a higher occurrence of normal-tension glaucoma in eyes with a large cup area, 61 along with Schwartz et al's findings that the size of the cup increases with age apart from the effect of pressure, 62 suggests that a disc vulnerability component exists in the genetics of POAG, rendering the optic disc more susceptible to glaucomatous changes independent of IOP. Several studies provide the molecular substrate for this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Determinants and Heritability of Intraocular Pressure and Cup-to-Disc Ratio in a Defined Older Population

et al. 2005

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Purpose-To investigate the heritability of intraocular pressure (IOP) and cup-to-disc ratio (CDR) in an older well-defined population. Design-Family-based cohort study.Participants-Through the population-based Salisbury Eye Evaluation study, we recruited 726 siblings (mean age, 74.7 years) in 284 sibships.Methods-Intraocular pressure and CDR were measured bilaterally for all participants. The presence or absence of glaucoma was determined by a glacuoma specialist for all probands on the basis of visual field, optic nerve appearance, and history. The heritability of IOP was calculated as twice the residual between-sibling correlation of IOP using linear regression and generalized estimating equations after adjusting for age, gender, mean arterial pressure, race, self-reported diabetes status, and history of systemic steroid use. The heritability of CDR was calculated using the same model and adjustments as above, while also adjusting for IOP.Main Outcome Measures-Heritability and determinants of IOP and CDR, and impact of siblings' glaucoma status on IOP and CDR.Results-We estimated the heritability to be 0.29 (95% confidence interval [CI], 0.12-0.46) for IOP and 0.56 (95% CI, for CDR in this population. Mean IOP in siblings of glaucomatous probands was statistically significantly higher than in siblings of normal probands (mean difference, 1.02 mmHg; P = 0.017). The mean CDR in siblings of glaucomatous probands was 0.07 (or 19%) larger than in siblings of glaucoma suspect referrals (P = 0.045) and siblings of normal probands (P = 0.004).Conclusions-In this elderly population, we found CDR to be highly heritable and IOP to be moderately heritable. On average, siblings of glaucoma patients had higher IOPs and larger CDRs than siblings of nonglaucomatous probands.Primary open-angle glaucoma (POAG) is the second most common cause of blindness in the world 1 and affects approximately 2.2 million Americans. 2 Although the diagnosis of POAG centers on the characteristic excavation and atrophy of the optic nerve head and functional deficit measured by visual field (VF) change, 3 the heritability of intraocular pressure (IOP) and cup-to-disc ratio (CDR) have not been studied extensively thus far, despite the wellestablished role of heredity in POAG. In this study, we estimate the heritability of IOP and CDR from a cohort of sibships recruited through the Salisbury Eye Evaluation study. In addition, we also report the distribution of IOP and CDR among siblings of glaucomatous probands versus siblings of normal probands. Materials and Methods Subjects and General DesignBetween 1993 and 1995, a random sample of potential participants (ages 65 to 84 years) was chosen from the Health Care Financing Administration Medicare database and recruited from Salisbury, located on the Eastern Shore of Maryland, to engage in the population-based Salisbury Eye Evaluation study. 28 The cohort was invited for a follow-up examination including VF testing, optic nerve head imaging, and IOP measurement. All subjects with abnormal scr...

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Section: Discussionmentioning

confidence: 99%

Determinants and Heritability of Intraocular Pressure and Cup-to-Disc Ratio in a Defined Older Population

et al. 2005

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“…It enhances assessment of features of the optic disk, such as neuroretinal rim and cup area, that are necessary for accurate diagnosis and monitoring. It is also important to understand that patient characteristics 28,35,72,125,128,149,178,181 and the method used for measurement 16,50,52,122,131 will influence disk size estimates. Longitudinal studies are needed to evaluate the complex relationship between disk size, neural tissue, clinical and demographic factors and the development of glaucoma.…”

Section: Discussionmentioning

confidence: 99%

“…28 The Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the OHTS evaluated the hypothesis that large disks may be an important predictor of POAG in OHTS participants. However, disk size was not associated with the development of POAG in OHTS participants.…”

Section: Race Disk Size and Glaucoma Susceptibilitymentioning

confidence: 99%

Optic Disk Size and Glaucoma

Hoffmann

Zangwill

Crowston

et al. 2007

Survey of Ophthalmology

142

110

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Assessment of optic disk size is an important, but often overlooked, component of the diagnostic evaluation for glaucoma. Measured values of optic disk size vary with the measurement technique utilized. Available methods for disk size measurement and their respective strengths and limitations will be discussed. Further, actual disk size varies with race and possibly other demographic characteristics. Disk size is also associated with variation of specific anatomical structures of the optic nerve head and the retinal nerve fiber layer. These disk size-dependent variations may influence the susceptibility to glaucoma or the likelihood of glaucoma diagnosis. This manuscript reviews the published evidence relating to disk size and glaucoma.

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“…The method used by this device has been described in detail. [38][39][40][41][42][43][44] In eligible eyes, after keratometric values were measured, one topographic image was obtained through a dilated pupil (by using tropicamide 1%, Alcon, Fort Worth, Texas, USA). This is in contrast to the standard protocol of 3 images recommended usually.…”

Section: Ocular Perfusion Measurementsmentioning

confidence: 99%

First-line therapy with latanoprost 0.005% results in improved ocular circulation in newly diagnosed primary open-angle glaucoma patients: a prospective, 6-month, open-label study

Gherghel

Hosking

Cunliffe

et al. 2006

Eye

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Purpose To evaluate the effect of latanoprost 0.005% on the optic nerve head (ONH) and retinal circulation of newly diagnosed and previously untreated primary open-angle glaucoma (POAG) patients. Methods Twenty-two newly diagnosed and previously untreated POAG patients (mean age7SD: 68.38711.92 years) were included in this longitudinal open-label study. Patients were treated with latanoprost 0.005% once a day. Intraocular pressure (IOP), systemic blood pressure (BP), mean ocular perfusion pressure (MOPP), and ocular perfusion parameters 'volume', 'velocity', and 'flow' measured at the optic nerve head (ONH) and retina by means of Heidelberg Retina Flowmeter system were evaluated during a 6-month follow-up period. Results Treatment with latanoprost 0.005% resulted in a significant decrease in IOP (Po0.0001) and increase in MOPP (Po0.0001). After correcting for changes in MOPP, the blood velocity measured at the ONH level was significantly higher after 6 months of treatment than at baseline (P ¼ 0.0310). In addition, blood volume and flow measured at the peripapillary retina level improved after 3 and 6 months of treatment (P ¼ 0.0170; P ¼ 0.0260, and P ¼ 0.0170; P ¼ 0.0240 respectively).Conclusion Previously untreated POAG patients exhibit reduced IOP, increased MOPP and improved ocular perfusion at the ONH and retina levels when treated with Latanoprost 0.005%. These effects could be beneficial for glaucoma patients suffering from ocular vascular dysregulation.

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Are large optic nerve heads susceptible to glaucomatous damage at normal intraocular pressure?

Cited by 86 publications

References 38 publications

Determinants and Heritability of Intraocular Pressure and Cup-to-Disc Ratio in a Defined Older Population

Determinants and Heritability of Intraocular Pressure and Cup-to-Disc Ratio in a Defined Older Population

Optic Disk Size and Glaucoma

First-line therapy with latanoprost 0.005% results in improved ocular circulation in newly diagnosed primary open-angle glaucoma patients: a prospective, 6-month, open-label study

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