Association Between Neurocognitive Decline and Visual Field Variability in Glaucoma

Diniz-Filho, Alberto; Delano‐Wood, Lisa; Daga, Fábio B.; Cronemberger, Sebastião; Medeiros, Felipe A.

doi:10.1001/jamaophthalmol.2017.1279

Cited by 48 publications

(58 citation statements)

References 30 publications

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“…However, this finding may also be explained by poor vision and narrowed VF affecting a patient’s performance on the MoCA, especially on sections that require the use of vision for reading and writing. Additionally, it is also possible that poor cognition can affect the reliability and variability of VF testing results [28]. This further complicates the association between VF loss in glaucoma and cognitive function.…”

Section: Discussionmentioning

confidence: 99%

Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment

et al. 2018

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Background: It is currently unclear whether primary open-angle glaucoma (POAG) affects neurological functions outside of vision, such as cognition. Objective: This study examined the association between POAG and cognitive impairment in African Americans. Methods: Masked interviewers administered the Montreal Cognitive Assessment (MoCA) to patients enrolled in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study at the Scheie Eye Institute. Cases were further assessed for retinal nerve fiber layer (RNFL) thickness and visual field (VF) loss. Univariate and multivariate linear regression analyses were performed to compare mean MoCA score between cases and controls and to assess the association between POAG severity and MoCA score. Results: A total of 137 patients completed the MoCA, including 70 cases and 67 controls. The mean age ± SD was 68.7 ± 11.2 years for cases and 65.7 ± 10.4 years for controls (p = 0.11). The mean MoCA total score (out of 30 points) was 20.3 among POAG cases and 21.3 among controls (mean difference = –1.03, 95% confidence interval, CI = –2.54 to 0.48, p = 0.18). After adjusting for age, gender, education level, diabetes, hypertension, and smoking status, the mean difference in the MoCA total score between cases and controls was –0.64 (95% CI = –1.72 to 0.45, p = 0.25). Among cases, more VF loss was associated with lower total MoCA score for mean deviation (adjusted linear trend p = 0.02) and VF index (adjusted linear trend p = 0.03). There was no significant association between average RNFL thickness and total MoCA score. Conclusions: POAG cases and controls had similar neurocognitive function as measured by the MoCA. Among POAG cases, worse VF loss was associated with lower MoCA. Future studies are needed to further elucidate the clinical effect of neuropathy in POAG.

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Section: Discussionmentioning

confidence: 99%

Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment

et al. 2018

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“… 35 Uncorrected refractive error, patient motivation and instruction, fatigue, technician experience, time of day, season, race, cognitive level, and percentage of false-positive responses have been recognized as additional sources of variability. 36 – 40 Large fluctuations are an obstacle to the proper modeling of VF data, and several strategies have been employed to reduce the noise. 41 A first measure relies on controlling known causes, such as repetition of examinations scored as poorly reliable and training and motivation of both patient and technical staff.…”

Section: Discussionmentioning

confidence: 99%

A Method to Measure the Rate of Glaucomatous Visual Field Change

Mohamed

Morales

Rabiolo

et al. 2018

Trans. Vis. Sci. Tech.

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PurposeTo develop a method to measure the rate of glaucomatous visual field (VF) deterioration and to identify fast progressors.MethodsRetrospective, longitudinal, observational study of 8486 eyes of 4610 glaucomatous patients with ≥6 VFs and ≥3 years of follow-up. A Glaucoma Rate Index (GRI) was calculated. VF locations were partitioned into exponential decay or exponential improvement models. A pointwise rate of change (PRC) was estimated with an exponential fit and expressed as the percent/year change of the age- and location-matched normal perimetric range, presented as a spatially conserved VF map. PRCs were summed and normalized with boundary rates set by simulated decaying and improving VF series on a scale of −100 to +100, respectively.ResultsA total of 89,704 VF examinations with 425,039 test location series was used. Median follow-up and number of VFs/eye were 9.7 years and 9 VFs, respectively. Initial and final mean deviations (±SD) were −4.2 (±5.2) and −5.7 (±6.4) dB. The proportions of test locations designated as decayed, improved, and unchanged were 13%, 4%, and 83%, respectively. Mean PRCs for decay, improvement, and no change were −3.7 (±4.7)%/y, 2.5 (±2.6)%/y, and −0.5 (±2.1)%/y, respectively. The number of eyes with negative and positive GRIs was 5802 (68%) and 2390 eyes (28%), respectively. The proportion of eyes defined as fast progressors was 6.8%.ConclusionsGRI provides a robust measure of glaucomatous VF change, operates without discontinuity over the entire perimetric range, and can be used to identify fast progressors.Translational RelevanceThis study describes a novel method that can help the clinician to determine VF progression.

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“…Owing to the low reliability of static perimetry test in patients with AD, this examination was not performed in this group of patients. 20,21 The group with perimetric POAG comprised patients who have been treated for this reason at the Oftalmika Eye Hospital with a normal MMSE score ( ‡27 points), and with glaucomatous features of optic nerve neuropathy. These features were diffuse or focal thinning of the neuroretinal rim, hemorrhages on the edge of ONH, abnormal cup/disc (C/D) ratio >0.6, asymmetry of the two eyes (C/D ratios exceeding 0.2).…”

Section: Study Design and Patient Recruitmentmentioning

confidence: 99%

Comparison of Retinal Microvasculature in Patients With Alzheimer's Disease and Primary Open-Angle Glaucoma by Optical Coherence Tomography Angiography

Zabel

Kałuz̊ny

Wiłkość-Dębczyńska

et al. 2019

Invest. Ophthalmol. Vis. Sci.

120

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PURPOSE. Comparison of retinal microvasculature within the macula and the optic nerve head in the eyes of patients with Alzheimer's disease (AD), primary open-angle glaucoma (POAG), and in a healthy control (HC) group, using optical coherence tomography angiography (OCTA). METHODS. In this cross-sectional study, 27 patients with AD, 27 with POAG, and 27 healthy controls were enrolled. The Mini-Mental State Examination test was used to assess cognitive function. Ophthalmic examination included OCTA, which was used for the imaging of vascular flow within the layer of radial peripapillary capillaries (RPCs), and also in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) of the retina. RESULTS. In the AD group, the density of vessels in DVP was significantly reduced and the foveal avascular zone was increased when compared to POAG and HC groups (P < 0.001). Patients with POAG had a significantly reduced vessel density in RPCs and SVP as compared to AD and HC groups (P < 0.001). The average thickness of peripapillary retinal nerve fiber layer was correlated with the vessel density in SVP in patients with POAG (Pearson's r ¼ 0.66; P ¼ 0.0002) and was significantly lower in POAG and AD groups than in the HC group (P < 0.001). CONCLUSIONS. AD and POAG are neurodegenerative diseases associated with apoptosis of nerve cells and impairment of microvasculature. Despite the fact that in both diseases there are abnormalities of the entire retinal vascular system, significant microcirculatory impairment in POAG patients affects superficial vessels, whereas in AD patients it affects vessels located in the deeper retinal layers.

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Association Between Neurocognitive Decline and Visual Field Variability in Glaucoma

Cited by 48 publications

References 30 publications

Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment

Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment

A Method to Measure the Rate of Glaucomatous Visual Field Change

Comparison of Retinal Microvasculature in Patients With Alzheimer's Disease and Primary Open-Angle Glaucoma by Optical Coherence Tomography Angiography

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