Does the Enlargement of Retinal Nerve Fiber Layer Defects Relate to Disc Hemorrhage or Progressive Visual Field Loss in Normal-tension Glaucoma?

Nitta, Koji; Sugiyama, Kazuhisa; Higashide, Tomomi; Ohkubo, Shinji; Tanahashi, Takao; Kitazawa, Yoshiaki

doi:10.1097/ijg.0b013e3181e0799c

Cited by 72 publications

(64 citation statements)

References 21 publications

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“…24 One recent report showed that DH was more frequent in eyes with RNFL defect enlargement. 9 The authors of that study speculated that enlargement of RNFL defect causes damage or loss of capillaries at the border of a RNFL defect. This may be explained by ''collapse theory,'' which refers to structural alteration resulting in mechanical rupture of the vessels leading to DH.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Typically, DH develops in association with notching, progressive changes in the optic disc rim, localized retinal nerve fiber layer (RNFL) defects, and enlargement of localized RNFL defects. [6][7][8][9] Many studies have shown that rim notching or loss, focal RNFL defects, and corresponding localized and global visual field (VF) deterioration occur after DH. [10][11][12] Some studies have shown more pronounced progressive changes in the VF in eyes with recurrent DH compared to eyes with a nonrecurrent DH.…”

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confidence: 99%

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Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Kim

2015

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare clinical characteristics and visual field (VF) progression between glaucomatous eyes with disc hemorrhage (DH) recurring at the same or different locations in relation to the initial DH location. METHODS.One hundred forty-seven open-angle glaucoma patients with DH who were observed for more than 4 years and had more than six VF tests were included. Disc hemorrhage that recurred at the same location as the initial DH was defined as a DH at the same location, and DH that recurred at a different location was defined as a DH at a different location. Overall rate of VF change using the mean deviation (MD) was compared between groups using a linear mixed model, and Kaplan-Meier survival analysis was performed.RESULTS. Seventy-seven (52.4%) eyes had nonrecurrent DH, and 70 (47.6%) eyes had recurrent DH detected during the follow-up period. Recurrent DH at the same location (À0.32 dB/y) was not significantly different from the nonrecurrent DH group in terms of the rate of VF change (P ¼ 0.116). However, the recurrent DH group at different locations (À1.07 dB/y) had a significantly different rate of VF change compared to the recurrent DH group at the same location (P ¼ 0.014). By Kaplan-Meier analysis, eyes with recurrent DH at different locations showed the fastest time to VF progression compared to other groups (log rank test, P < 0.001).CONCLUSIONS. Eyes with recurrent DH recurring at different locations from initial DH sites had more pronounced VF progression.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Kim

2015

Invest. Ophthalmol. Vis. Sci.

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“…4 However, DH has been observed more frequently in patients with normal-tension glaucoma (NTG) than in patients with high-tension glaucoma, [10][11][12] and in early rather than in late stages of disease. 2,13 Hemodynamic disturbances, including ischemic microinfarction in the optic nerve head, 14 disorders of retinal circulation, 15 decrease in capillary perfusion, 16 and primary vascular dysregulation (PVD) 17 also have been proposed as causes of DH; these support vascular factors having a significant role in the pathogenesis of DH.…”

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confidence: 99%

Spontaneous Retinal Venous Pulsation and Disc Hemorrhage in Open-Angle Glaucoma

Kim

Weinreb

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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METHODS. Spontaneous venous pulsation was assessed and compared using a confocal scanning laser ophthalmoscope movie tool in 52 eyes of 52 patients with DH, and 111 eyes of 111 patients in without DH. Logistic regression analysis was used to determine the factors associated with the occurrence of DH.RESULTS. The frequency of SVP was 60.7% in overall patients with OAG. The absence of SVP was associated with lower untreated IOP (OR 0.880; P ¼ 0.045), longer axial length (OR 1.654; P ¼ 0.007), and worse visual field mean deviation (OR 0.884; P ¼ 0.035). The absence of SVP was not significantly associated with DH by logistic analysis (OR 0.844; P ¼ 0.626). Better visual field mean deviation (OR 1.098; P ¼ 0.043), lower untreated IOP (OR 0.886; P ¼ 0.021), and the tendency to cold hands (OR 2.688; P ¼ 0.032) were associated with DH.CONCLUSIONS. In consecutive patients with OAG, the absence of SVP was not associated with DH.

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“…A history of migraine, narrower neuroretinal rim width at the baseline, low mean arterial ocular perfusion pressure, and the use of systemic beta blockers were independent risk factors for the occurrence of disc hemorrhage in treated NTG patients (74) . The occurrence of an enlarged RNFL defect was more frequent in NTG patients who presented with disc hemorrhage, and the location of the defect was in the same region as that of the disc hemorrhage (75) . Using serial EDI-OCT, Lee et al observed that deformation or disruption of the lamina cribrosa precedes the occurrence of disc hemorrhage.…”

Section: Disc Hemorrhagementioning

confidence: 82%

Normal-tension glaucoma: an update

Esporcatte¹,

Tavares²

2016

Arquivos Brasileiros De Oftalmologia

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However, several structural and functional differences support the fact that different mechanisms may have a stronger role in the pathogenesis of NTG versus high-pressure POAG. Also, a recent study reported genetic variants associated with different tendencies towards POAG with lower or higher IOP (6) . Furthermore, clinical impression and anecdotal evidence suggest that NTG with mean IOP in the high teens (>15 mmHg), in which circadian fluctuation and CCT could lead to a possible misdiagnosis of an IOP ≤21 mmHg, would differ from NTG with mean IOP in the low teens (≤15 mmHg), with different ABSTRACT Descritores: Glaucoma de ângulo aberto; Pressão in traocular; Doenças do nervo óptico; Anti-hipertensivos/uso terapêuticopathogenesis and progression patterns, harder to achieve target IOP, and higher incidence of disc hemorrhages. Nonetheless, a recent report does not support this assumption and underscores low-teens NTG as an important entity (7) . The proportion of NTG varies depending on different population studies. In Asian epidemiological protocols, NTG constituted the majority of open-angle glaucomas (52%-92%), depending on the country and study methodology (8) . Normal IOP was measured in 57.1% cases of POAG in a South African study (9) . In white populations, the proportion of NTG was lower than that observed in Asian and African populations. In studies conducted in the United States, Netherlands, and Italy, NTG presented proportions of 31. 7%, 38.9%, and 30%, respectively (10-12) . The etiology of NTG is most likely multifactorial and still not well defined. Moreover, several alternative treatments based on this different pathogenesis have been discussed. The objective of this study was to review the mechanisms involved in the onset and progression of NTG and the efficacy of established and alternative therapies for NTG treatment. PathogenesisThe pathogenesis of NTG is unclear, and perhaps the development of the disease is a consequence of a complex interaction of several systemic and ocular factors. Different studies have shown that the cardiovascular system and intracranial pressure may be involved in the main pathways of optic nerve damage. Nevertheless, the complex relationship between these mechanisms and glaucoma pro gression continues to be debated.

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Does the Enlargement of Retinal Nerve Fiber Layer Defects Relate to Disc Hemorrhage or Progressive Visual Field Loss in Normal-tension Glaucoma?

Abstract: The enlargement of RNFLD in NTG was closely associated with DH occurrence and the deterioration of visual field.

Cited by 72 publications

References 21 publications

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Spontaneous Retinal Venous Pulsation and Disc Hemorrhage in Open-Angle Glaucoma

Normal-tension glaucoma: an update

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