Multiple Temporal Lamina Cribrosa Defects in Myopic Eyes with Glaucoma and Their Association with Visual Field Defects

Sawada, Yu; Araie, Makoto; Ishikawa, Makoto; Yoshitomi, Takeshi

doi:10.1016/j.ophtha.2017.04.027

Cited by 55 publications

(53 citation statements)

References 30 publications

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“…It has been reported that small disc size and long AXL might be related to the development of the focal LC defect. 33,34 In this study, the focal γPPA group had a significantly larger width of both the horizontal and vertical optic disc widths and shorter AXL than the conventional γPPA group. Moreover, the values in the focal γPPA group were similar to those in the no γPPA group (Table 2).…”

Section: Discussionmentioning

confidence: 50%

Characteristics of Focal Gamma Zone Parapapillary Atrophy

Kim

Weinreb

Zangwill

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Citation: Kim HR, Weinreb RN, Zangwill LM, Suh MH. Characteristics of focal gamma zone parapapillary atrophy. Invest Ophthalmol Vis Sci. 2020;61(3):17. https://doi.org/10.1167/iovs.61.3.17 PURPOSE.The purpose of this study was to investigate the characteristics of focal γ-zone parapapillary atrophy (focal γPPA) in patients with primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SD-OCT). METHODS.Three groups of POAG eyes (n = 214) were defined according to the circumferential extent of Bruch's membrane (BM) within the β-zone PPA, as follows: (1) no γPPA (intact BM; n = 81), (2) conventional γPPA (γPPA involving the fovea-BM-opening axis; n = 89), and (3) focal γPPA (γPPA not involving the fovea-BM-opening axis; n = 44). Clinical and ocular characteristics, including age, axial length (AXL), and focal lamina cribrosa (LC) defects were compared among the three groups. RESULTS.The focal γPPA group was significantly older (60.6 ± 11.0 years) and had shorter AXL (24.10 ± 1.34 mm) than those of the conventional γPPA group (46.2 ± 13.8 years and 26.53 ± 1.61 mm, respectively; P < 0.001). These values of the focal γPPA group were similar to those of the no γPPA group (23.73 ± 0.97 mm for AXL and 64.0 ± 13.0 years for age). The focal γPPA group had a significantly higher prevalence of focal LC defects than did the other two groups (70.5% [31/44] for the focal γPPA group versus 46.1% [41/89] for the conventional γPPA group versus 37.0% [30/81] for the no γPPA group; P = 0.002). CONCLUSIONS.Focal γPPA was differentiated from conventional γPPA by older age and shorter AXL. Further, focal γPPA was frequently accompanied by focal LC defects. Longitudinal studies elucidating whether focal LC defects and focal γPPA share common pathogenesis are warranted.

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Section: Discussionmentioning

confidence: 50%

Characteristics of Focal Gamma Zone Parapapillary Atrophy

Kim

Weinreb

Zangwill

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…A focal LC defect was defined as a loss of high reflectivity from the anterior-to-posterior border of the full-thickness LC on B-scan images. To avoid false-positives, the defects were required to have had a maximal diameter greater than 100 μm and a depth greater than 30 μm, and to have been present in two adjacent B-scans 14,15 . Shadows were differentiated from LC defects on the basis of their characteristic signal void behind the vessels and tissues.…”

Section: Detection Of Lamina Cribrosa Defectmentioning

confidence: 99%

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Sung

Heo

Piao

et al. 2020

Sci Rep

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We investigated the relationship between microstructure of β-parapapillary atrophy (β-ppA) and morphologic features of optic nerve head (onH) and posterior pole in highly myopic eyes. eighty-nine highly myopic eyes were included in this study. Bruch's membrane opening (BMo) area, lamina cribrosa (Lc) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (ct), macular Bruch's membrane (BM) length, and width of β-ppA with and without Bruch's membrane (ppA +BM and ppA −BM ) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA −BM was larger with increasing BMo area (P = 0.001), whereas the BMO area was not associated with the width of PPA +BM . the large ppA +BM was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P < 0.001), longer macular BM length (P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-ppA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.Classic funduscopic β-parapapillary atrophy (β-PPA) is a region of visible large choroidal vessels and sclera due to the lack of retinal pigment epithelium (RPE). β-PPA can be histologically subclassified based on the presence or absence of Bruch's membrane (BM): β-PPA with BM (PPA +BM ; β zone) and β-PPA without BM (PPA −BM ; γ zone). It has been known that PPA +BM might be due to age-related atrophy of the RPE and associated with the development of glaucoma 1-4 . Whereas, PPA −BM has been considered as a result of mechanical stretching in the peripapillary sclera and border tissue during axial elongation; hence a significant association between axial length and PPA −BM width has been consistently reported 1-3,5 . However, we previously reported that PPA +BM was also found in 20-30-year-old myopia subjects and suggested that PPA +BM in young myopia patients might be related to axial elongation, not age-related atrophy 6 . In accordance with our report, Lee et al. 7 recently found an enlargement of PPA +BM as myopia progressed and proposed that PPA +BM found in children might be an entirely different entity from PPA +BM in elderly individuals, sharing an etiology with PPA −BM .Several factors might contribute to β-PPA development during axial elongation, but the etiology of PPA +BM and PPA −BM enlargement remains elusive so far. It is unclear why some myopia patients exhibit only PPA −BM , whereas others with a similar degree of myopia exhibit both PPA +BM and PPA −BM . In this study, we hypothesized that morphologic features of the optic nerve head (ONH) and the posterior pole might give clues to the mechanisms of differential developments of β-PPA in myopic eyes. Therefore, the purpose of this work was to investigate the relationship between microstructure of β-PPA and the morphologic featur...

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“…Optic disc tilt in highly myopic eyes deform the lamina cribrosa (LC) and may obstruct axoplasmic flow within the optic nerve head, thus promoting glaucomatous optic nerve damage 75. Imaging of the LC integrity in these eyes may yield information on the risk of glaucoma 11.…”

Section: Introductionmentioning

confidence: 99%

“…Imaging of the LC integrity in these eyes may yield information on the risk of glaucoma 11. Sawada et al 75 evaluated LC defects in myopic eyes with and without open-angle glaucoma using enhanced depth OCT and found these defects to be related to the optic disc tilt angle and were associated with glaucomatous visual field defects in both location and severity.…”

Section: Introductionmentioning

confidence: 99%

“…The border tissue is a cuff of collagenous tissue arising from the sclera that joins the Bruch’s membrane at the optic disc margin 75. Han et al 78 evaluated the externally oblique border tissue length, optic nerve head tilt angle and optic canal obliqueness, and observed that temporally located maximal values for these parameters were independently associated with the presence of myopic normal-tension glaucoma, and were consistent with the location of retinal nerve fibre layer defects.…”

Section: Introductionmentioning

confidence: 99%

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Imaging in myopia: potential biomarkers, current challenges and future developments

et al. 2019

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Myopia is rapidly increasing in Asia and around the world, while it is recognised that complications from high myopia may cause significant visual impairment. Thus, imaging the myopic eye is important for the diagnosis of sight-threatening complications, monitoring of disease progression and evaluation of treatments. For example, recent advances in high-resolution imaging using optical coherence tomography may delineate early myopic macula pathology, optical coherence tomography angiography may aid early choroidal neovascularisation detection, while multimodal imaging is important for monitoring treatment response. However, imaging the eye with high myopia accurately has its challenges and limitations, which are important for clinicians to understand in order to choose the best imaging modality and interpret the images accurately. In this review, we present the current imaging modalities available from the anterior to posterior segment of the myopic eye, including the optic nerve. We summarise the clinical indications, image interpretation and future developments that may overcome current technological limitations. We also discuss potential biomarkers for myopic progression or development of complications, including basement membrane defects, and choroidal atrophy or choroidal thickness measurements. Finally, we present future developments in the field of myopia imaging, such as photoacoustic imaging and corneal or scleral biomechanics, which may lead to innovative treatment modalities for myopia.

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Multiple Temporal Lamina Cribrosa Defects in Myopic Eyes with Glaucoma and Their Association with Visual Field Defects

Cited by 55 publications

References 30 publications

Characteristics of Focal Gamma Zone Parapapillary Atrophy

Characteristics of Focal Gamma Zone Parapapillary Atrophy

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Imaging in myopia: potential biomarkers, current challenges and future developments

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