Optic Nerve Damage in Human Glaucoma

Quigley, Harry A.

doi:10.1001/archopht.1981.03930010635009

Cited by 1,085 publications

(337 citation statements)

References 22 publications

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“…[1][2][3][4] The optic disc examination using ophthalmoscope varies widely depending on the examiner, and since in normal eyes the individual variation of the optic disc shape is large, this examination, although it suitable as a glaucoma screening test, cannot contribute decisively to the early and definite diagnosis of glaucoma. 5 It has been shown that changes of the optic disc or in the vicinity of the disc and RNFL defects precede the visual acuity impairment.…”

supporting

confidence: 41%

“…Particularly, it has the problem that visual field defects can be detected only after a substantial progression of the loss of the optic nerve axon, and therefore it is limited for the early diagnosis of glaucoma. [1][2][3][4] Several investigators have shown that the RNFL defect precedes the visual field defect, and recently Quigley et al have reported that in glaucomatous optic nerve damage, the RNFL damage due to the damage of the retinal ganglion cells could become an important marker for the impairment of ocular function, [5][6][7][17][18][19] and that such reduction of the RNFL thickness precedes the optic disc change. 2,13,14,[17][18][19] In addition, for the detection of the extremely early glaucomatous change, numerous studies reported the greater importance of the continuous retinal nerve fiber examination compared to the µ continuous optic disc examination.…”

mentioning

confidence: 42%

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Quantitative Analysis of Retinal Nerve Fiber Layer Thickness of Normal Children and Adolescents

Ahn

Son²,

Kim

et al. 2005

Korean J Ophthalmol

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supporting

confidence: 41%

mentioning

confidence: 42%

Quantitative Analysis of Retinal Nerve Fiber Layer Thickness of Normal Children and Adolescents

Ahn

Son²,

Kim

et al. 2005

Korean J Ophthalmol

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“…1,2) It is one of the most common causes of visual impairment and blindness throughout the world and is more common in the elderly.3) The major risk factor for glaucoma is elevated intraocular pressure (IOP), which leads to apoptosis and loss of retinal ganglion cells. 4) In treating glaucoma, the focus is on reducing IOP, and retinal and optic nerve damage.…”

mentioning

confidence: 51%

Reduction in Intraocular Pressure by the Instillation of Eye Drops Containing Disulfiram Included with 2-Hydroxypropyl-.BETA.-cyclodextrin in Rabbit

Ito

Nagai

Shimomura

2010

Biological & Pharmaceutical Bulletin

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Glaucoma is characterized by nerve degeneration that causes the disappearance of retinal ganglion cells, visual field loss and excavation of the optic disk, and ophthalmopathy. 1,2) It is one of the most common causes of visual impairment and blindness throughout the world and is more common in the elderly.3) The major risk factor for glaucoma is elevated intraocular pressure (IOP), which leads to apoptosis and loss of retinal ganglion cells. 4) In treating glaucoma, the focus is on reducing IOP, and retinal and optic nerve damage. However, the retinal and optic nerve damage that result from elevated IOP are not satisfactorily controlled by the current therapies. Therefore, the search for successful therapies for glaucoma is a high priority.Nitric oxide (NO) is synthesized from the guanidino-nitrogen of L-arginine and molecular oxygen by nitric oxide synthase (NOS). Endothelial NOS and neuronal NOS are present in most ocular tissues, including those responsible for aqueous dynamics, i.e. the ciliary processes, ciliary muscle and trabecular meshwork.5-7) NO causes relaxation of the ciliary muscle and trabecular meshwork. 8,9) The relaxation of the ciliary muscle tends to decrease trabecular outflow facility and increase uveoscleral outflow, while relaxation of the trabecular meshwork increases trabecular outflow facility. Thus the effects of NO on IOP vary depending upon the site of action. On the other hand, recently, Kiel et al. 10) reported that the systemic inhibition of NOS by N G -nitro-L-arginine methyl ester (L-NAME) causes a large, rapid decrease in IOP by due to ciliary vasoconstriction in rabbits. Therefore, agents that inhibit NOS in the blood vessel of ciliary body might prove useful in the treatment of glaucoma.Diethyldithiocarbamate (DDC) is a potent NOS inhibitor and radical scavenger. 11,12) However, DDC is unstable in neutral solution, and is not able to penetrate through the cornea into the aqueous humor.13) Disulfiram (DSF), a dimer of DDC, has long been used to treat alcoholic syndrome without severe side effects. 14) However, its application in the ophthalmic field is limited due to its poor water solubility.Cyclodextrins are cyclic oligosaccharides comprising R-Dglucose linked by R-(1-4) glucosidic bonds. Natural cyclodextrins and their synthetic derivatives have been studied extensively to improve certain properties such as their solubility, stability, and/or bioavailability.15) 2-Hydroxypropyl-bcyclodextrin (HPbCD) is a cyclic oligosaccharide with a hydrophilic outer surface and a lipophilic cavity that is capable of forming inclusion complexes with many lipophilic drugs by taking up the drug molecule, or part of it, into its lipophilic cavity. 16,17) In aqueous solution, hydroxypropylmethylcellulose (HPMC), a water-soluble polymer, increases the solubilizing effect of cyclodextrins on lipophilic drugs by increasing the stability constants of the drug/cyclodextrin inclusions.18) We previously found that HPbCD and HPMC increase the solubility of DSF, and solve the problem of its poor wat...

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“…10,12 It may be that a sizeable proportion of these patients have early glaucoma (not detectable perimetrically), which is consistent with the theory that structural changes precede the earliest detectable visual field defects in glaucoma. [1][2][3][4] Another reason for differences in sensitivity and specificity values are the criteria used for determining a positive or negative result. We used the GDx number and HRT regression classification because as a screening procedure the criteria should be as simple as possible to attain but yet give good reliability, other groups have used specific parameters of the optic disc topography or different 'cutoffs' in GDx number between normal and abnormal.…”

Section: Discussionmentioning

confidence: 49%

“…Both retinal nerve fibre layer (RNFL) thickness disturbances and optic disc damage have been shown to precede visual loss, [1][2][3][4] so that objective assessment of these parameters may help physicians detect and monitor glaucoma earlier.…”

Section: Introductionmentioning

confidence: 44%

A comparison of HRT II and GDx imaging for glaucoma detection in a primary care eye clinic setting

Andreou

Wickremasinghe

Asaria

et al. 2006

Eye

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Purpose To evaluate the performance of the HRT II (Heidelberg retinal tomograph) and GDx (glaucoma detection) retinal nerve fibre analyzer in GDx when used in the primary care eye clinic setting for glaucoma screening. Patients and Methods The study was prospective, cross-sectional, and hospitalbased. One-hundred and twelve patients, 59 women and 53 men with a mean age of 57.8 years (range 18-85 years), had consecutive HRT II disc imaging and GDx retinal nerve fiber layer analysis. The Moorfield's regression classification and the 'GDx number' were used to predict the likelihood of glaucoma. A separate clinician, masked to the instrument results determined a definitive diagnosis, based on clinical examination. The extent of agreement between instrument prediction and the clinician diagnosis of glaucoma was examined by generating sensitivity and specificity tables. Results The HRT II had a sensitivity of 0.79 (95% CI: 0.60-0.92) and a specificity of 0.70 (95% CI: 0.60-0.78). The positive predictive value of the HRT II was 0.43 (95% CI: 0.29-0.57). Using a GDx number of 50 as 'cutoff' for glaucoma detection, the GDx had a sensitivity of 0.80 (95% CI: 0.59-0.93) and a specificity of 0.72 (95% CI: 0.61-0.80), with a positive predictive value of 0.43 (95% CI: 0.28-0.59). Conclusions For glaucoma detection, neither the HRT II nor the GDx are effective as stand-alone screening devices in the primary care setting.

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Optic Nerve Damage in Human Glaucoma

Cited by 1,085 publications

References 22 publications

Quantitative Analysis of Retinal Nerve Fiber Layer Thickness of Normal Children and Adolescents

Quantitative Analysis of Retinal Nerve Fiber Layer Thickness of Normal Children and Adolescents

Reduction in Intraocular Pressure by the Instillation of Eye Drops Containing Disulfiram Included with 2-Hydroxypropyl-.BETA.-cyclodextrin in Rabbit

A comparison of HRT II and GDx imaging for glaucoma detection in a primary care eye clinic setting

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