What is glaucoma

To review and summarize the characteristics of corneal hysteresis (CH) and its relationship with glaucoma A PubMed search was carried out using the terms “corneal hysteresis”, “glaucoma”, and “biomechanics” Up to March 2018, all studies published in English are included in this review The value of CH reflects the ability of corneal tissue to absorb and release energy during bidirectional flattening It is an important biomechanical parameter of the cornea The CH value of healthy adults is about 11 mmHg The measurement of CH is reproducible and different People have different CH values, which are determined by the shape of the individual’s cornea The study found that all types of glaucoma, including primary open angle glaucoma, angle-closure glaucoma, normal tension glaucoma, congenital glaucoma, binocular asymmetrical glaucoma, CH values are lower than normal people, therefore, CH is therefore a good indicator of glaucoma diagnosis and screening Lower CH values are associated with thinner retinal nerve fiber layer (RNFL), larger linear cup/disk ratio (LCDR) and degree of optic disc defect A lower CH value can also result in a lower visual field index CH and the basic intraocular pressure play a synergistic role in the progression of glaucoma The study found that CH can change with changes in basic intraocular pressure, means CH increases when intraocular pressure decreases, while the CH decreases conversely when intraocular pressure increases Most clinical case studies have shown a decrease in CH after LASER refractive surgery CH has its limitations, such as corneal damage or corneal surgery, but in general, CH is a risk factor for glaucoma progression CH is used as a predictor of glaucoma risk and may help to assess the effect of corneal thickness on intraocular pressure The clinical significance of CH in the diagnosis and efficacy of glaucoma will become more explicit In the future, CH can also play an important role in the diagnosis and treatment of glaucoma

Corneal hysteresis and glaucoma.

The corneal viscoelasticity have great clinical significance, such as the early diagnosis of keratoconus. In this work, an analysis method which utilized the elastic wave velocity, frequency and energy attenuation to assess the corneal viscoelasticity is presented. Using phase-resolved optical coherence tomography, the spatial-temporal displacement map is derived. The phase velocity dispersion curve and center frequency are obtained by transforming the displacement map into the wavenumber-frequency domain through the 2D fast Fourier transform (FFT). The shear modulus is calculated through Rayleigh wave equation using the phase velocity in the high frequency. The normalized energy distribution is plotted by transforming the displacement map into the spatial-frequency domain through the 1D FFT. The energy attenuation coefficient is derived by exponential fitting to calculate the viscous modulus. Different concentrations of tissue-mimicking phantoms and porcine corneas are imaged to validate this method, which demonstrates that the method has the capability to assess the corneal viscoelasticity.

Assessment of corneal viscoelasticity using elastic wave optical coherence elastography.

Glaucoma is the leading cause of irreversible blindness worldwide and the prevalence is on the rising trend. Intraocular pressure (IOP) reduction is the mainstay of treatment. The current practice of IOP monitoring is based on spot measurements during clinic visits during office hours. However, there are up to 50% of glaucoma patients who had normal initial IOP, while some treated patients continued to have progressive glaucomatous optic nerve damage even with a low IOP. Recent studies have shown that the IOP of glaucoma patients fluctuated during the day with different patterns, and some of them had peak IOP outside office hours. These findings provided us with new insights on the role of 24-hour IOP monitoring in managing normal tension glaucoma and patients with progressive deterioration despite apparently well-controlled IOP. Nevertheless, results to date are rather inconsistent, and there is no consensus yet. In this review, we briefly highlighted the current modalities of 24-hour IOP monitoring and summarized the characteristic 24-hour IOP pattern and the clinical relevance of IOP parameters in predicting glaucomatous progression in different glaucoma subtypes. We also discussed the therapeutic efficacy of current glaucoma treatment modalities with respect to the mentioned 24-hour IOP profiles, so as to strengthen the role of 24-hour IOP monitoring in identifying and stratifying the risks of progression in glaucoma patients, as well as optimizing treatments according to their IOP profiles.

/pdf/role-of-24-hour-intraocular-pressure-monitoring-in-glaucoma-4bvukymrt4.pdf

Role of 24-Hour Intraocular Pressure Monitoring in Glaucoma Management.

This paper focuses on analysis of data acquired using Triggerfish contact lens sensor and devices for continuous monitoring of cardiovascular system properties. One of the aims of our research is to build machine learning models that can be applied in clinical practice to detect glaucoma independently of currently used imaging techniques. We show that cardiac sensor data derived attributes are complementary to Triggerfish data and improve mean AUC estimates of the predictive models. We propose methods of attribute generation for raw data recorded by the devices. During data preprocessing we consider division of 24-hour monitoring period for time intervals depending on physiological circadian cycle properties. Comprehensive comparison of model predictive performance metrics is included. Our predictive model involving measurements of corneal biomechanical properties and sensor data based attributes provides AUC of 0.87. It can support glaucoma detection without direct intraocular pressure measurement. We also refer to the issues related to personalized medicine and application of machine learning techniques. 

Sensor data analysis and development of machine learning models for detection of glaucoma

Purpose There are multiple reports of the role of corneal hysteresis (CH) as an independent risk factor for the diagnosis and risk of progression of normal-tension glaucoma (NTG). Our study measured CH with the Ocular Response Analyzer (ORA) in patients with intraocular pressure (IOP) <21 mmHg to investigate if a low CH would identify NTG in this Asian-based practice. Methods This was a prospective cross-sectional study of patients who underwent routine eye examination during 2016 in a private practice in Honolulu, Hawaii, where most patients are Asian. Inclusion criteria are: 1) ≥65 years 2) IOP <21 (compensated IOP by ORA), and 3) CH values <10 using ORA as measured by a single experienced technician. Exclusion criteria are: 1) sight-limiting ocular or corneal disease that would preclude accurate measurements for the purposes of the study. 2) Any patient who had difficulty in being tested with the ORA. 3) Patients who had any history of any type of glaucoma. All patients that met the inclusion criteria underwent fundus photography to measure cup-to-disc ratio and cup-to-disc asymmetry and also had central corneal thickness measured. Thickness of the retina nerve fiber layer was measured by ocular coherence tomography. The eyes with an average retina nerve fiber layer thickness less than 80 μm were classified as possible NTG and were scheduled for a visual field test. The field examination was considered valid only if the fixation, false positives, and false negatives were within the acceptable range. Patient demographics and data on preexisting diseases were collected including age, sex, coexisting medical conditions, and previous intraocular surgery. Those with thinning of retina nerve fiber layer on optical coherence tomography had a Humphrey visual field test to confirm the diagnosis of glaucoma. Results Seventy-six eyes of 46 patients that met the eligibility criteria were included in the study. Twenty-one previously undiagnosed eyes were confirmed as having NTG, which corresponds to an incidence of 27.6%. Conclusion CH measurement is a valuable test to assist in early diagnosis of NTG, especially in the elderly Asian population. With an established diagnosis, aggressive early treatments medically or surgically to further lower IOP can prevent irreversible blindness, which can severely impact the patient's family and socioeconomic status.

/pdf/the-role-of-corneal-hysteresis-during-the-evaluation-of-2thhd8qmm7.pdf

The role of corneal hysteresis during the evaluation of patients with possible normal-tension glaucoma.

Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures This study evaluated four-letter personality type from each participant. Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) (p = 0.049), thinking (T) than feeling (F) (p = 0.027), and judging (J) than perceiving (P) (p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

/pdf/myers-briggs-type-indicator-personality-types-of-3kw462cxdx.pdf

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents

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The role of corneal hysteresis during the evaluation of patients with possible normal-tension glaucoma.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents