Glaucoma is a group of optic neuropathies characterized by a progressive degeneration of retina ganglion cells (RGCs) and their axons that precedes functional changes detected on the visual field. The macular ganglion cell complex (GCC), available in commercial Fourier-domain optical coherence tomography, allows the quantification of the innermost retinal layers that are potentially involved in the glaucomatous damage, including the retinal nerve fiber (RNFL), ganglion cell and inner plexiform layers. The average GCC thickness and its related parameters represent a reliable biomarker in detecting preperimetric glaucomatous damage. The most accurate GCC parameters are represented by average and inferior GCC thicknesses, and they can be associated with progressive visual field loss. Although the diagnostic accuracy increases with more severe glaucomatous damage and higher signal strength values, it is not affected by increasing axial length, resulting in a more accurate discrimination of glaucomatous damage in myopic eyes with respect to the traditional RNFL thickness. The analysis of the structure-function relationship revealed a good agreement between the loss in retinal sensitivity and GCC thickness. The use of a 10-2° visual field grid, adjusted for the anatomical RGCs displacement, describes more accurately the relationship between RGCs thickness and visual field sensitivity loss.

/pdf/ganglion-cell-complex-analysis-in-glaucoma-patients-what-can-zb73l0ackj.pdf

Ganglion Cell Complex Analysis in Glaucoma Patients: What Can It Tell Us?

Purpose

The aim of this study was to measure retinal nerve fibre layer thickness (RNFLT) and its associated factors in a population-based setting.



Methods

The population-based Beijing Eye Study 2011 included 3468 individuals. The study participants underwent spectral-domain optical coherence tomography (Spectralis®; Spectralis OCT)–assisted measurement of the RNFLT. For this study, exclusion criteria were glaucoma, pseudoexfoliation, best-corrected visual acuity of >0.5 logMAR, macular diseases, previous ocular surgery and known neurological diseases. The only inclusion criterion was an age of 50+ years.



Results

The inclusion criteria were fulfilled by 2548 participants. Mean RNFLT was 102 ± 11 μm. RNFLT was significantly (p < 0.001) thicker in the temporal inferior sector (153 ± 21 μm) than in the temporal superior sector (138 ± 21 μm), nasal inferior sector (118 ± 24 μm), nasal superior sector (106 ± 21 μm), temporal sector (76 ± 13 μm) and nasal sector (73 ± 15 μm). The mean intereye difference in RNFLT was 4.4 ± 6.0 μm. In multivariate analysis, thicker RNFLT was associated with younger age (p < 0.001), female gender (p < 0.001), urban region (p = 0.003), larger optic disc size (p < 0.001), larger neuroretinal rim area (p < 0.001), hyperopic refractive error (p < 0.001), larger beta zone of parapapillary atrophy (p = 0.008) and thicker subfoveal choroidal thickness (p = 0.02). RNFLT decreased by about 0.2 μm (0.2%) per year of life and by 1 μm (1%) per dioptre of myopia.



Conclusion

Mean RNFLT (measured by Spectralis® OCT; 102 ± 11 μm) was associated with younger age, female gender, urban region of habitation, larger optic disc, larger rim, hyperopic refractive error, larger parapapillary beta zone and thicker subfoveal choroidal thickness. Independent of age and refractive error, the RNFL was thickest temporal inferiorly and thinnest temporally and nasally.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.12240

Retinal nerve fibre layer thickness measured by Spectralis spectral‐domain optical coherence tomography: The Beijing Eye Study

Purpose To examine macular retinal thickness and retinal layer thickness with spectral domain optical coherence tomography (OCT) in a population of children with normal ocular health and minimal refractive errors. Methods High resolution macular OCT scans from 196 children aged from 4 to 12 years (mean age 8 ± 2 years) were analysed to determine total retinal thickness and the thickness of 6 different retinal layers across the central 5 mm of the posterior pole. Automated segmentation with manual correction was used to derive retinal thickness values. Results The mean total retinal thickness in the central 1 mm foveal zone was 255 ± 16 μm, and this increased significantly with age (mean increase of 1.8 microns per year) in childhood (p<0.001). Age-related increases in thickness of some retinal layers were also observed, with changes of highest statistical significance found in the outer retinal layers in the central foveal region (p<0.01). Significant topographical variations in thickness of each of the retinal layers were also observed (p<0.001). Conclusions Small magnitude, statistically significant increases in total retinal thickness and retinal layer thickness occur from early childhood to adolescence. The most prominent changes appear to occur in the outer retinal layers of the central fovea.

/pdf/macular-retinal-layer-thickness-in-childhood-3t60sbszt0.pdf

Macular retinal layer thickness in childhood.

Knowledge of the normal in vivo thickness of the retina, and its individual layers in pediatric populations is important for diagnosing and monitoring retinal disorders, and for understanding the eye’s normal development and the impact of eye growth and refractive error such as myopia (short-sightedness) upon retinal morphology. In this prospective, observational longitudinal study, total retinal thickness (and individual retinal layer thickness) and the changes in retinal morphology occurring over an 18-month period were examined in 101 children with a range of refractive errors. In childhood, the presence of myopia was associated with subtle but statistically significant (p<0.05) changes in the topographical thickness distribution of macular retinal thickness (and retinal layer thickness), characterised by a thinning of the parafoveal retina (and parafoveal or perifoveal thinning in most outer and inner retinal layers). The parafoveal retina was on average 6 μm thinner in myopic children. However, over 18 months, longitudinal changes in retinal thickness and individual layers were of small magnitude (average changes of less than 2 μm over 18 months), indicative of a high degree of stability in retinal morphology in healthy adolescent eyes, despite significant eye growth over this same period of time. This provides the first detailed longitudinal assessment of macula retinal layer morphology in adolescence, and delivers new normative data on expected changes in retinal structure over time and associated with myopia during this period of childhood development.

/pdf/longitudinal-changes-in-macular-retinal-layer-thickness-in-4g9a0tf62c.pdf

Longitudinal changes in macular retinal layer thickness in pediatric populations: Myopic vs non-myopic eyes

Peripapillary choroidal thickness in childhood.

.

Purpose: To compile a multicenter normative database of retinal nerve fibre layer (RNFL) and macular thicknesses and macular volume values in healthy Caucasian children 4–17 years using spectral-domain optical coherence tomography (SD-OCT). To analyse variations in the OCT measurements as a function of age, sex, refraction, and axial length (AL).



Methods:  An observational, multicenter and cross-sectional study among 301 healthy Caucasian children recruited at three Spanish centres was performed. To compile the database, each child underwent a dilated eye examination and a cycloplegic refraction, five AL measurements (IOL Master; Carl Zeiss Meditec, Dublin, CA, USA), five OCT scans with Cirrus OCT: three peripapillary RNFL scans (Optic Disc Cube 200X200 protocol) and two macular scans (Macular Cube 512X128 protocol). One eye of each subject was selected randomly for analysis.



Results:  Two hundred eighty-three children (117 boys, 41.34%; 166 girls, 58.66%) were included in this study. The mean age of the children was 9.58 ± 3.12 years (range, 4–17). The mean SE was +0.63 ± 1.65 D; (range, −4.88 to +5.25). The mean AL was 22.94 ± 1.10 mm (range, 20.10–26.27). The mean global RNFL thickness was 97.40 ± 9.0 μm (range, 77–121.7 μm). Multivariate analysis showed a positive correlation between the RNFL and spherical equivalent (SE) (p = 0.014). The mean central macular thickness was 253.85 ± 19.76 μm, the average thickness 283.62 ± 14.08 μm, and the mean macular volume 10.22 ± 0.49 μm3. Multivariate analysis showed a positive correlation between central macular thickness and age (p < 0.001). Boys had a significantly thicker central macula than girls (p < 0.001).



Conclusions:  Normative paediatric SD-OCT data might facilitate use of SD-OCT for assessing childhood ophthalmic diseases. This study provides a multicenter paediatric normative database of SD-OCT peripapillary RNFL and macular data.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1755-3768.2012.02562.x

Multicenter Spanish study of spectral‐domain optical coherence tomography in normal children

We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.

/pdf/unilateral-punctate-keratitis-secondary-to-wallenberg-1ouij040wn.pdf

Unilateral Punctate Keratitis Secondary to Wallenberg Syndrome

Editor, W e have read with great interest the article by Mansouri et al. (2013) published in your journal. The authors reported marked reduction in intra-ocular pressure (IOP) in a female patient during sexual activity with the timing of the largest drop of the IOP corresponding to the recorded moment of orgasm. They hypothesized that the rapid increase in prolactin and dopamine levels occurring during orgasm (Kruger et al. 2005) may have an IOPlowering effect resulting in immediate reduction in the IOP in this distinct patient. Actually, previous studies have already reported the IOP-lowering effect of dopamine in vivo, while low IOP values have been correlated with low prolactin levels in the plasma of women with seasonal affective disorder (Mekki & Turner 1985; Stojek et al. 1991). Hereby, we would like to share our experience of IOP measurements in patients with hyperprolactinaemia, but without any documented ocular pathology. In a prospective case series of five patients, data were collected for healthy eyes in patients with hyperprolactinaemia. Data included IOP and blood prolactin levels. Mean IOP for the right eyes (OD) was 8.4 mmHg and for the left eyes (OS) 8 mmHg, which is significantly lower than the mean IOP of the normal population (Leydhecker 1976). Mean prolactin blood level was 432.4 ng/ml, while the normal range is 2–18 ng/ml in males and 2–29 ng/ml in (non-pregnant) females. Significant negative correlation was found between IOP and prolactin blood levels for both eyes (OD: Pearson’s correlation coefficient, r = 0.9368, p = 0.019; OS: Pearson’s correlation coefficient, r = 0.922, p = 0.026) suggesting that the higher the levels of blood prolactin the lower the IOP. Detailed status of patients is depicted in Table 1. These preliminary data are in agreement with the clinical hypothesis of Mansouri et al., indicating that sex hormones such as prolactin, may have an important role in the physiology of IOP regulation. Of course, it should be interesting to investigate IOP changes in these patients after establishing normal levels of blood prolactin. Larger studies are required to delineate the exact nature of the IOP effects induced by sex hormones such as prolactin.

Multicenter macular ganglion cell analysis: normative paediatric reference range.

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Multicenter Spanish study of spectral‐domain optical coherence tomography in normal children

Unilateral Punctate Keratitis Secondary to Wallenberg Syndrome

Multicenter macular ganglion cell analysis: normative paediatric reference range.