Dissertations / Theses on the topic 'Glaucoma'
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1
Baker, H. "Glaucoma awareness." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/16272/.
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This thesis investigates three different aspects of glaucoma awareness using both quantitative and qualitative methods. Patient Awareness: This qualitative study looked at patients perceptions of glaucoma. Participants (N=28) reported low levels of awareness of glaucoma prior to their diagnosis and assumed that symptoms were the ‘normal’ deterioration of eyesight. As symptoms have a gradual onset, participants had learnt to cope with diminishing sight ability. Findings suggested health promotion a priority to increase public awareness of the existence and symptoms of glaucoma among those at high risk. Current public awareness: This study looked to document public awareness and knowledge of glaucoma. The study used health knowledge questionnaires in three different populations: 1. nationally representative sample of 1009 people 2. telephone Interviews – 500 Isle of Wight, 226 Ealing 3. face-to-face interviews – 300 Ealing Between 71-93% of those interviewed by telephone had heard of glaucoma. However, only 23% of those interviewed face-to-face in Ealing reported having heard of glaucoma. We found a relatively high level of awareness and knowledge of glaucoma in the general UK population but identified at least one pocket of poor knowledge in a specific subpopulation. Can we change awareness? This study investigated whether a public health campaign could increase awareness and change help-seeking behaviour with respect to ocular health with residents in Southall, Ealing aged 60+. The health knowledge questionnaire from the previous study was used to assess the campaign. The health campaign comprised of four components. 1. Television 2. Local Press 3. Local Radio 4. Places of worship The results showed a significant increase in the number of people who had heard of Glaucoma rising from 22% to 53%. Before the intervention most people had heard about glaucoma from their GP, friend or relative. After intervention the majority (69%) had heard of glaucoma from the radio. This study showed a significant increase in awareness from using different kinds of media and showed radio to be the most effective in the target community. Although the campaign raised awareness it did not show a change in help seeking behaviour.
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Sharma, A. "Glaucoma care." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10041509/.
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What is the problem? The number of people coming to the hospital eye departments is likely to increase in the future, as a result of an ageing population, increased optometric case finding and raised public awareness. This fact coupled with the increased economic pressures in health-care financing, and the relative shortage of ophthalmologists in the United Kingdom is going to put significant strain on ophthalmology provision. As a result of these issues, there has been a drive by the government to move eye care into the community and to have more primary care involvement. A variety of alternative models have been proposed for patient care in the community. An important part of assessing these models is to investigate their relative cost effectiveness as well as safety, capacity and patient acceptance. What are the current models? There have been many shared care models that have been proposed. These have included the Community and Hospital Allied Network Glaucoma Evaluation Scheme (CHANGES), the Peterborough Scheme, East Devon Scheme, Waltham Forest Scheme and the Nottingham Scheme. One of the main schemes was the Bristol Shared Care Scheme. This scheme was shown not to be cost effective. It did show that community optometrist’s measurements were of comparable accuracy to those made in the hospital. The annual cost per patient follow-up by a community optometrist was £68.98-£108.98 compared to £14.50-£59.95 in the hospital. The main reason for the cost difference was due to a variation in the patient recall interval between the community and hospital. The second reason was due to the re-referral of patients back from the community clinics to the hospital clinics. What was our contribution? We developed an Integrated Glaucoma Care Model. This involved training and accrediting community optometrists to run Moorfields glaucoma clinics in their Optometric practices whilst alternating attending glaucoma clinics in the hospital. Our results showed that it was more costly to run the community based glaucoma clinics compared to hospital based clinics. These were the same findings as in the Bristol shared care model. The main reasons for the higher costs in the community were due to the large overhead costs of running the glaucoma scheme in the community optometric practices as well as fewer patients being seen in the community compared to the hospital. The community optometrists involved in our scheme were in general found to be competent, efficient and safe. The patient perspectives of our model were overall positive with a large majority of patients happy to be seen in the community again. What were our recommendations? Our main recommendation was to evolve our model to run the shared care scheme within the hospital setting to avoid the high rental costs of the optometric practices. This model is being successfully run at Bristol Eye Hospital where there is a complete shared care department involving optometrists. This type of model could utilise hospital optometrists but could also have accredited community optometrists attending the hospital and participating in such schemes. A second possibility could be to run these shared care schemes in hospital satellite settings or mobile units. An example of this is the Newmedica model. There is a clear requirement for cost effectiveness evaluation of such schemes along with an assessment of safety, capacity and patient acceptance before any conclusions can be reached.
3
Lester, Karen Leah. "Reverse engineering glaucoma." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3022786/.
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Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide, and the only modifiable risk factor is intraocular pressure (IOP). Glaucoma is a complex disease with specific endophenotypes, and disease pathogenesis is likely to involve multiple pathways linking genetic and environmental interactions. Growth factors present in the aqueous humour in POAG increase outflow resistance and elevate IOP. TGF-β2 alters ECM production and turnover in the trabecular meshwork (TM) and has been shown in numerous studies to play a role in the pathogenesis of POAG. No current pharmacological interventions target the deleterious effects of TGF-β2 of the TM which produced elevated IOP. In addition to TGF-β another well characterised glaucoma stimulus is corticosteroids. Corticosteroids are used in ophthalmology to decrease inflammation and preserve ocular function. However side effects including cataract, enhanced infection, and glaucoma are associated with their use. Small, naturally occurring regulatory genes, micro RNAs (miRNAs), target many genes downstream of TGF-β2 and are expressed in response to corticosteroids. The current work set out to identify key differentially expressed genes by RNA-Seq in the human trabecular meshwork (TM) in response to two glaucoma stimuli; TGF-β2 and dexamethasone; and investigate the ability of miRNAs to manipulate gene expression within the TM to reduce pathological insults central to glaucoma. Investigating the influence of TGF-β2 on gene expression in primary human TM cells demonstrated that the majority of the significantly differentially expressed genes were involved in extracellular matrix remodelling and actin cytoskeletal re-organisation likely via the RhoA signalling pathway. The influence of dexamethasone on gene expression in primary human TM cells identified genes involved in extracellular matrix remodelling and genes required for glucocorticoid receptor nuclear translocation. Differentially expressed miRNAs in healthy and glaucomatous human TM cells were identified by a miRNA microarray. Manipulation of validated mRNA targets by identified miRNAs indicated a complex regulatory network and in vitro functional analyses further identified regulation of actin cytoskeleton remodelling via miRNA inhibition. The findings of this study indicate that TGF-β2 and dexamethasone have significant effects on extracellular matrix remodelling and actin cytoskeletal re-organisation in human TM cells. The RNA-Seq and miRNA array have identified potential novel therapeutic targets for glaucoma.
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Ritland, Jon Ståle. "Primary Open-Angle Glaucoma & Exfoliative Glaucoma : Survival, Comorbidity and Genetics." Doctoral thesis, Norwegian University of Science and Technology, Department of Cancer Research and Molecular Medicine, 2008. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-2226.
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Lee, Simon. "Visual monitoring of glaucoma." Thesis, University of Oxford, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.291080.
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Theodossiades, Julia Elizabeth. "Glaucoma detection by optometrists." Thesis, University College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.414489.
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Bernardes, Joana Roque. "Tratamento do glaucoma canino." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2008. http://hdl.handle.net/10400.5/865.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA realização deste trabalho teve como objectivo o estudo das diferentes opções de tratamento do glaucoma canino, assim como, a busca da melhor opção para cada caso. Este trabalho baseou-se numa extensa pesquisa bibliográfica e no estudo de vários casos clínicos. Ao longo deste trabalho mencionei as várias opções médicas e cirúrgicas de tratamento do glaucoma canino. Além disso, referi o possível recurso a medicinas alternativas como a acupunctura. Existe um vasto campo de escolha no que se refere ao tratamento médico do glaucoma, com várias estratégias possíveis a seguir e muitos medicamentos a eleger. A eleição do tratamento baseia-se nas indicações, contra-indicações, efeitos secundários dos vários medicamentos e as possibilidades económicas do proprietário. O factor económico é, muitas vezes, um factor de peso na eleição do tratamento. Além deste vasto leque de opções que já são utilizadas, existe ainda um grande número em estudo que, num futuro próximo, poderão ser utilizadas para auxiliar no combate a esta afecção. Quando as opções médicas falham, dispomos ainda de várias técnicas cirúrgicas que podem ser efectuadas para resolução deste problema.
ABSTRACT - The goals of this work were to study the different options in the treatment of the canine glaucoma, as well as to search the best treatment option to each case. The study bases are a large amount of bibliography research and the study of several clinical cases. Through all this work I’ve mentioned the several medical and surgical options in the treatment of the canine glaucoma. Beyond that, I’ve mentioned the possible use of alternative medicines like acupuncture. There’s a large variety in what refers to the medical treatment of the canine glaucoma, with a big variety of possible strategies to choose and lot’s of medicines to use. The selection of the treatment has bases in the indications, adverse effects and secondary effects of the various medicines and the economical possibilities of the owner. The economical factor is, most of the times, very important in the treatment option to choose. In spite of all the options that are already in use, there are several options that still are being studied and that in a near future may be able to be used in the treatment of this disease. When the medical options fail, there still are several surgical options that can be used to solve this problem.
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Strouthidis, N. G. "Measuring progression in glaucoma." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1446208/.
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Background: Primary open angle glaucoma is characterised by progressive optic neuropathy associated with characteristic visual field loss. The ability to measure disease progression is of vital importance in the management of patients with glaucoma. Conventionally, disease progression has been monitored using static automated perimetry. Recently, devices which image the optic nerve head quantifiably have been introduced. This thesis sets out to compare structural and functional progression in ocular hypertensive subjects followed longitudinally using novel progression algorithms. Plan of research: The investigations may be considered in three parts. Firstly, the factors affecting the test-retest variability of the Heidelberg Retina Tomograph (HRT) are identified and methods to improve repeatability are investigated. Secondly, novel HRT trend and event analyses, based on the findings of the test-retest studies, are compared with established field progression techniques in ocular hypertensive and control subjects. Thirdly, a previously described novel spatial filter is assessed in terms of its impact on the monitoring of visual field progression and in terms of its agreement with a previously described 'structural' map. Results: Rim area was identified as the most repeatable HRT parameter its variability can be improved by using the 320pm reference plane and by using only good quality images. Agreement as regards structural and functional progression was poor, regardless of the estimated specificities of the algorithms used or technique adopted. The novel spatial filter appeared to confer some advantage in terms of specificity, comparable to the effect of confirmatory testing. The functional relationship between test-points, characterised by the filter, correlated well with the expected structural pattern. Clinical significance: The poor agreement suggests that the monitoring of both structure and function is essential to provide the best chance of detecting progression at all stages of the disease. Spatial filtering techniques may provide some additional benefit in the monitoring of progression, particularly once structural data are incorporated.
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Bernier, Sophie. "Épidémiologie génétique du glaucome primaire à angle ouvert : étude de deux mutations du gène TIGR obsrvées chez deux familles de l'est du Québec /." Thèse, Ste-Foy : Chicoutimi : Université Laval ;. Université du Québec à Chicoutimi, 1999. http://theses.uqac.ca.
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Gal, Michelle Rose. "A novel glaucoma drainage valve." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0015/MQ58723.pdf.
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James, C. B. "Pulsatile ocular bloodflow in glaucoma." Thesis, University of Oxford, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335841.
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Samsel, Paulina Anna. "Retinal plasticity in experimental glaucoma." Thesis, Cardiff University, 2010. http://orca.cf.ac.uk/54163/.
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Our study confirmed the existence of a perineuronal net in the rat retina and indicated that molecular weight distribution and immunohistochemical tissue localisation of glycosaminoglycans varied in young, old and glaucomatous rat retinas.
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Rodrigues, Lara Teresa Rei. "Glaucoma e sua componente genética." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1194.
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O glaucoma é uma doença caracterizada por alterações específicas do campo visual e da papila, geralmente acompanhadas de hipertensão intra-ocular e que se não for tratada a tempo conduz à cegueira.
Com uma prevalência de 2% a 12% o glaucoma é a principal causa de cegueira irreversível no mundo.(1-3)
É uma doença heterogénea e complexa caracterizada pela perda progressiva de axónios do nervo ótico conduzindo a perda do campo visual, muitas vezes associada a elevada tensão intra-ocular.(1, 4) Estima-se que em 2020 cerca de 79,6 milhões de pessoas sofram de glaucoma. O glaucoma primário de ângulo aberto (GPAA) é o tipo mais comum de glaucoma, em todas as populações. Mesmo com um cuidado controlo da tensão intra-ocular 25-30% dos doentes gradualmente perdem o seu campo visual.(5) Os defeitos no campo visual do doente causados pelo glaucoma são muitas vezes impercetíveis pelo próprio o que leva a um diagnóstico tardio, quando a deteção precoce do glaucoma é fator crucial para o melhor tratamento e prognóstico.(6) Permanece por isso um problema da atualidade o diagnóstico, identificação de grupos de risco e início atempado do tratamento nesta doença.(5)
Mutações genéticas em várias populações foram identificadas por estudos genéticos e uma base genética para a patogénese de glaucoma tem sido estabelecida.
Estudos epidemiológicos revelam que história familiar, elevada tensão intra-ocular, idade, descendência africana, espessura do centro da córnea, miopia e diabetes mellitus são fatores de risco para o glaucoma.(7, 8) Aproximadamente metade dos doentes com glaucoma primário de ângulo aberto tem história familiar de glaucoma.(7) Estima-se que história familiar de glaucoma em parentes diretos aumente entre 1 a 10 vezes mais a probabilidade de um indivíduo também vir a sofrer da mesma patologia.(9)
A suscetibilidade a doenças complexas, particularmente aquelas de início tardio como o glaucoma, resulta da combinação da interação da componente genética com fatores ambientais.(10)
Mutações em vários genes, como miocilina, optineurina, WDR36 e CYP1B1, estão associados com aumentado risco de desenvolver glaucoma em múltiplas populações.(1)
Novos métodos de diagnóstico e tratamento, baseados em defeitos genéticos responsáveis pelo glaucoma, permitirão que indivíduos em risco sejam identificados e tratados com sucesso antes que o dano no nervo ocorra.(5)Glaucoma is a disease characterized by specific modifications of the visual field and the papilla, usually accompanied by intraocular hypertension and if not treated in time leads to blindness. With a prevalence of 2% to 12% glaucoma is a major cause of irreversible blindness in the world.(1-3) It is a complex and heterogeneous disease characterized by progressive loss of axons in the optic nerve leading to loss of visual field, often associated with elevated intraocular pressure.(1, 4) It is estimated that in 2020 about 79,6 million people will be suffering from glaucoma. The primary open angle glaucoma (POAG) is the most common type of glaucoma, in all populations. Even with careful control of intraocular pressure 25-30% of patients gradually lose its visual field.(5) The visual field defects caused by glaucoma in patients are often imperceptible by itself which leads to a late diagnosis, when the early detection of glaucoma is crucial to better treatment and prognosis.(6) So it remains a problem of current diagnosis, identification of risk groups and timely initiation of treatment in this disease.(5) Genetic mutations in various populations have been identified by genetic studies and genetic basis for glaucoma pathogenesis has been established. Epidemiological studies show that family history, elevated intraocular pressure, age, African descent, the center thickness of the cornea, myopia and diabetes mellitus are risk factors for glaucoma. (7-8) Approximately half of patients with primary open angle glaucoma has a family history of glaucoma.(7) It is estimated that a family history of glaucoma in relatives direct increase between 1 and 10 times the probability of an individual also suffer the same pathology.(9) The susceptibility to complex diseases, particularly those like the late-onset glaucoma, results from a combination of component interaction of genetic and environmental factors. (10) Mutations in some genes such as myocilin, optineurina, WDR36 CYP1B1 and are associated with increased risk of developing glaucoma in multiple populations(1). New methods of diagnosis and treatment based on genetic defects responsible for glaucoma, will enable individuals at risk are identified and successfully treated before the nerve damage occurs.(5)
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Rooney, Colum. "Blood vessel diameter in glaucoma." Thesis, Aston University, 2016. http://publications.aston.ac.uk/30071/.
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Glaucoma is a leading cause of visual disability in the UK and major referral reason between high street optometry and hospital based ophthalmology. The standard optometric tests used to determine necessity of referral are currently leading to a high false positive burden on glaucoma clinics. The disease of glaucoma is considered to be multifactorial in the reasons for its onset and progression. An increasing body of research proposes a vascular dysregulation hypothesis, and retinal artery diameter reduction, as a recognisable risk factor for both the onset and progression of glaucoma. The Heidelberg Retina Tomograph (HRT) is a commercially available laser scanning ophthalmoscope designed principally for the detection of glaucoma by evaluation of the optic disc neuroretinal rim. An additional ability of the HRT is to measure, via an interactive window, the blood vessels of the scanned image without the need for export of the image or magnification to view them in detail. This thesis contributes to the field of early glaucoma detection by measurement of artery diameter via the interactive window on the HRT machine. The volunteers were divided into three groups normal, glaucoma and ocular hypertensive (OHT) and followed over a period of one year to determine if vessel diameter changed in relation to visual field or neuroretinal rim parameters. The main results in this thesis show that artery diameter does change with glaucoma onset and that the HRT machine is a valid instrument for collection of this data.
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Zanón, Moreno Vicente. "Estrés oxidativo en el glaucoma primario de ángulo abierto. Prevención de la ceguera por glaucoma." Doctoral thesis, Universitat de València, 2008. http://hdl.handle.net/10803/10081.
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Con este estudio hemos pretendido demostrar que los mecanismos de estrés oxidativo y nitrosativo están relacionados con el glaucoma primario de ángulo abierto (GPAA), y que los neurotransmisores están implicados en las señales que relacionan la hipertensión ocular (HTO) con la muerte por apoptosis de las células ganglionares de la retina y la pérdida subsecuente de las fibras del nervio óptico, lo que conduce a la atrofia óptica y a la ceguera glaucomatosa.Este estudio de casos y controles lo hemos realizado en muestras de humor acuoso y plasma de sujetos con glaucoma primario de ángulo abierto y sujetos con cataratas no patológicas (grupo comparativo), seleccionados de entre aquellos que acudieron a las consultas de oftalmología del Hospital Universitario Dr. Peset (Valencia), Centro de Especialidades de Monteolivete (Valencia) y Hospital Punta de Europa (Algeciras).A cada individuo se le realizó un examen oftalmológico completo (presión intraocular, agudeza visual, fondo de ojo, campo visual y análisis de fibras nerviosas por GDx).Se evaluó el estrés oxidativo mediante la determinación del malonildialdehído (MDA, producto de la peroxidación lipídica), la determinación de la actividad antioxidante de las enzimas superóxido dismutasa (SOD) y glutation peroxidasa (GPx) y la determinación del estado antioxidante total (AOXT). El estrés nitrosativo mediante la determinación de la concentración total de óxido nítrico (ON). Los niveles de serotonina (5-HT) y su principal metabolito (ácido 5-hidroxiindolacético, 5-HIAA) se determinaron por HPLC; y la expresión de la proteína poli (ADP-ribosa) polimerasa-1 (PARP1) mediante western blot e immunoblotting.Los niveles de MDA, SOD, GPx y ON resultaron superiores significativamente en el grupo de sujetos con glaucoma respecto al grupo de cataratas. El estado antioxidante total observado en el grupo glaucoma fue significativamente inferior al observado en el grupo cataratas. Se observó una disminución en los niveles de 5-HT en los sujetos con glaucoma frente a los sujetos con cataratas, aunque la diferencia no fue significativa; y un aumento significativo en los niveles de 5-HIAA en el grupo glaucoma frente al grupo cataratas. Por último, la expresión de PARP1 resultó significativamente superior en el grupo de sujetos con glaucoma respecto al de sujetos con cataratas.Hemos demostrado un aumento del estrés oxidativo y del estrés nitrosativo en el glaucoma primario de ángulo abierto frente a las cataratas. La serotonina y su metabolito actúan facilitando la alteración de la homeostasis del humor acuoso en pacientes con glaucoma, permitiendo el aumento de la presión intraocular. El aumento de la expresión de la proteína poli (ADP-ribosa) polimerasa-1 demuestra que en el glaucoma se produce un aumento de la muerte por apoptosis de las células, tanto de las células de la malla trabecular y de las células ganglionares de la retina.Las moléculas analizadas en el presente estudio podrían ser utilizadas como marcadores de la progresión de la enfermedad glaucomatosa, facilitando el control de la misma y, de este modo, frenando la progresión hacia la ceguera irreversible.The aim of this study is to demonstrate that oxidative and nitrosative stress mechanisms are related to primary open-angle glaucoma (POAG) and that neurotransmitters are involved with the signals that linked the ocular hypertension (OHT) with the retinal ganglion cell death by apoptosis and the loss of optic nerve fibers, which lead to optic atrophy and glaucomatous blindness. This case-control study has been carried out in aqueous humor and plasma samples of subjects with POAG and subjects with non-pathological cataracts (comparative group), selected from Dr. Peset University Hospital (Valencia), Monteolivete Specialities Centre (Valencia) and Punta de Europa Hospital (Algeciras).Oxidative stress has been tested by means the malodialdehyde determination (MDA, a product of lipid peroxidation), the antioxidant activity determination of superoxide dismutase (SOD) and glutatión peroxidase (GPx) enzymes and the total antioxidant status assay (TAS). Nitrosative stress has been evaluated by analyzing the total nitric oxide concentration (ON). Serotonin (5-HT) and hydroxiindolacetic acid (5-HIAA) levels have been determined by HPLC. Finally, the expression of poly (ADP-ribose) polymerase-1 (PARP1) has been tested by western blot and immunoblotting.We have demonstrated with this study an increase of oxidative and nitrosative stress in POAG subjects with respect to cataracts subjects. Serotonin and its metabolite act facilitating the alteration of the homeostasis of the aqueous humor in glaucoma patients, leading to an increase in intraocular pressure. Results of PARP1 expression prove that there is an increase of cell death by apoptosis in primary open-angle glaucoma. The molecules tested in this study may be used as markers of glaucoma progression and might help us to prevent the glaucomatous blindness.
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Johnson, Thomas Vincent. "Investigations of novel cell transplantation-based therapies for glaucoma." Thesis, University of Cambridge, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608952.
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Landers, John. "An epidemiological study of risk factors associated with progression from ocular hypertension to primary open angle glaucoma." Connect to full text, 2001. http://hdl.handle.net/2123/798.
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Thesis (M.P.H.)--University of Sydney, 2001.Includes tables. Title from title screen (viewed Apr. 23, 2008). Submitted in fulfilment of the requirements for the degree of Master of Public Health to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Includes bibliography. Also available in print form.
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Goldberg, Roger A. "An evaluation of the therapeutic trends in glaucoma and the potential impact of improved glaucoma surgery." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12022008-114357/.
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Harper, Robert Anthony. "Screening for primary open angle glaucoma." Thesis, University of Oxford, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316859.
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Lei, Yuan. "Retinal plasticity in ageing and glaucoma." Thesis, Cardiff University, 2008. http://orca.cf.ac.uk/54708/.
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This project is to investigate retinal plasticity at the cellular level, i.e. changes of the cell density, cell pattern, cell morphology and the perineuronal net, in the aged and glaucomatous retinas. A multiphoton-DAPI method was developed to study retinal transneuronal degeneration. In glaucoma, the neurodegeneration at the retinal ganglion cell layer (RGCL) initiates a cascade of transneuronal degeneration in the inner nucleus layer (INL) and the outer nucleus layer (ONL). On the other hand, in ageing, neurons in both the RGCL and ONL are markedly affected the neuronal loss in the INL correlates with both layers. This suggests other mechanisms in addition to transneuronal degeneration that contribute to the retinal degeneration in ageing. In glaucoma, the pattern of the neuronal loss in the RGCL was analysed. Supported by the microscopic observation, nearest neighbour analysis (NNA) reveals a combination of diffuse and clustered patterns of neuronal loss. In particular, the diffuse pattern was more common in the central retina whereas the clustered loss was prominent in the mid- peripheral retina. It is very likely that these two patterns of neuronal loss were produced by two different pathologic mechanisms leading to RGC depletion. There appear to be differences between the chondroitin glycosaminoglycan (CS-GAG) staining and the aggrecan core protein staining in the RGCL, INL and the inner plexiform layer. This suggests that some of the GAG attachment regions of aggrecan have been removed in these domains. The major source of CS-GAG staining appears to be from aggrecan because only negative staining for decorin, biglycan, lumican, keratocan and versican was found. Also, negative 5D4 staining suggests that this aggrecan is not or minimally substituted with keratocan sulphate. This study emphasises the importance of the perineuronal net in potentially restricting the recovery and regeneration of neurons in the adult retina.
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Glen, Fiona Charlotte. "Aspects of visual disability in glaucoma." Thesis, City University London, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.586911.
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Glaucoma is a chronic and progressive disease of the optic nerve that can lead to irreversible loss of function in the visual field (VF). Whilst much research tends to focus on areas such as the development of measures for diagnosing, monitoring and treating glaucoma, less is known about how this visual degradation manifests itself as the person goes about their lives outside of the clinic. This thesis describes five studies which examine different aspects relating to the experience of disability and the quality of life (QoL) of people with glaucoma. In study I, a systematic literature review revealed that only approximately I % of research studies in glaucoma relate to investigations of the effects of the disease on the patient's QoL, and the proportion of studies relating to QoL in glaucoma was less than in many other disabling chronic diseases, including age related macular degeneration (AMD). More than 80% of the studies identified were found to involve the use of questionnaires; a method that although useful for gaining insight into the patient's own perceptions of their condition, is subject to bias. More objective performance-based measurements of functioning may also be useful for determining the impact of glaucoma on the person's life. This approach was taken in study 2, which investigated the performance of 54 patients with varying levels of glaucomatous VF loss on a face recognition (FR) task compared with 41 people with normal vision. It was found that patients with more advanced VF defects performed significantly worse on average than patients with early and moderate defects, and controls (F=3.2; p<0.05). Multiple regression analysis revealed that contrast sensitivity (CS) measurements were important for FR. The importance of contrast for performance on the FR task was thus investigated further in study 3, which examined the effects of image contrast manipulations on the performance of 40 visually healthy participants on a modified version of the FR task. There were no statistically significant effects across contrast conditions, suggesting difficulties relating to face image contrast alone might not fully explain poorer performance. Study 4 investigated whether eye movements may underlie the likelihood of a patient experiencing task difficulties. It was found that, for patients with significant 10° VF defects, those who made larger eye movements also appeared to be better performers (rho=0.60; p=O.OOI). These effects were not found in people with healthy vision, which could imply that some patients use eye movements to 'adapt' to their condition. A final exploratory study aimed to examine patient perceptions of their VF defect, by interviewing patients about their condition. Patients appeared to differ in terms of their level of awareness of their defect, despite all having advanced VF loss. These findings may suggest the potential of further research investigating the link between conscious awareness of one's defect and the employment of adaptive strategies in glaucoma for overcoming VF loss.
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Patterson, Andrew James. "Analysis of retinal images in glaucoma." Thesis, Nottingham Trent University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431887.
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Chong, Rachel Shujuan. "Early synaptic changes in experimental glaucoma." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708807.
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Bergin, Ciara. "Improving measurements in perimetry for glaucoma." Thesis, City University London, 2011. http://openaccess.city.ac.uk/930/.
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Glaucoma is a leading cause of visual impairment and, if untreated, irreversible blindness. Perimetry is the clinical tool for assessing the functional ‘seeing’ part of the field of view (visual field) and is widely used in the detection and clinical monitoring of glaucoma. These measurements rely on a psychophysical response making them inherently variable. This measurement noise can disguise both disease pathology and progression. The work described in this thesis aims to improve the quality of perimetric measurements. The platform for this is the Moorfields Motion Displacement Test (MMDT), a perimetric test that uses unconventional test stimuli and can be delivered on an ordinary computer monitor. Specifically, this thesis describes efforts to develop novel, mathematically derived, test algorithms, designed to be used with the MMDT. The performance of these new testing methods is assessed using pilot studies involving patients and visually healthy people, computer simulation and interim results from a large prospective clinical study. One of these test algorithms, the Enhanced Suprathreshold Testing Algorithm [ESTA] provides shorter test duration, making it attractive for case-finding and screening for glaucoma, without seemingly negatively affecting diagnostic precision, and has become patented technology. Another bespoke test algorithm (Weighted Binary Search; WEBS) provides a threshold test for the MMDT. The thesis also describes a study examining the resistance of several newer clinical perimetric instruments to the optical artefact of stray light that might be caused by media opacity. This is clinically important because cataract and degraded optical media is a leading cause of false-referral for glaucoma. This work, being the first of its kind, indicates that the MMDT has greater resilience to simulated effects of media opacity compared with other clinically used devices.
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Burton, Robyn. "Reading performance in patients with glaucoma." Thesis, City University London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.591913.
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Glaucoma is a progressive disease of the optic nerve that can result in visual impairment and in tum inhibit performance on everyday visual tasks. Three connected experimental studies described in this thesis primarily aim to investigate the performance of people with glaucoma on a computer-based task of reading whilst simultaneously recording eye movements. Fifty four patients with bilateral glaucoma and 40 age-similar people with normal vision took part in the experiments. The first study measured change in reading speed when letter contrast is reduced. Results showed that average reduction in reading speed caused by a difference in letter contrast between 100% and 20% is significantly more apparent in patients when compared with age-related people with normal vision and similar cognitive/reading ability (p=0.01). Furthermore, patients more adversely affected by a contrast change were generally those with more severe visual field (VF) defects, poorer contrast sensitivity and poorer visual acuity. A second study explored the relationship between specific locations of the binocular VF and measured reading speed. Results suggested that damage to the inferior left region of the binocular VF was most strongly associated with the reading speed of the patient group. It is possible that this is the VF region used when locating a new line of text and it may be of clinical importance to preserve sensitivity in this area of the VF. The third study used a subset of patients with advanced glaucomatous (N=IS) VF defects to explore the relationship between eye movements and reading speed. Three eye movement measures were explored namely. text saturation (difference between the first and last fixation on lines of text), perceptual span (total number of letters read per number of saccades) and saccadic frequency (total number of saccades made to read a single word presented in isolation in a bespoke lexical decision task). Some, but not all, patients with advanced VF defects read slower than controls but differences in eye movements accounted for much of this variability. These patients also saturated text more during reading when compared to controls (p=O.004) which may explain previously-reported difficulties with sustained reading in glaucoma. In conclusion, principal findings from the studies described in this thesis show, for the first time, that reading speed in patients with glaucoma is particularly affected by changes in text contrast and specific regions of the VF are associated with impaired reading speed. Moreover, eye movement analysis may provide a window into the functional deficits associated with reading in glaucoma
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Brucker, Margaret. "The Binocular Visual Field in Glaucoma." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523998138093264.
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Kac, Marcelo Jarczun. "Amplitude de pulso ocular em pacientes portadores de glaucoma primário de ângulo aberto assimétrico." Niterói, 2010. https://app.uff.br/riuff/handle/1/4780.
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Prefeitura da Cidade do Rio de Janeiro
Objetivo: Avaliar a amplitude de pulso ocular (APO) utilizando o tonômetro de contorno dinâmico (TCD) em pacientes com glaucoma primário de ângulo aberto (GPAA) assimétrico e pressão intra-ocular (PIO) assimétrica. Métodos: 48 pacientes (96 olhos) com GPAA assimétrico foram recrutados. Três medidas da PIO e da APO foram aferidas utilizando o TCD. Para o diagnóstico de assimetria eram necessárias uma diferença de perda de campo visual maior que 6 dB no índice “mean deviation” (MD), e uma diferença de 5 mmHg na PIO medida com o tonômetro de aplanação de Goldmann (TAG) entre o olho mais afetado e o contra-lateral. Todos os participantes se submeteram a um exame oftalmológico completo, incluindo paquimetria ultrassônica e ecobiometira. Os critérios de exclusão consistiram de: doenças ou cicatrizes corneanas, uso de medicação anti-glaucomatosa tópica ou sistêmica e cirurgia ocular prévia. Resultados: Não houve diferença com significância estatística (p = 0,142) entre o comprimento axial dos olhos do grupo melhor (22,95 +/- 0,91 mm) e pior (22,85 +/- 0,97 mm). Houve diferença estatisticamente significativa (p = 0,011) entre a espessura corneana central do grupo de olhos melhores (537,08 +/- 29,54 μm) e do grupo de olhos piores (534,40 +/- 29,87 μm). Os valores da APO do grupo de olhos melhores (3.32 +/- 1.14 mmHg) foram significativamente menores (p = 0,001) do que os obtidos no grupo de olhos piores (3,83 +/- 1,27 mmHg). Quando corrigimos as medidas de APO pela diferença de PIO entre os olhos houve uma perda da significância estatística entre os grupos (p = 0,996). Conclusão: A APO é semelhante entre os dois olhos de pacientes portadores de GPAA assimétrico com PIO assimétrica. De acordo com esses dados não há evidência de que a APO possa ter um papel no GPAA hipertensivo assimétrico
Aim: To evaluate ocular pulse amplitude (OPA) using the dynamic contour tonometer (DCT) in patients with asymmetric primary open-angle glaucoma (POAG) and asymmetric intra-ocular pressure (IOP). Methods: The participants consisted of 48 patients (96 eyes) with asymmetric POAG. Three measurements of IOP and OPA were taken using DCT. The diagnosis of asymmetry required a difference of glaucomatous visual field loss greater than 6 dB in the global index MD and a difference of 5 mmHg in IOP measured by Goldmann aplannation tonometry (GAT) between the more affected and the contra-lateral eye. All participants underwent full ophthalmologic clinical assessment including ultrasonic pachymetry and biometric measurements. Exclusion criteria were corneal diseases or scars, topical or systemic glaucomatous medications, and previous ocular surgery. Results: No difference (p = 0.142) was found between the axial length measurements of the better eyes group (22.95 +/- 0.91 mm) and worse eyes group (22.85 +/- 0.97 mm). There was a statistically significant difference (p = 0.011) between the central corneal thickness values of the better eyes group (537.08 +/- 29.54 μm) and worse eyes group (534.40 +/- 29.87 μm). The OPA values of the better eyes group (3.32 +/- 1.14 mmHg) were significantly lower (p = 0.001) than those obtained on worse eyes group (3.83 +/- 1.27 mmHg). When correcting the OPA readings by the IOP there was a loss of statistical difference between groups (p = 0.996). Conclusion: OPA is similar in both eyes of asymmetric hypertensive POAG patients with asymmetric IOP. According to this data there was no evidence that OPA could play a role in asymmetric hypertensive POAG
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Hashimoto, Mitsuo [UNESP]. "Reprodutibilidade da curva de pressão intraocular de 24 horas em pacientes com glaucoma e suspeita de glaucoma." Universidade Estadual Paulista (UNESP), 2015. http://hdl.handle.net/11449/138410.
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000858467.pdf: 2346803 bytes, checksum: 8eb03d0cf9e13d4b51d80092c6ea5380 (MD5)Foi avaliada a reprodutibilidade das medidas de pressão intraocular (PIO) nos mesmos horários da curva tensional diária (CTD) de 24 horas, com três repetições. Foram estudados 33 indivíduos com glaucoma e suspeita de glaucoma sem tratamento. Todos os participantes foram submetidos a 3 CTDs de 24 horas. Os pacientes foram internados e as medidas foram realizadas às 9:00 hs, 12:00 hs, 15:00 hs, 18:00 hs, 21:00 hs, 24:00 hs e 6:00 hs com tonômetro de aplanação de Goldmann (TAG). A medida das 6:00 hs também foi realizada no leito, utilizando-se um tonômetro manual de Perkins antes da medida com o TAG. Uma segunda CTD de 24 horas foi realizada após um intervalo entre uma e três semanas e uma terceira após mesmo intervalo. A reprodutibilidade foi avaliada em cada horário da CTD de 24 horas com o coeficiente de correlação intraclasse (CCI) e os gráficos de Bland- Altman. Nos gráficos de Bland-Altman considerou-se como limite de concordância uma diferença de até 3 mmHg entre as medidas. O CCI variou de 0,736 a 0,917 nos diferentes horários, estando a maioria deles acima de 0,800. Nos gráficos de Bland- Altman, a porcentagem de pontos dentro do limite de concordância de 3 mmHg variou de 72,7 a 97,0%, sendo na maioria das observações acima de 80%. Concluiuse que as medidas da PIO em cada momento da CTD de 24 horas nas três repetições apresentaram excelente ou boa reprodutibilidade em indivíduos com glaucoma e suspeita de glaucoma
The reproducibility of measurements of intraocular pressure (IOP) at the same points of the 24-hour daily tension curve (DTC) with three replications was evaluated. Thirtythree untreated subjects with glaucoma and suspected glaucoma were studied. All participants underwent three 24-hour DTCs. Briefly, participants were hospitalized and IOP measurements obtained at 9:00 AM, noon, 3:00 PM, 6:00 PM, 9:00 PM, midnight and 6:00 AM using a Goldmann applanation tonometer. The 6:00 AM measurement was also obtained at bedside with a handheld Perkins tonometer prior to Goldmann tonometry. A second 24-hour DTC was performed 1 to 3 weeks after the first, and a third and final curve was obtained 1 to 3 weeks after the second. Reproducibility of measurements at each time point of the 24-hour DTC was assessed by means of the intraclass correlation coefficient (ICC) and Bland-Altman plots. A 3-mmHg difference in IOP was defined as the limit of agreement for Bland- Altman plots. ICCs ranged from 0.736 to 0.917 at different time points, with the majority exceeding 0.800. The percentage of points within the 3-mmHg limit of agreement on Bland-Altman plots ranged from 72.7% to 97.0%, exceeding 80% in most cases. In conclusion, in patients with glaucoma or suspected glaucoma, IOP measurements obtained at each time point of the 24-hour DTC showed good or excellent reproducibility across the three curves performed
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Hashimoto, Mitsuo. "Reprodutibilidade da curva de pressão intraocular de 24 horas em pacientes com glaucoma e suspeita de glaucoma /." Botucatu, 2015. http://hdl.handle.net/11449/138410.
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Orientador: Hamilton Almeida RolloCoorientador: Maria Rosa Bet de Moraes Silva
Banca: Edson Nacib Jorge
Banca: Ralph Cohen
Banca: José Paulo Cabral de Vasconcellos
Banca: Maria de Lourdes Veronese Rodrigues
Resumo: Foi avaliada a reprodutibilidade das medidas de pressão intraocular (PIO) nos mesmos horários da curva tensional diária (CTD) de 24 horas, com três repetições. Foram estudados 33 indivíduos com glaucoma e suspeita de glaucoma sem tratamento. Todos os participantes foram submetidos a 3 CTDs de 24 horas. Os pacientes foram internados e as medidas foram realizadas às 9:00 hs, 12:00 hs, 15:00 hs, 18:00 hs, 21:00 hs, 24:00 hs e 6:00 hs com tonômetro de aplanação de Goldmann (TAG). A medida das 6:00 hs também foi realizada no leito, utilizando-se um tonômetro manual de Perkins antes da medida com o TAG. Uma segunda CTD de 24 horas foi realizada após um intervalo entre uma e três semanas e uma terceira após mesmo intervalo. A reprodutibilidade foi avaliada em cada horário da CTD de 24 horas com o coeficiente de correlação intraclasse (CCI) e os gráficos de Bland- Altman. Nos gráficos de Bland-Altman considerou-se como limite de concordância uma diferença de até 3 mmHg entre as medidas. O CCI variou de 0,736 a 0,917 nos diferentes horários, estando a maioria deles acima de 0,800. Nos gráficos de Bland- Altman, a porcentagem de pontos dentro do limite de concordância de 3 mmHg variou de 72,7 a 97,0%, sendo na maioria das observações acima de 80%. Concluiuse que as medidas da PIO em cada momento da CTD de 24 horas nas três repetições apresentaram excelente ou boa reprodutibilidade em indivíduos com glaucoma e suspeita de glaucoma
Abstract: The reproducibility of measurements of intraocular pressure (IOP) at the same points of the 24-hour daily tension curve (DTC) with three replications was evaluated. Thirtythree untreated subjects with glaucoma and suspected glaucoma were studied. All participants underwent three 24-hour DTCs. Briefly, participants were hospitalized and IOP measurements obtained at 9:00 AM, noon, 3:00 PM, 6:00 PM, 9:00 PM, midnight and 6:00 AM using a Goldmann applanation tonometer. The 6:00 AM measurement was also obtained at bedside with a handheld Perkins tonometer prior to Goldmann tonometry. A second 24-hour DTC was performed 1 to 3 weeks after the first, and a third and final curve was obtained 1 to 3 weeks after the second. Reproducibility of measurements at each time point of the 24-hour DTC was assessed by means of the intraclass correlation coefficient (ICC) and Bland-Altman plots. A 3-mmHg difference in IOP was defined as the limit of agreement for Bland- Altman plots. ICCs ranged from 0.736 to 0.917 at different time points, with the majority exceeding 0.800. The percentage of points within the 3-mmHg limit of agreement on Bland-Altman plots ranged from 72.7% to 97.0%, exceeding 80% in most cases. In conclusion, in patients with glaucoma or suspected glaucoma, IOP measurements obtained at each time point of the 24-hour DTC showed good or excellent reproducibility across the three curves performed
Doutor
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Ekström, Curt. "Studies on the Epidemiology of Open-angle Glaucoma." Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8323.
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Glaucoma is a common disease in the elderly population. Open-angle glaucoma (OAG) is the predominant form of glaucoma. Chronic simple glaucoma and capsular glaucoma, characterized by the occurrence of pseudoexfoliation in the anterior eye segment, are the most frequent types of OAG. The purpose of the present thesis was to study the epidemiology of OAG in the municipality of Tierp, whose population has a high exposure to pseudoexfoliation.
In a case-finding study, the prevalence of known cases of OAG by December 31, 1983 was estimated to 1.4% in people ≥45 years of age. Sixty-three percent of all cases had capsular glaucoma. Patients with advanced glaucoma were older, had had the disease for longer, had higher mean initial intraocular pressure, and had more extensive visual field defects at the time of diagnosis.
A population survey of people 65–74 years of age was conducted in 1984–86. The prevalence of OAG was 5.3%. Pseudoexfoliation was found in 17%, being more common in females. Pseudoexfoliation was associated with OAG only in people previously diagnosed with the disease (odds ratio = 16). In cases detected at the survey, an intraocular pressure ≥20 mmHg was a serious risk factor of having OAG (odds ratio = 9.7).
In a 5-year follow-up study of participants in the population survey, increased intraocular pressure and pseudoexfoliation were recognized as independent risk factors for the development of OAG (standardized risk ratios = 3.4 and 9.8, respectively). Interaction between increased intraocular pressure and pseudoexfoliation was indicated. By May 2006, the incidence of OAG was estimated to 7.1 per 1,000 person-years. The incidence of capsular glaucoma was more than twice that of chronic simple glaucoma.
The prevalence and incidence of OAG was higher than that reported from other studies conducted on Caucasian populations. The probable explanation for this finding is exposure to pseudoexfoliation.
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Dinis, Ana Belmira Trindade. "Suspeita de glaucoma, excesso de divergência e adaptação de LC hidrófila tóricas." Master's thesis, Universidade da Beira Interior, 2013. http://hdl.handle.net/10400.6/1491.
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Durante a realização de qualquer estágio são vários os casos clínicos a que se pode deparar um jovem optometrista. Assim, o seguinte relatório faz a análise de três casos clínicos, seleccionados no decorrer do estágio efectuado na clínica Ocular Eye Care. Cada caso redige-se segundo uma anamnese, bem como, os mais variados testes optométricos essenciais à análise e diagnóstico do problema de cada indivíduo.
Suspeita de glaucoma, insuficiência de divergência e adaptação de LC hidrófila tórica são os temas que compõem os casos clínicos em questão.During the completion of any traineeship there are several clinical cases that a young optometrist may encounter. Thus, the following report analysis three clinical cases, selected during the traineeship made in the clinical Ocular Eye Care. Each case is drawn up according to an anamnesis, as well as, the most varied optometric tests essential to the analysis and diagnosis of the problem of each individual. Suspected glaucoma, insufficiency of divergence and adaptation hydrophilic toric CL are the themes that make up the clinical cases in question.
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Silva, Marcelo Jordão Lopes da. "Influencia da idade, espessura central da cornea e do indice de qualidade na tonometria de contorno dinamico." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309857.
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Orientador: Vital Paulino CostaTese (doutorado)- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Os objetivos deste trabalho são comparar a pressão intra-ocular (PIO), medida com tonometria de contorno dinâmica (TCD) e tonometria de aplanação de Goldmann (TAG), analisar a influência da espessura central da córnea (ECC) e idade, em ambas as medições, bem como a influência do índice de qualidade sobre as leituras da TCD. Foram avaliados 500 indivíduos saudáveis (1000 olhos), sem história prévia de glaucoma ou hipertensão ocular (idade: 7 a 86 anos) recrutados consecutivamente. TAG, TCD e ECC foram obtidos de ambos os olhos de cada indivíduo, nessa ordem, por três observadores. A média de cinco medidas da ECC foi utilizada para análise. As medições da TCD foram aceitas quando o escore de qualidade variou entre 1 (qualidade superior) e 3 (menor qualidade). A média das PIOs obtidas com TCD foram superiores em 3,2 mmHg às medições com TAG. A análise de Bland-Altmann revelou má concordância entre as leituras de TCD e TAG, com intervalos de confiança de 95% de ± 6,98 mmHg. Os valores da ECC variaram entre 449 e 653 µm. As PIOs medidas com TAG mostraram-se fortemente correlacionadas à ECC (r? = 0,28, p <0,001), enquanto as PIOs obtidas com TCD apresentaram fraca correlação com a ECC (r2 = 0,01, p = 0,017). Tanto as medidas de TCD (r2 <0,01, p = 0,044) quanto as obtidas com TAG (r2 = 0,01, p <0,001) apresentaram fraca correlação com a idade. Os escores de qualidade das medidas de TCD foram 1 (n = 369, 36,9%), 2 (n = 340, 34,0%) e 3 (n = 291, 29,1%). As leituras de medida com TCD com escore de qualidade 3 (18,8 ± 3,4 mmHg) foram significativamente maiores do que aquelas com escore 1 (16,7 ± 2,9 mmHg) e 2 (17,4 ± 2,9 mmHg) (p <0,001). Concluiu-se que a medida com TCD não é influenciada pela ECC, ao contrário daquela com TAG. As medidas de PIO tomadas com TCD e com TAG não são influenciados pela idade. Finalmente, medidas de TCD com qualidade inferior apresentam valores maiores que as de qualidade superior.
Abstract: The purposes of this study are to compare the IOP measurements obtained with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to analyze the influence of central corneal thickness (CCT) and age on both measurements, and the influence of the quality score on DCT readings. 500 healthy subjects with no previous history of glaucoma or ocular hypertension (ages: 7 to 86 years old) were consecutively recruited. GAT (Haag Streit R900, Switzerland), DCT (SMT Swiss Micro Technology, Switzerland), and CCT (Sonomed Micropach 200P+, USA) measurements were obtained from both eyes of each individual, in this order, by three observers. The mean of five CCT measurements was used for analysis. DCT measurements were accepted when quality scores varied between 1 (higher quality) and 3 (lower quality). In our series, the mean DCT measurements were 3.2 mmHg higher than GAT readings. CCT values varied between 449 and 653 µm. IOP measured by GAT correlated strongly with CCT (r2=0.28, p<0.001), whereas DCT readings correlated poorly with CCT (r2=0.01, p=0.017). Both DCT (r2<0.01, p=0.044) and GAT (r2=0.01, p<0.001) measurements correlated poorly with age. Bland-Altmann analysis revealed disagreement between DCT and GAT readings, with 95% confidence intervals of ± 6.98 mmHg. Quality scores for DCT measurements were 1 (n=369, 36.9%), 2 (n=340, 34.0%) and 3 (n=291, 29.1%). DCT readings with quality score of 3 (18.77±3.35 mmHg) were significantly higher than those with quality scores of 1 (16.61±2.91 mmHg) and 2 (17.44±2.93 mmHg) (p<0.001). In conclusion, DCT is not influenced by CCT, unlike GAT. Both DCT and GAT measurements are not influenced by age. DCT measurements with lower quality scores are associated with higher readings.
Doutorado
Doutor em Ciências Médicas
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Maciel-Guerra, Andrea Trevas 1960. "Glaucoma congenito primario : uma entidade genetica heterogenea." [s.n.], 1986. http://repositorio.unicamp.br/jspui/handle/REPOSIP/316578.
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Orientador: Bernardo BeiguelmanDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A visão clássica sobre o mecanismo de herança do glaucoma congênito primário é a que essa anomalia é sempre transmitida de modo autossômico recessivo monogênico. A análise dos dados familiais de 1408 portadores dessa anomalia mostra que o glaucoma congênito primário é, na verdade, uma entidade genética heterogênea, visto que foi possível detectar pelo menos duas formas autossômicas monogênicas dessa doença, sendo uma dominante e outra recessiva. Há, ainda, um grande contingente de anômalos cuja etiologia (genética) não fui passível determinar. Assim sendo é fundamental, tanto para o geneticista quanto para o o oftalmologista, que se procure distinguir as diferentes entidades genético-clínicas ao nível anatômico e/ou bioquímico
Mestrado
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Tribble, James R. "Retinal degeneration and remodelling in experimental glaucoma." Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/93668/.
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Glaucoma is an optic neuropathy characterised by the loss of retinal ganglion cells (RGC). Dendritic atrophy occurs early in the disease, prior to soma and axonal degeneration. RGCs exhibit reduced branching density and dendritic field size. This thesis seeks to further characterise dendritic atrophy in glaucoma in the context of two external factors that may contribute to the disease pathology – immune system effects mediated via complement and the influence of the perineuronal net (PNN), a specialised extracellular matrix that surrounds RGCs. RGC morphology was investigated in a rat bead model of experimental glaucoma using ballistic labelling techniques; morphological changes were related to synaptic loss and PNN composition using immunohistochemistry. A model was derived for the classification of diseased RGCs in order to prevent labelling bias in subsequent investigations. The immune system was modulated using a complement inhibitor (using a transgenic mouse and pharmacological agent in rats) and PNNs disrupted using the bacterial enzyme Chondroitinase ABC. Experimental glaucoma caused significant dendritic loss, with partial protection conferred by both complement inhibition and PNN digestion. Analysis of retinal sections also revealed partial protection of synapses. PNNs did not show any changes in their composition in the rat in experimental glaucoma but human glaucoma eyes showed increased glycosaminoglycan sulphation in the RGC layer which was correlated with visual deficit. Manipulation of the RGC external environment therefore proved successful in protecting from dendritic atrophy.
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Li, Yuen-mei Emmy, and 李琬微. "Cost-effectiveness of treating normal tension glaucoma." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45173114.
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Sharma, G. U. "Modulation of wound healing after glaucoma surgery." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1527404/.
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Glaucoma is the leading cause of irreversible blindness worldwide. Glaucoma is a progressive eye disorder characterised by atrophy of the optic nerve. In some cases, poor aqueous drainage may cause raised intraocular pressure, which causes damage to the optic nerve, leading to blindness. One of the approaches to lower intraocular pressure is to surgically create a drainage channel for the outflow of aqueous humour. Impaired wound healing and continued scarring response at the site of surgery can lead to suboptimal intraocular pressure control and eventual failure of surgery in many patients. Current treatments in the form of cytotoxic agents (e.g., mitomycin C, 5-Fluorouracil) are associated with severe side effects. The anti-Vascular Endothelial Growth Factor (VEGF) monoclonal antibody bevacizumab, (Avastin) has shown potential to decrease scarring after glaucoma surgery. However, bevacizumab clears rapidly from the subconjunctival space when injected. To overcome rapid clearance, a slow release dosage form of bevacizumab was developed. The slow release implantable dosage form is preferable for two reasons – first, it can provide local delivery of the drug to the tissue and, secondly, the desired effect of the drug can persist for a longer duration of time. The bevacizumab slow release tablet was formulated and characterised, and its anti-angiogenic efficacy was tested in an in vivo rabbit corneal angiogenesis model. The bevacizumab implantable tablet was formulated successfully without any signs of protein aggregation and was able to inhibit VEGF induced corneal angiogenesis for up to 30 days in a rabbit model. Wound healing is a complex process that involves the different overlapping phases of haemeostasis, inflammation, angiogenesis and remodeling of the extracellular matrix. The current in vitro models study each aspect of wound healing in isolation. The most commonly used in vitro model for studying conjunctival contraction is fibroblast populated collagen gels. However, it does not take into consideration an important aspect of wound healing, that is, inflammation. A novel co-culture in vitro model was developed using human Tenon’s fibroblasts and U937 cell line-derived macrophages seeded in a collagen matrix. The presence of macrophages significantly increased fibroblast-mediated contraction; correlating with the clinical observation that inflammation significantly increases conjunctival contraction and may increase the chances of failure of surgery. In this model, it was found that the presence of macrophages was able to overcome the effect of high doses of mitomycin C on fibroblasts, similar to the clinical situation where the use of mitomycin C does not necessarily guarantee the success of the surgery, especially in cases where the eye is highly inflamed. The co-culture model will be useful in investigating new drugs that could potentially act on both inflammatory cells and fibroblasts. It is challenging to develop anti-scarring drugs because the mechanisms for scarring are varied and there is continuous cross talk between the different mediators of scarring. Due to the involvement of multiple pathways, when one pathway is inhibited, another pathway can still initiate scarring. Hence, we sought a prophylactic treatment to deal with fibrosis caused after glaucoma surgery. A novel approach of increasing the stiffness of the tissue by cross-linking collagen was investigated as a potential prophylactic treatment to inhibit tissue contraction after glaucoma surgery. Collagen gels were cross-linked using riboflavin and ultraviolet radiation, using a similar dose that is used clinically in the treatment of keratoconus. It was found that cross-linking increased the stiffness of the collagen gels and was able to inhibit fibroblast-mediated tissue contraction in the presence of macrophages and in a porcine ex vivo model. It is envisaged that cross-linking the tissue during glaucoma surgery could potentially dampen the scarring response, especially in high-risk patients. Overall, this thesis focused on trying to better understand ways to treat the multifactorial condition of fibrosis. It is not only important to have an efficacious drug molecule but it is also important to strategise the delivery of the anti-scarring drugs. We also showed, with the help of an in vitro model, that the presence of inflammatory cells can nullify the effect of anti-scarring drugs. While modulating the complicated process of wound healing with the help of drugs is challenging, there is a possibility that the prophylactic treatment of cross-linking could better protect patients and reduce the need for medication. Finally, apart from molecules and cells, modulating the extracellular matrix could offer an additional approach to reducing scarring.
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Nelson, Patricia. "Visual Function and Visual Disability in Glaucoma." Thesis, Heriot-Watt University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.518609.
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Mulholland, Padraig Joseph. "Temporal summation with age and in glaucoma." Thesis, Ulster University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.650307.
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Standard automated perimetry (SAP) serves as the cornerstone in the diagnosis and monitoring of functional deficits associated with glaucoma. Achromatic contrast thresholds are typically measured at pre-defined locations in the visual field for circular stimuli of constant area and duration. However, the selection of SAP stimulus parameters was made with little or no regard to the ability of the visual system to sum light energy over both space and time, and how such aspects of visual function might vary across the visual field and in glaucoma. In recent years there has been renewed interest in the spatial summation of perimetric stimuli, it being suggested that the sensitivity of SAP, and thus the relationship of contrast thresholds to underlying retinal ganglion cell density, might be improved through a simple scaling of stimulus area. In this thesis we re-examined temporal summation to provide an evidence base from which the selection of appropriate stimulus parameters for SAP might be made. Specifically, we investigated the various factors that can influence the upper limit of complete temporal summation (critical duration) including stimulus area, rate of high-frequency flicker, age and glaucoma. We observed that the critical duration is intrinsically linked to the degree of spatial summation exhibited at any point in the visual field, with the result that temporal summation varies across the visual field when examined using a stimulus scaled to the localised area of complete spatial summation (Ricco's area). We also found the critical duration to be significantly increased in glaucoma when examined using both a standard Goldmann III stimulus and a stimulus scaled to the localised Ricco's area under the conditions of SAP. Based on the results of this thesis we propose the use of stimuli modulating in area, duration and luminance to improve the sensitivity and specificity of perimetry in the detection of glaucoma.
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Maciel-Guerra, Andrea Trevas 1960. "Estudo genetico-clinico de glaucoma congenito primario." [s.n.], 1989. http://repositorio.unicamp.br/jspui/handle/REPOSIP/316550.
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Orientador: Antonio Sergio RamalhoTese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: O Glaucoma Congênito Primário (GCP) é uma entidade genética heterogênea, geralmente considerada distinta da Megalocórnea e do glaucoma congênito de manifestação tardia ou juvenil. A fim de detectar indicações da heterogeneidade genética do GCP a nível clínico, foram examinados 67 portadores dessa anomalia, dos quais se obtiveram dados anamnésticos e de exame oftalmológico. Os resultados da análise se segregação, bem como a alta freqüência de consangüinidade observada nessa amostra indicam que o padrão de herança autossômico recessivo predomina entre nossos pacientes. A associação significativa encontrada entre a recorrência familial do GCP e a existência de consangüinidade entre os genitores, o início das manifestações ao nascimento e a bilateralidade e simetria da doença indica que os casos que manifestem essas três características sejam considerados de alto risco de recorrência na irmandade, enquanto que aqueles em que nenhuma dessas características é observada devam ser considerados os de mais baixo risco. A existência de megalocórnea ou de glaucoma congênito de manifestação tardia ou juvenil em um dos olhos do portador de GCP ou em outros membros da família sugere fortemente que essas entidades nosológicas correspondam a diferentes formas de expressão de uma mesma anomalia básica do ângulo iridocorneal, indicando que devam ser analisadas em conjunto. Estudos aprofundados do glaucoma congênito se fazem necessários, portanto, para elucidação de seus diversos aspectos genéticos e clínicos
Abstract: Primary Congenital Glaucoma (PCG) is a heterogeneous genetic entity which is usuall_ considered distinct from Megalocornea and congenital glaucoma of late or juvenil onset. History and ophthalmological data were obtained from 67 PCG cases in order to find out indications of the genetic heterogeneity_ of this disease at the clinical level. The results obtained from a complex segregation analysis, as well as the high frequency of parental consanguinity in this sample, indicate that the autosomal recessive pattern of inheritance predominate among our patients. A high recurrence risk is expected to the sibs of PCG cases with parental consanguinity, onset of the disease at birth and bilateral and symmetrical involviment, while those which exhibit none of these features seem to be at the lowest risk of having affected sibs. Since megalocornea and congenital glaucoma of late or juvenile onset can be found in the other eye of a PCG patient or in other individuals in the same family, these diseases appear to be manifestations of the same basic abnormality of the iridocornea1 angle. Hence, the_ should be analyzed together with PCG. Comprehensive studies of congenital glaucoma are thus necessary to elucidate its clinical and genetical peculiarities
Doutorado
Doutor em Ciências
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Vasalauskaite, Asta. "Visual function in human and experimental glaucoma." Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/98604/.
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Injury to optic nerve (ON) axons plays a major role in glaucoma progression. ON crush is an established model of axonal injury which results in retrograde degeneration and death of retinal ganglion cells (RGCs). However, it is unknown how signal transmission to higher visual structures such as primary visual cortex (V1) is affected after ON crush. In human glaucoma, visual function is assessed using visual field (VF) tests, but it is also not clear how the test results relate to the disease progression in the retina. Unilateral ON crush was performed on the left eyes of adult C57BL/6 mice. V1 function of the right hemisphere was assessed longitudinally by optical imaging (OI) and in vivo calcium two-photon imaging under anaesthesia before and at 7 days, 14 days and 30 days after ON crush. Human retinas from glaucoma patients were investigated for changes in RGC density and compared to the score from the VF data obtained prior to the patients’ death. ISI and 2P experiments demonstrate a significant shift in OD towards the ipsilateral eye and significant reduction of signal magnitude in V1 in response to contralateral eye stimulation in all ON crush animals. Additionally, response magnitude to ipsilateral eye stimulation was significantly increased after ON crush. While there was significant RGC loss in human glaucoma compared to age matched controls that was correlated to mean VF loss, the scores from the individual VF test points were uncorrelated to RGC density in anatomically equivalent areas. This work demonstrates that unilateral ON crush results in immediate loss of signal transmission from the retina to V1 via a crushed ON. A significant increase of responsiveness in V1 to non-crushed eye stimulation was observed, which indicates that injury of the ON in adulthood may evoke compensatory plasticity in V1.
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Kozariychuk, N. Ya. "Dry eye syndrome in patients with glaucoma." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19659.
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Annangudi, Palani Suresh Babu. "Lipid-based Oxidative Protein Modifications in Glaucoma." Case Western Reserve University School of Graduate Studies / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=case1129558048.
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VERTICCHIO, VERCELLIN ALICE CHANDRA. "VASCULAR RISK FACTORS AND GLAUCOMA OPTIC NEUROPATHY." Doctoral thesis, Università degli studi di Pavia, 2021. http://hdl.handle.net/11571/1434314.
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Anahory, Barbara Bettencourt. "Factores de neuroprotecção do nervo óptico no glaucoma." Master's thesis, Universidade da Beira Interior, 2009. http://hdl.handle.net/10400.6/895.
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Glaucoma é a designação genérica de um grupo de doenças que atingem o nervo óptico e envolvem a escavação da cabeça do mesmo, bem como a perda de células ganglionares da retina num padrão característico de neuropatia óptica (10).
Segundo dados estatísticos da Organização Mundial de Saúde é a segunda causa de cegueira no Mundo, sendo responsável por 5,2 milhões de cegos, ou seja, corresponde a 15% dos casos de cegueira mundial (12,17). Prevendo-se que em 2010 hajam 60,5 milhões de pessoas com glaucoma de ângulo aberto e glaucoma de ângulo fechado, aumentando em 2020 para 79,6 milhões (13).
Actualmente, o glaucoma primário de ângulo aberto é o tipo de glaucoma mais frequente, ocorrendo em aproximadamente 90% de todos os doentes glaucomatosos (66).
Esta é uma doença silenciosa, principalmente nas fases iniciais, sendo difícil a sua detecção, pelo que a diminuição da acuidade visual, só é evidenciada quando a doença se encontra num estádio avançado e geralmente irreversível (15).
Actualmente, sabe-se que o glaucoma é uma doença do nervo óptico, em que o aumento da pressão intra-ocular é o principal factor de risco (11). Durante mais de um século, o tratamento do glaucoma era inteiramente dirigido a baixar a pressão, no entanto, a progressão da doença ocorria, mesmo em doentes onde esta era normal ou mesmo reduzida (11).
Assim, surge a necessidade de melhor compreender o processo de degeneração do nervo óptico, permitindo alargar os horizontes terapêuticos desta patologia. A degeneração neuronal parece ocorrer por um mecanismo primário e secundário. No primeiro, ocorre uma lesão directa, por aumento da pressão intra-ocular, actuando a nível mecânico, axoplasmático e vascular. No segundo, as células ganglionares da retina e as fibras nervosas, previamente lesionadas, libertam inúmeras substâncias tóxicas, que danificam as células da vizinhança, através de mecanismos de apoptose e excitotoxicidade.
É neste contexto que surge o conceito de neuroprotecção, que pode ser adquirida por vias farmacológias e imunológicas. Esta evita o mecanismo de degeneração, nas células ganglionares da retina, que foram inicialmente poupadas pela lesão primária, neutralizando ou inibindo os vários elementos extracelulares implicados na lesão secundária (46), mantendo-as assim vivas, estrutural e funcionalmente (47). Embora em inúmeros estudos experimentais tenha sido demonstrada a eficácia desta terapia, faltam ainda algumas evidências que permitam a sua aprovação em humanos (29).
Apesar das controvérsias e ainda vastas pesquisas necessárias nesta área, é certo que, futuramente, o tratamento da doença glaucomatosa passa pela neuroprotecção.Glaucoma is the generic name of a group of diseases that affect the optic nerve and involve the excavation of it´s head, as well as the loss of retinal ganglion cells in a characteristic pattern of optic neuropathy (10) . New statistics gathered by the World Health Organization show that glaucoma is the second leading cause of blindness globally, accounting for 5.2 million blinds, which corresponds to 15% of cases of blindness worldwide (12, 17) .It is expected that in 2010 there will be 60.5 million people with open angle glaucoma and closer angle glaucoma, increasing in 2020 to 79.6 million(13) . Currently, the primary open-angle glaucoma is the most common type of glaucoma, occurring in approximately 90% of all glaucoma patients (66) . This is a silent disease, especially in the early stages, of difficult detection, and the decreased visual acuity is only noticed when the disease is at an advanced stage and usually irreversible (15) . Currently, it is known that glaucoma is a disease of the optic nerve, in which the increase of intraocular pressure is the main risk factor (11). For over a century, the treatment of glaucoma was entirely directed towards lowering the pressure, however, the progression of the disease occurred even in patients where pressure was normal or even reduced (11) . Thus, arises the need to better understand the process of degeneration of the optic nerve, allowing extended the therapeutic horizons for this pathology. The neuronal degeneration seems to occur by a primary and secondary mechanism. In the first case, there is a direct injury caused by increased intraocular pressure, acting at a mechanical, vascular and axoplasmatic level. In the second case, the retinal ganglion cells and nerve fibers, previously injured, release numerous toxic substances that damage the neighborhood, through mechanisms of apoptosis and excitotoxicity. It is in this context that the concept of neuroprotection arises, which may be acquired through pharmacological and immunological means. This prevents the degeneration mechanism within the retinal ganglion cells, which were initially spared by the primary injury neutralizing or inhibiting the various extracellular factors involved in secondary injury (46) and keeping them structurally and functionally alive (47) . In spite of the efficacy demonstrated in numerous experimental studies, in humans are missing some evidences for this therapy is approved (29) . Despite the controversy and extensive research needed in this area, it is true that, in future, the treatment of glaucomatous disease will be related to neuroprotectors.
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Schweitzer, Cédric. "Analyse épidémiologique du glaucome dans une population âgée : l'étude ALIENOR (Antioxydants, Lipides Essentiels, Nutrition et maladies Occulaires)." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0186/document.
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Le glaucome est une maladie neurodégénérative qui se définit par une perte progressive en fibres nerveuses rétiniennes et un rétrécissement du champ visuel. Il s’agit de la première cause de cécité irréversible dans le monde et le principal facteur de risque est la pression intraoculaire (PIO). L’étude ALIENOR (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) est une étude épidémiologique qui a pour but de déterminer l’incidence des différentes pathologies oculaires liées à l’âge avec les facteurs nutritionnels, démographiques ou environnementaux dans une population représentative de la région de Bordeaux. En 2009-2010, 624 sujets âgés de plus de 74 ans ont bénéficié d’un examen ophtalmologique complet incluant un examen du nerf optique en rétinophotographie et en tomographie à cohérence optique spectral-domain (SD-OCT), d’une mesure la PIO au tonomètre à air et d’une évaluation des propriétés biomécaniques de la cornée. Une mesure de l’accumulation cutanée de produits de glycation avancée a été réalisée par autofluorescence. Le diagnostic de glaucome a été réalisé en utilisant les critères de la classification ISGEO (International Society for Epidemiologic and Geographical Ophthalmology). Les paramètres biomécaniques de la cornée étaient modifiés avec l’âge et chez les sujets ayant une histoire résidentielle à des latitudes plus exposées aux ultraviolets ambiants. L’épaisseur de cornée était plus élevée chez les sujets anciennement fumeurs. L’autofluorescence cutanée ≥ 2.7 UA (Unité Arbitraire) était indépendamment associée au glaucome. Les paramètres d’épaisseur en fibres nerveuses rétiniennes du SD-OCT présentaient de bonnes performances diagnostiques pour discriminer les sujets glaucomateux des témoins et la base normative présentait de bonnes performances discriminatives lorsqu’au moins un des paramètres était considéré comme anormal. Notre étude apporte des résultats originaux en termes de facteurs de risque de glaucome ou de déterminants des facteurs de risque de glaucome. De plus les performances diagnostiques du SD-OCT pourraient fournir des informations utiles pour optimiser les stratégies de dépistage du glaucome dans une population générale âgéeGlaucoma is a neurodegenerative disease defined by a progressive loss of optic nerve axons and retinal ganglion cells resulting in a characteristic enlargement of the optic nerve head cup and associated visual field defects. It remains the first cause of irreversible blindness worldwide and intraocular pressure (IOP) is the main risk factor. The ALIENOR (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) study is a population-based study. It aims to assess the associations of age-related eye diseases with nutritional, demographic and environmental factors in a representative population of the Bordeaux area. In 2009-2010, 624 subjects, aged 74 years or more, underwent a complete eye examination, including an optic nerve head evaluation using retinophotography and a spectral-domain optical coherence tomography (SD-OCT), an IOP measurement using air-puff tonometry and an evaluation of biomechanical properties of the cornea. A measurement of skin accumulation of advanced glycation end-products was performed using an autofluorescence reader. Glaucoma diagnosis was made using ISGEO (International Society for Epidemiologic and Geographical Ophthalmology) criteria. Biomechanical properties of the cornea were modified by increasing age and in subjects having a higher lifetime ambient ultraviolet exposure. Central corneal thickness was thicker in former smokers. Skin autofluorescence values ≥ 2.7 AU (Arbitrary Unit) were independently associated with glaucoma. SD-OCT retinal nerve fiber layer thickness parameters had good diagnostic performances for discriminating glaucoma and control subjects and the normative database had good diagnostic performances if at least one parameter was considered abnormal by the machine. Our study provides new insights on glaucoma risk factors and determinants of glaucoma risk factors. Furthermore diagnostic performances of SD-OCT may provide valuable information in a screening strategy to optimize glaucoma detection in a general population of elderly people
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Salmon, John Frank. "Primary angle-closure glaucoma in Cape people of mixed ethnic background with special emphasis on chronic angle-closure glaucoma." Doctoral thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/25847.
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Mok, Kwok-hei. "The characterization of retinal nerve fiber layer thickness in normal, high-tension and normal-tension glaucoma using optical coherence tomography." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31381005.
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Friström, Björn. "Aspects of the diagnosis and treatment of glaucoma /." Linköping : Univ, 2001. http://www.bibl.liu.se/liupubl/disp/disp2001/med690s.pdf.
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Bhatt, Mittal Gopalbhai. "Detecting glaucoma in biomedical data using image processing /." Link to online version, 2005. https://ritdml.rit.edu/dspace/handle/1850/939.
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Balian, Carmen. "Central Visual Field Assessment in Late Stage Glaucoma." Thesis, University of Waterloo, 2006. http://hdl.handle.net/10012/2955.
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Glaucoma is defined as a progressive optic neuropathy, characterized by loss of visual function and often associated with high intra-ocular pressure. Testing the patients' visual function with Standard Automated Perimetry (SAP) is currently the clinical standard for detecting glaucomatous visual field loss. A new test algorithm using the Frequency Doubling illusion has been introduced on the Matrix perimeter (Humphrey Matrix; Carl Zeiss Meditech, Dublin CA) that measures the central 10° using a 2°x 2° square flickering stimulus. This stimulus has the theoretical advantage of being both a large target, with good repeatability, and being perceptually selective, by preferentially stimulating the magnocellular projecting ganglion cells. The purpose of this thesis was to determine the within-technique, between-visits repeatability and the within-visit, between-technique comparison of several techniques available to measure the central 10° visual field in patients with late stage glaucoma. In particular, to examine test-retest variability and compare sensitivity threshold values, visual field indices, and total and pattern deviation probability maps among the following techniques: Full Threshold SAP 10-2 size III (SAP III), Full Threshold SAP size V (SAP V), SITA SAP 10-2 size III (SS III), and Matrix 10-2 2° stimulus (M2).
Forty nine patients with advanced glaucomatous visual field defects attended 3 visits. During each visit, 1 eye was examined with each of the 4 techniques mentioned above. Data from the first visit was discarded to eliminate bias that may occur from the learning effect. Coefficient of Repeatability values of SAP III, SAP V, SS III, and M2 were calculated to be 10. 33, 9. 00, 9. 90, and 12. 04%dB respectively, relative to the average difference in threshold estimates between visits. M2 had the most uniform test-retest characteristics across the full range of sensitivities; however the 90% confidence interval was the widest of all techniques in the normal to near normal range (24 to 38dB). M2 showed the greatest defects in both total and pattern deviation probability plots. Threshold estimates of SAP III and SS III were shown to be similar and slightly more variable than SAP V. M2 showed greater defects than SAP III in both total and pattern deviation probability plots. Compared to SAP III and SS, M2 estimated sensitivity as less severe. Estimates of 20 dB and above on M2 were estimated at approximately 30 dB with SAP V. In the moderate to abnormal sensitivity range, Matrix estimated points to be shallower than that estimated by SAP V.
This thesis showed that test-retest variability of the SAP techniques decreased with increasing sensitivity whereas; variability was constant throughout the dynamic range for M2 and smaller in the moderate to severe range. However M2 was worst in the normal to near-normal sensitivity range. This suggests that M2, compared to all SAP techniques, will be disadvantaged for the detection of early visual field loss but better positioned to repeatably detect and follow moderate to severe loss in the central 10° of patients with late stage glaucoma.