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OCT e Glaucoma www.amedeolucente.itNo commercial interests.

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Presentation on theme: "OCT e Glaucoma www.amedeolucente.itNo commercial interests."— Presentation transcript:

1 OCT e Glaucoma commercial interests

2 2 Glaucoma 2 ͣcausa di cecità al mondo, 1 ͣcausa di cecità irreversibile Italia 2,5% over 40 Caucasici * Dati OMS 2010 * Bonomi L, et al. The Egna-Neumarkt Study, ,5 milioni in USA 3,36 milioni 2020

3 The Glaucoma Continuum 3 Modificato da Weinreb R. et al A. J. Ophthalmol 2004; 138;

4 Retinal Ganglion Cell 4 Weinreb R. The Lancet 363; 1711, 2004 Perdita /Cell /anno ?

5 OH v/s Glaucoma Kass M A et al; OHTS Ocular Hypertension Treatmaent Study 2002 Miglior S. et al; Results of the European Prevention Study IOP + CCP+ ETA’+ PSD + CUP/DISK + Etnia + sesso + PA + ecc

6 Relationship between MD and RGC number Relationship between MD and RGC number 6 Adapted from Medeiros FA, Lisboa R, Weinreb RN, et al. A combined index of structure and function for staging glaucomatous damage. Arch Ophthalmol. 2012;130(5):E1-10.) 1 dB = 0.1 Log 5000/9000 Ganglion Cells/Year

7 Mean Deviation (dB) Average Thickness (µm) Estimated RCG count (x cells) 7 MD dB Thickness µm A) A) At early stages of damage (high RGC counts), changes in estimated RGC counts correspond to relatively smaller changes in MD (continuous line) and relatively larger changes in average RNFL thickness (dashed line). B) B) At advanced stages of damage (low RGC counts), changes in estimated RGC counts correspond to relatively large changes in MD, but only small changes in average RNFL thickness. OK KO

8 CSFI Combined Structure Function Index 8 Felipe A. Medeiros, Renato Lisboa, Robert N. Weinreb, Christopher A. Girkin, Jeffrey M. Liebmann, Linda M. Zangwill. Arch Ophthalmol. 2012

9 Biblio CSFI 1. Sibota R, Sony P, Viney G, et al. Diagnostic capability of optical coherence tomography in evaluating the degree of glaucomatous retinal nerve fiber damage. Invest Ophthalmol Vis Sci 2006;47(5): Medeiros FA, Lisboa R, Weinreb RN, et al. A combined index of structure and function for staging glaucomatous damage. Arch Ophthalmol. 2012;130 (5):E Harwerth RS, Wheat JL, Fredette MJ, Anderson DR. Linking Structure and function in glaucoma. Prog Retin Eye Res. 2010;29(4): Medeiros FA, Zangwill LM, Anderson DR, et al. Estimating the rate of retinal ganglion cell loss in glaucoma. Am J Ophthalmol. 2012; Jul 26. [Epub ahead of print]. 9 Specificità 95%

10 SD-OCT & Glaucoma RNFL Retinal Nerve Fiber Layer RNFL Retinal Nerve Fiber Layer ONH Optical Nerve Head ONH Optical Nerve Head GCC Ganglion Cell Complex GCC Ganglion Cell Complex AS-OCT Anterior Segment OCT AS-OCT Anterior Segment OCT SD-OCT & CV SD-OCT & CV 10

11 GCC Ganglion Cell Complex 11 Schultze A, et al. Diagnostic ability of retinal ganglion cell complex …. Graefes Arch Clin Exp Ophthamol 2011 Jul; 249 (7) : Complex scan pattern 50% Ganglionari in macula 7 mm scan area a-scan 0.58 sec

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15 15 Ganglion cells IPL

16 Abnormal GCC in spite of normal RNFL Thickness 16 Garas A et al Reproducibility of retinal nerve layer and macular thickness ecc Ophthalmology 2010 Elsevier

17 Normal RNFL Thickness v/s abnormal GCC 17

18 Report Ganglion Cell OU Analysis 18

19 Stages of Glaucoma & GCC 19

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21 SD-OCT & Glaucoma RNFL Retinal Nerve Fiber Layer RNFL Retinal Nerve Fiber Layer ONH Optical Nerve Head ONH Optical Nerve Head GCC Ganglion Cell Complex GCC Ganglion Cell Complex AS-OCT Anterior Segment OCT AS-OCT Anterior Segment OCT SD-OCT & CV SD-OCT & CV 21

22 SD-OCT & CV FORUM Zeiss Cirrus & Humphrey con FORUM HEYEX Heidelberg Spectralis & HEP con HEYEX Bundle Haag-Streit * Optovue & Octopus Bundle Haag-Streit * 22

23 HFA Visual Field and Cirrus RNFL Combined Report 23

24 RNFL & Visual Field Combined OU Report 24

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26 Finite Element Modeling of the Lamina Cribrosa of the Optic Nerve Head in Glaucoma Finite Element Modeling of the Lamina Cribrosa of the Optic Nerve Head in Glaucoma Devers Eye Institute / National Institute of Health Optic Nerve Head Research Laboratory directed by Dr. Claude Burgoyne (Portland Oregon) 26

27 Finite Element Modeling of the Lamina Cribrosa of the Optic Nerve Head in Glaucoma Finite Element Modeling of the Lamina Cribrosa of the Optic Nerve Head in Glaucoma Devers Eye Institute / National Institute of Health Optic Nerve Head Research Laboratory directed by Dr. Claude Burgoyne (Portland Oregon) 27

28 Structural and functional recovery in juvenile open angle glaucoma after trabeculectomy C K S Leung, J Woo, M K Tsang and K K Tse Eye (Lond) Jan;20(1):132-4 Fundus photographs, OCT optic nerve head scans (vertical cut) and Humphrey visual field pattern deviation plots of the left eye obtained the day before trabeculectomy (a) and 1 week postoperatively (b). The red lines on the fundus photographs indicate the location of the OCT scans in the middle panel. Eye (Lond) Jan;20(1): REcovery? REVERSIBLE?REVERSIBLE?

29 Structural and functional recovery in juvenile open angle glaucoma after trabeculectomy C K S Leung, J Woo, M K Tsang and K K Tse Eye (Lond) Jan;20(1): Post Op. 117 µm Pre Op µm buffer-zone A time interval in which optic nerve damage can be reversed by appropriate interventions. = degree of IOP reductionage of presentation compliance of the lamina cribrosa composition of supporting tissue Reversal is likely to be dependent on the degree of IOP reduction, the age of presentation, and may vary with the compliance of the lamina cribrosa and the composition of supporting tissue of retinal ganglion cells.

30 Reversibility of glaucomatous demange 1.Kotecha A, Siriwardena D, Fitzke FW, Hitchings RA, Khaw PT. Optic disc changes following trabeculectomy: longitudinal and localisation of change. Br J Ophthalmol 2001; 85: 956–961. | Article | PubMed | ISI | ChemPort | 2.Aydin A, Wollstein G, Price LL, Fujimoto JG, Schuman JS. Optical coherence tomography assessment of retinal nerve fiber layer thickness changes after glaucoma surgery. Ophthalmology 2003; 110: 1506–1511. Article PubMed ISI 3.Tsai CS, Shin DH, Wan JY, Zeiter JH. Visual field global indices in patients with reversal of glaucomatous cupping after intraocular pressure reduction. Ophthalmology 1991; 98: 1412–1419. | PubMed | ISI | ChemPort | 30 Biblio

31 Grazie per l’attenzione 31


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