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Title: Usefulness of chosen methods of optic disc evaluation in open angle glaucoma follow-up

Abstract:

Glaucomatous neuropathy is still one of the main reasons of blindness in the world. These days there is a number of available methods of treatment of this disease, namely pharmacology, which is becoming more and more effective, laser and surgical procedures. Yet the questions are: „when is more agressive treatment recommended?, when can we be certain that progression has occured and actions should be undertaken to avoid deterioration of visual function?”. Objective laser analysers such as HRT (Heidelberg Retina Tomograph) are used more and more often. However, although advanced diagnostic methods are applied, still there is a place for a clinical, subjective evaluation of a patient. The aim of my thesis was to evaluate usefulness of HRT and clinical evaluation of a photography of the optic nerve head with respect to monitoring of patients who suffer from primary open angle glaucoma and to determine parameters of HRT which reflect the progression of galucomatous neuropathy best. The selection criteria of the investigated group included: the diagnosis of primary open angle glaucoma with both high and low intraocular pressure, the refractive error less then 5 D, the corrected visual acuity at least 5/10, the lack of other ophtalmologic and general disorders excluding stabilized ; arterial hypertension, the pharmacological treatment of glaucoma, the condition after laser or glaucoma surgeries. The research was conducted from April 2005 to November 2011. On average follow-up period in a patients grup was for 37 months (from 11 to 67 months) and in a contol group was 29,8 months (from 15 to 40 months). The selection criteria of the control group included: the lack of suspicion of glaucoma, no glaucoma presence in family background, the c/d ratio less than than 0,6 and the lack of the asymetry of a disc/cup ratio greater than 0,1. The study included 37 patients (73 eyes) average age was 60,3 years.There were 25 females and 12 males. One eye was excluded from the research due to the previous injury. In the control group there were 12 patients (24 eyes), 7 females and 5 males, average age was 56 years. ; The baseline examination included: best corrected visual acuity with Snellen’s charts, intraocular pressure with Goldmann applanation tonometer, corneal pachymetry, assessment of irideocorneal angle with Goldmann indirect goniolens (gonioscopy), slit-lamp examination of a anterior part of an eye, fundoscopy with the volk lens after pupil dilation with 1% Tropicamide eye grops, visual field testing 30-2 with Humphrey statistic perimeter, examination of the optic nerve head with Heidelberg Retina Tomograph and optic disc photography taken with Topcon TRC-50DX camera. The photographies of the optic nerve head were evaluated by two independent specialists of glaucomatous neuropathy. They knew the chronology of the photographies but they did not know then patients data. If a case of dcontrary opinions on the same photography in terms of glaucomatous neuropathy progression, the final opinion was given by the third independent observer. Additional evaluation of the photography of the optic nerve disc was neccessary in only few cases. The results of the study were analysed statisticaly. The values of mean deviation (MD) parameter of the visual field showed significant statistical defferences between the investigated group and the control group. Patients diagnosed for glaucoma demonstrated characterstic, glaucomateous defects in the visual field, resulting in lower values (-6,513dB) of MD as compared to the control group (-0,110 dB). During the observation, no considerable statistic change of MD parameter in the patients group with glaucoma was determined. The lack of statistically important dicrease of MD parameter indicates no progression in the visual field in this group. Apart from height variation contour and RNFL (retinal ; nerve fiber layer) cross section area, all other stereotactic parameters of an optic nerve in HRT test presented statisticaly significant discrepancies between the investigated group and the control group. The majority of HRT parameters allowed to differentiate patients with glaucoma from healthy persons. In order to select HRT parameters which determine the progression of glaucoma, I constructed a series of logistic models with respect to one or two HRT parameters. In my research the following parameters presented significant statistic change: the cup area, the c/d ratio, the rim area and the mean cup depth. The progression of glaucomatous neuropathy was diagnosed when three of four parameters mentioned above indicated significant statistic change. In the group of 73 eyes of patients with glaucoma, HRT progression was observed in 61 cases. The sensitivity of HRT test with respect to the evaluation of glaucomatous neuropathy progression was determined at the level of 83,6%. The secifity of this method, the percentage of eye with the progression, from the control group was defined as 66,7%. In the clinical evaluation of the photography of the optic nerve head, the most often the progression was indicated based on “desolated vessels on the disc ” and “local thinning of neuroretinal rim (notch)”. The most seldom (only 2 cases), the progression was based basing on the c/d and the r/d changes. In the group of 73 eyes of patients with glaucoma, progression in clinical evaluation of the photography of the optic disc was observed in 58 cases. The sensitivity of the evaluation of progression with respect to the photography of the optic nerve disc in the investigated group was 72,6%. And the specifity of this method was 70,8%. ; The χ2 test which compared the sensitivity and the specifity of both methods indicates that the parameters of these two method do not vary statisticaly significantly. In my research, both methods appeared to be useful for the diagnosis of the progression of glaucomatous neuropathy. The first symptoms of progression in HRT method were observed after an average of 16,3 months, while for the half of the investigated group such symptons were observed after an average of 13 months. For clinical evaluation of the photography of the optic nerve disc, the first manifestaion of progression was observed after 17,5 months, while for the half of the investigated group such symptons were observed after 12 months. The difference of 1 month is not significant. The time differences in diagnosing the progression of glaucomatous neuropathy showed no statistical significance.Both HRT and clinical evaluation of the photography of the optic nerve head had the same clinical importance in monitoring open angle glaucoma progression.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

okulistyka

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Bożena Romanowska-Dixon

Date issued:

2014

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3987

Call number:

ZB-122379

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

May 24, 2021

In our library since:

Jun 15, 2015

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http://dl.cm-uj.krakow.pl:8080/publication/3987

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ZB-122379 May 24, 2021
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