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Impact of Intraocular Pressure on Optic Nerve Head Deformation

  • Christopher LeungEmail author
Chapter
Part of the Advances in Visual Science and Eye Diseases book series (AVSED, volume 1)

Abstract

Glaucoma is a form of chronic optic neuropathy characterized by progressive thinning of the retinal nerve fiber layer (RNFL), narrowing of the neuroretinal rim, and deformation of the optic nerve head (ONH). Deciphering the temporal sequence of the structural changes of the RNFL, neuroretinal rim, and ONH and their associations with the decline in visual function and change in intraocular pressure (IOP) levels has major implications in the clinical management of glaucoma patients. In a previous study following 90 glaucoma patients with confocal scanning laser ophthalmoscopy (CSLO) imaging of the ONH surface and optical coherence tomography (OCT) imaging of the RNFL at 4-month intervals over 4 years [1], we showed that among patients demonstrating both progressive RNFL thinning and posterior deformation of the ONH, 82.6% of eyes had posterior deformation of the ONH before progressive RNFL thinning, and the median lag time was approximately 16 months (Fig. 26.1). Whereas 7% of eyes had progressive RNFL thinning at the onset of posterior deformation of the ONH, about 46% had posterior deformation of the ONH at the onset of progressive RNFL thinning. This finding suggests posterior deformation of the ONH may occur before progressive RNFL thinning in many patients with glaucoma, and a therapeutic time window may exist upon detection of posterior deformation of the ONH before irreversible loss of the RNFL.

References

  1. 1.
    Xu G, Weinreb RN, Leung CK. Optic nerve head deformation in glaucoma: the temporal relationship between optic nerve head surface depression and retinal nerve fiber layer thinning. Ophthalmology. 2014;121:2362–70.CrossRefGoogle Scholar
  2. 2.
    Wu Z, Xu G, Weinreb RN, Yu M, Leung CK. Optic nerve head deformation in glaucoma: a prospective analysis of optic nerve head surface and lamina Cribrosa surface displacement. Ophthalmology. 2015;122:1317–29.CrossRefGoogle Scholar
  3. 3.
    Wu Z, Lin XC, Crowther M, Mak H, Yu M, Leung CK. Impact of rates of change of lamina cribrosa and ONH surface depths on visual field progression in glaucoma. Invest Ophthalmol Vis Sci. 2017;58(3):1825–33.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology and Visual SciencesThe Chinese University of Hong KongHong KongChina

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