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Glaucoma: Overview01:25

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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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The eye is a spherical, hollow structure composed of three tissue layers. The outer layer — the fibrous tunic, comprises the sclera — a white structure — and the cornea, which is transparent. The sclera encompasses some of the ocular surface, most of which is not visible. However, the 'white of the eye' is distinctively visible in humans compared to other species. The cornea, a clear covering at the front of the eye, enables light penetration. The eye's middle...
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At the molecular level, visual signals trigger transformations in photopigment molecules, resulting in changes in the photoreceptor cell's membrane potential. The photon's energy level is denoted by its wavelength, with each specific wavelength of visible light associated with a distinct color. The spectral range of visible light, classified as electromagnetic radiation, spans from 380 to 720 nm. Electromagnetic radiation wavelengths exceeding 720 nm fall under the infrared category,...
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A Decrease in Bruch's Membrane Opening-Minimum Rim Area Precedes Decreased Retinal Nerve Fiber Layer Thickness and

Hyun Sup Choi1, Chan Woong Joo, Sung Pyo Park

  • 1Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Journal of Glaucoma
|October 10, 2021
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Bruch's membrane opening-minimum rim area (BMO-MRA) decreases faster than retinal nerve fiber layer thickness (RNFLT) and visual field index (VFI) in early glaucoma. This finding aids in detecting early glaucomatous damage and progression.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Optic Nerve Head Imaging

Background:

  • Glaucoma is a progressive optic neuropathy characterized by damage to the optic nerve head (ONH).
  • Early detection of glaucomatous damage is crucial for timely intervention and vision preservation.
  • The relationship between structural ONH changes and functional vision loss in glaucoma requires further elucidation.

Purpose of the Study:

  • To compare the rate of decrease in Bruch's membrane opening-minimum rim area (BMO-MRA), peripapillary retinal nerve fiber layer thickness (RNFLT), and visual field index (VFI) in glaucoma.
  • To determine the sequence of structural and functional changes during glaucoma progression.

Main Methods:

  • A retrospective cross-sectional study of 121 eyes (73 with open-angle glaucoma, 48 normal).
  • Spectral domain optical coherence tomography (SD-OCT) for ONH and RNFLT analysis.
  • Humphrey Field Analyzer for VFI assessment; broken-stick and polynomial regression models for tipping point and change analysis.

Main Results:

  • A decrease in BMO-MRA preceded decreases in RNFLT and VFI.
  • The tipping point for RNFLT related to VFI was 88.62 μm, and for BMO-MRA was 60.00 μm.
  • BMO-MRA decreased more rapidly than RNFLT and VFI, particularly in early glaucoma stages.

Conclusions:

  • Bruch's membrane opening-minimum rim area (BMO-MRA) is a sensitive indicator of early glaucomatous damage.
  • The ONH parameter BMO-MRA shows a faster decline than RNFLT and VFI in early glaucoma.
  • BMO-MRA changes may serve as an early marker for detecting and monitoring glaucoma progression.