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Editors Selection IGR 23-3
Structural Examination Methods: Outer retina changes in glaucoma
Comment by Jost Jonas on:
27113 Evidence of outer retinal changes in glaucoma patients as revealed by ultrahigh-resolution in vivo retinal imaging, Choi SS; Zawadzki RJ; Lim MC et al., British Journal of Ophthalmology, 2010;
It has been debated for almost twenty years, whether glaucoma is associated with changes in the deep retinal layers in addition to the classic loss of retinal ganglion cells and a decrease in the thickness of the retinal nerve fiber layer. Early studies by Panda et al. showing a decreased count of photoreceptors in eyes with secondary angle-closure glaucoma and high intraocular pressure, were contradicted by well-designed and carefully performed experimental studies in monkeys and histological studies of human eyes by Quigley et al. New developments in imaging techniques including optical coherence tomography and adaptive optics have allowed visualizing and measuring the outer retinal layers markedly more precisely than it has ever been possible before. Examining ten glaucoma eyes and applying these new imaging techniques, Choi et al. (1723) demonstrated changes in the outer retinal layers, in particular in the cones, along with an expected thinning of the inner retina.
New imaging techniques showed changes in the outer retinal layers, in particular in the cones, along with thinning of the inner retina
This pilot study by Choi et al. clearly re-opens the question about glaucoma related changes in the deep retinal layers and potentially in the retinal pigment epithelium and the choriocapillaris. If the results are confirmed by future studies, questions to be addressed could be whether the deep retinal changes lead to a functional loss in addition to the psychophysical deficits associated with the optic nerve damage; and whether the glaucoma related damage in the outer retinal layers differs between various types of glaucoma. It was previously discussed that glaucomatous changes in the deep retinal layers may be more pronounced in the so called age-related atrophic type of primary open-angle glaucoma which was termed by George Spaeth and which is characterized by a marked fundus tessellation, a large parapapillary atrophy, a shallow optic disc cupping and relatively low intraocular pressure measurements.
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