A Study on Preperimetric Open Angle Glaucoma with Young Age: Natural Clinical Course, Risk Factors for Progression and Patterns of Imaging = 젊은 연령 시야결손전녹내장에 관한 연구: 자연경과와 위험인자 및 이미징 패턴

다국어 초록 (Multilingual Abstract)

Preperimetric open angle glaucoma (OAG) is characterized by the presence of glaucomatous optic disc and damage in the retinal nerve fiber layer (RNFL), with
normal visual field (VF) on standard automated perimetry. While glaucoma can affect individuals of all ages, the proportion of young adults in the glaucoma population is growing. Knowledge of the natural course and risk of disease progression, which presently is lacking, are essential. Also, the glaucomatous structural changes depending on the age of occurrence is largely unknown.
In Chapter Ⅰ, the over-5-year natural clinical course of preperimetric OAG of young age of onset (under age 40) without treatment was investigated. Additionally, the risk factors associated with structural and/or functional progression in these patients was evaluated. Optic disc photography, red-free RNFL photography, optical coherence tomography (OCT), and VF examinations were performed every 6 months. Glaucoma progression was defined as structural or functional deterioration. A linear mixed-effects model was used to estimate the rate of structural and functional changes. Kaplan-Meier survival analysis and log-rank testing were used to compare survival experiences, and Cox proportional hazards modeling was performed to identify risk factors for glaucoma progression. As a result, of the 98 eyes of 98 patients (mean age, 30.6 years old), glaucoma progression was detected in 42 eyes (42.9%). The rate of average RNFL thickness thinning was -0.46 ± 0.50 mm/y, and the mean deviation change was -0.03 ± 0.13 dB/y. The glaucoma progression probability at 5 years was 39% by structural criteria and 5% by functional criteria. Older age at diagnosis (P=0.004), presence of temporal raphe sign (horizontal straight line on macular ganglion cell-inner plexiform layer thickness map) (P=0.011), lamina pore visibility (P=0.034), and greater pattern standard deviation (P=0.005) were significant factors for glaucoma progression.
In Chapter II, by using OCT, we sought to investigate the structural topographic patterns and characteristics of RNFL and macular ganglion cell-inner plexiform layer (GCIPL) thinning in young-age onset (below 40) and old-age-onset (over 40) preperimetric OAG patients. The RNFL and GCIPL deviation images were acquired by Cirrus HD-OCT, and overlaid, thus converted to a “deviation frequency map”, respectively. The topographic thinning patterns and parameters of RNFL and GCIPL thickness measurements were compared. A total of 194 eyes of 194 patients with preperimetric OAG and 97 eyes of 97 age-matched normal subjects were analyzed. Young-age-onset eyes of preperimetric OAG mainly had RNFL defects inferotemporally (264–296°) with GCIPL defects in the inferior region (213–357°). Old-age-onset preperimetric OAG eyes had RNFL defects inferotemporally (266–294°) and superotemporally (33–67°) with GCIPL defects in the inferior and superior regions (206–360°, 0–22°). The inferior quadrant of RNFL thickness and inferotemporal area of GCIPL thickness were significantly thinner in young-age-onset eyes compared with old-age onset eyes (P= 0.012, 0.016), while the superior quadrant of those were significantly thinner in the old-age-onset eyes (P= 0.003, 0.005).
Therefore, in the study of preperimetric OAG of young age of onset, the natural course and risk of disease progression, structural changes depending on the age of occurrence were investigated. This study demonstrated meaningful results which can provide baseline insights of the early change of glaucoma in clinical applications.

목차 (Table of Contents)

• Abstract i
• Table of Contents iii
• List of Abbreviations iv
• List of Tables v
• List of Figures vi
• Chapter 1 Preperimetric Open Angle Glaucoma with Young Age of Onset: Natural Clinical Course and Risk Factors for Progression
• Introduction 1
• Methods 2
• Results 9
• Discussion 23
• Chapter 2 Patterns of Optical Coherence Tomography Imaging in Preperimetric Open Angle Glaucoma: A Comparative Study with Young-Age-Onset and Old-Age-Onset Eyes
• Introduction 28
• Methods 30
• Results 38
• Discussion 49
• Bibliography 53
• Abstract in Korean 60
• Acknowledgement 62