Paulo A. Lotufo

Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features.

In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.

Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation.

Myopic axial elongation is associated with various non-pathological changes.

Predictions of Optic Nerve Traction Forces and Peripapillary Tissue Stresses Following Horizontal Eye Movements.

Following eye movements, our models predicted high optic nerve sheath traction forces of the same order of magnitude as extraocular muscle forces.

Size and Shape of Bruch's Membrane Opening in Relationship to Axial Length, Gamma Zone, and Macular Bruch's Membrane Defects.

Beyond 26.0 mm of axial length, horizontal and vertical BMO diameter increased by 0.21 mm (95%

Optic neuropathy in high myopia: Glaucoma or high myopia or both?

In this review, we summarize similarities and differences in optic neuropathy arising from non-pathologic high myopia and glaucoma by considering their respective structural and functional characteristics on fundus photography, optical coherence tomography scanning, and visual field tests.

Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change.

We propose a new and reproducible classification system of VF abnormalities for nonpathologic high myopia. Applying a comprehensive classification system will facilitate communication and comparison of findings among studies.

Intraocular Pressure and Glaucomatous Optic Neuropathy in High Myopia.

GON was associated with elevated IOP in myopic eyes with an axial length of ≤27.4 mm, while in more highly myopic eyes (axial length ≥27.5 mm), larger optic disc, longer axial elongation and older age-but…

Prevalence of myopic retinopathy in rural Central India.

Prevalence of MR in rural Central India was low (11/4561 or 0.2%), and correlated with a 16 times higher risk of open-angle glaucoma, after adjusting for axial length and gender.

Physical activity and eye diseases. The Beijing Eye Study.

Higher physical activity and less sedentary lifestyle were associated with a lower prevalence of diabetic retinopathy, while the occurrence of other major ocular diseases such as any type of cataract and of glaucoma, retinal vein…

Prevalence and Associated Factors of Pseudoexfoliation in a Russian Population: The Ural Eye and Medical Study.

In this typical, ethnically mixed, population from Russia with an age of 40+ years, PEX prevalence (3.6%; 95% CI, 3.1-4.1) was associated with older age, Russian ethnicity, higher intraocular pressure and open-angle glaucoma.

Intraocular pressure elevation and choroidal thinning.

Choroidal thickness in the subfoveal region and in the peripapillary region decreased parallel to an acute increase in IOP in individuals 2 h after a dark room test.

Intraocular Pressure and Its Associations in a Russian Population: The Ural Eye and Medical Study.

IOP was associated with a multitude of systemic and ocular parameters, the associations of which may be considered in defining the normal range of IOP.

Histology of myopic posterior scleral staphylomas.

Marked scleral thinning and spatially correlated BM defects histologically characterized myopic scleral staphylomas, while thickness and density of the choriocapillaris and RPE and BM thickness did not differ significantly between staphylomatous versus non-staphylomatous eyes in the respective regions.

MicroRNA regulation in an animal model of acute ocular hypertension.

Acute IOP elevation led to changes in the expression of miRNAs, whose target genes were associated with the regulation of microglia-mediated neuroinflammation or neural apoptosis.

Association of Systemic Medication Use with Glaucoma and Intraocular Pressure: The European Eye Epidemiology Consortium.

We identified a potentially harmful association between use of CCBs and glaucoma prevalence.

Automated Beta Zone Parapapillary Area Measurement to Differentiate Between Healthy and Glaucoma Eyes.

Larger βPPA area, as determined by automated OCT assessment, is significantly associated with a diagnosis of glaucoma, even after adjusting for age and AL, and may aid in differentiating healthy from glaucomatous eyes.

The Proportion of Individuals Likely to Benefit from Customized Optic Nerve Head Structure-Function Mapping.

Anatomically customized mapping shifts the map markedly in approximately 12% of the general population in the nasal step region, where visual field locations can map to the opposite pole of the ONH than conventionally considered.

Retinal Nerve Fiber Layer Thickness and Rim Area Profiles in Asians: Pooled Analysis from the Asian Eye Epidemiology Consortium.

In this large pooled analysis of Asian population studies, Indian and Japanese eyes were observed to have thinner RNFL profiles. These findings suggest the need for an ethnic-specific normative database to improve glaucoma detection.

Myopic Versus Glaucomatous Parapapillary Beta Zone in Myopic Eyes Versus Eyes With Secondary Angle-Closure Glaucoma.

The glaucomatous beta zone in eyes with chronic angle-closure glaucoma (with the alpha zone, parapapillary RPE drusen, thickened BM, and higher RPE cell count in the adjacent alpha zone) differs histologically from the myopic beta…

Bruch Membrane Opening Detection Accuracy in Healthy Eyes and Eyes With Glaucoma With and Without Axial High Myopia in an American and Korean Cohort.

As BMO location inaccuracy was 2.4 times more likely in eyes with high axial myopia regardless of diagnosis, optical coherence tomography images of high myopes should be reviewed carefully, and when possible, BMO location should…

Prevalence of Glaucoma in Europe and Projections to 2050: Findings from the European Eye Epidemiology Consortium.

The current and future burden of glaucoma in Europe may be substantially higher than previously estimated, with a considerable proportion of disease in the general population remaining undetected.

Positive and Negative Associations of Myopia with Ocular Diseases in Population-Based Studies.

Myopia is associated with a lower prevalence of DR, AMD, and ACG and a lower incidence of DR and AMD, whereas high myopia more than moderate myopia is associated with a higher prevalence and incidence of OAG.

Diagnostic Accuracy of Macular Thickness Map and Texture En Face Images for Detecting Glaucoma in Eyes With Axial High Myopia.

The current results suggest that our novel en face texture-based analysis method can improve on most investigated macular tissue thickness measurements for discriminating between highly myopic glaucomatous and highly myopic healthy eyes.

Diagnostic Accuracy of Optic Nerve Head and Macula OCT Parameters for Detecting Glaucoma in Eyes With and Without High Axial Myopia.

The diagnostic accuracy for pRNFL and GCIPL was high for high axial myopic eyes and shows promise for glaucoma detection in high myopes.

High Myopia Normative Database of Peripapillary Retinal Nerve Fiber Layer Thickness to Detect Myopic Glaucoma in a Chinese Population.

The HM-specific normative database is more capable of detecting HMG eyes than the SS OCT built-in database, which may be an effective tool for differential diagnosis between HMG and HM.

Effect of Changing Heart Rate on the Ocular Pulse and Dynamic Biomechanical Behavior of the Optic Nerve Head.

In our model, the OPA, pulse volume, and ONH deformations decreased with an increasing heart rate, whereas the LC became stiffer.

Peripapillary choroidal vascular layers: the Beijing Eye Study.

Small-to-medium vessel layer (SMVL) and LVL, thickest superiorly and thinnest inferiorly, increased with younger age and higher cognitive function after adjusting for axial length and prevalence of angle-closure glaucoma.

Multimodal Deep Learning Classifier for Primary Open Angle Glaucoma Diagnosis Using Wide-Field Optic Nerve Head Cube Scans in Eyes With and Without High Myopia.

Combining OCT-based RNFL thickness maps with texture-based en face images showed a better ability to discriminate between healthy and POAG than thickness maps alone, particularly in high axial myopic eyes.

Prevalence, Features, and Risk Factors of Macular Retinoschisis in High Myopic Population: The Beijing Eye Study 2011.

The prevalence of MRS was 27.9% among the elderly highly myopic population.

Prevalence and Associations of Peripheral Arterial Disease in China: The Beijing Eye Study.

The PAD prevalence (3.0%, 95% CI 2.0%, 4.0%) was relatively low in this cohort from rural and urban Beijing, with older age, lower educational level, lower quality of life, higher glucose serum concentration, lower estimated…

Macular pigment optical density and its determinants in a Russian population: the ural eye and medical study.

A higher RPD prevalence and lower stage of open-angle glaucoma were ophthalmological disorders associated with a higher MPOD in a multivariable analysis, including parameters of older age, pseudophakia, female sex, rural region, lower body mass…

Longitudinal Changes of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer in Highly Myopic Glaucoma: A 3-Year Cohort Study.

The patterns of pRNFL and mGC-IPL thinning differ between HMG and OAG.

Associations of fundus tessellation, myopic diffuse chorioretinal atrophy and choroidal thickness with visual acuity in myopia.

MMD stage 1 (fundus tessellation) is associated with decreased BCVA and may be considered pathological.

Gaze-Induced Optic Nerve Head Deformations Are Greater in High Myopia and Strains Increase With Axial Length.

This study demonstrates that gaze-induced ONH deformations increase with axial elongation.

Choriocapillaris, Photoreceptors, and Inner Retinal Layer in Spatial Relationship to Parapapillary Alpha, Beta, Gamma, and Delta Zones.

Nonglaucomatous non-highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers.

Atrial fibrillation and flutter and ocular diseases. The Ural eye and medical study and the Ural very old study.

In these multi-ethnic populations from Russia, AF prevalence was not associated with any major ocular disease and may not play a major role in the pathogenesis of these disorders.

Myopia and Other Refractive Error and Their Relationships to Glaucoma Screening.

In the range from hyperopia to moderate myopia, refractive error is not a strong glaucoma risk factor and may not be included in glaucoma screening strategies.

Global Glaucoma Prevalence: Burden and Projection to 2060.

There is a significant, previously underestimated, increase in OAG burden globally, driven by the rising prevalence of myopia.

Clinical and histological aspects of the anatomy of myopia, myopic macular degeneration and myopia-associated optic neuropathy.

Axial myopia is characterized by a panoply of morphological, clinical and histological, features in association with longer axial length.

Independent Effects of Axial Length and Intraocular Pressure on the Highly Myopic Optic Nerve Head.

Higher IOP and longer AXL are associated with distinct structural changes of the ONH in highly myopic eyes, particularly involving the lamina cribrosa.

Mortality and ocular parameters and diseases.

Diabetic retinopathy was the only major ophthalmic disease or parameter, in addition to vision impairment, which was associated with an increased death risk.

Glaucomatous, Glaucoma-Like, and Non-Glaucomatous Optic Neuropathy in High Myopia: The Two-Continent Study.

Highly myopic eyes had considerable prevalences of NGON and GLON/GON, usually higher than 20% and 10%, respectively.

Relationship of 24-2C Central Visual Field Damage to Juxtapapillary Choriocapillaris Dropout in Glaucoma Eyes With or Without Axial Myopia.

MvD area and angular circumference are significantly associated with central VF damage detected by VF 24-2C in POAG eyes with and without axial myopia.

Rates of Choriocapillaris Microvascular Dropout and Macular Structural Changes in Glaucomatous Optic Neuropathy With and Without Myopia.

Rates of GCIPL thinning were associated with rates of MvD area and angular circumference change over time in myopic POAG eyes.

Wide-Field Optical Coherence Tomography Imaging Improves Rate of Change Detection in Progressing Glaucomatous Eyes Compared With Standard-Field Imaging.

In this cohort that includes eyes with and without high axial myopia, the mean rate of retinal nerve fiber layer thinning measured using SWF images was faster in eyes with progressing glaucoma than in eyes with nonprogressing glaucoma.

Ocular and General Determinants of Intraocular Pressure: The Two-Continent Eye Study.

Among numerous ocular and systemic factors influencing IOP readings (with a relative low correlation coefficient), corneal curvature radius was one of the main ocular determinants.

Prevalence of Glaucoma in an Old Population: The Ural Very Old Study.

In this population-based recruited multiethnic cohort aged 85+ years, the prevalence factors of glaucoma-related blindness and MSVI were relatively high, and the majority of glaucomatous eyes were untreated and had single IOP readings of ≤21 mmHg.

Drusen in the macula and parapapillary region.

The findings of this study, also taking into account its methodological limitations, suggest that macular drusen and parapapillary drusen shared the morphological feature of periodic-acid-Schiff-positive material between the RPE basal membrane and BM and that…

Optic Nerve Head Histopathology in High Axial Myopia.

The intrapapillary and parapapillary changes in the highly myopic optic nerve head may be reason for the increased susceptibility for glaucomatous optic nerve damage in high axial myopia.

Retinal pigment epithelium cell density in relationship to axial length in human eyes.

The decrease in the RPE cell density mainly in the equatorial to retro-equatorial region in association with longer axial length suggests a region of enlargement of Bruch's membrane in the equatorial to retro-equatorial area in association with axial elongation.

Association between axial length and horizontal and vertical globe diameters.

Myopic enlargement of the globe beyond an axial length of 24 mm takes place predominantly in the sagittal axis, leading to a change in the globe form from a sphere to an elongated form.

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data.

Formulae used to predict CSFP derived from clinical data fared poorly against a large retrospective dataset.

Scleral and choroidal volume in relation to axial length in infants with retinoblastoma versus adults with malignant melanomas or end-stage glaucoma.

This study on children eyes with retinoblastoma and adult eyes with malignant melanomas or end-stage glaucoma suggests that primary eye growth up to an age of 2 years is associated with an increase in scleral volume.

Retinal Microglia in Glaucoma.

Activated microglia appear early in the glaucomatous process and may contribute detrimentally to the neuronal apoptosis in the later stage.

Chemokine (C-C motif) ligand 2 and chemokine (C-C motif) ligand 7 in angle-closure glaucoma.

Concentrations of CCL2 and CCL7 as major inflammatory cytokines with potential influence on the risk of filtering surgery failure were significantly elevated after an acute glaucoma attack and decreased with longer interval to the attack.

Dynein, kinesin and morphological changes in optic nerve axons in a rat model with cerebrospinal fluid pressure reduction: the Beijing Intracranial and Intraocular Pressure (iCOP) study.

Experimental models with an acute IOP rise or with an acute CSFP reduction showed similar morphologic changes in the retinal ganglion cell axons and similar immunohistochemical changes in the axonal motor proteins kinesin HC and dynein IC.

Retinal Thickness and Axial Length.

Myopic axial globe elongation was associated with retinal thinning in the equatorial and pre-equatorial region, while foveal retinal thickness was mostly unaffected by axial length.

Histologic differences between primary high myopia and secondary high myopia due to congenital glaucoma.

Thinning of Bruch's membrane overall is typical for SHM while eyes with PHM have a normal Bruch's membrane thickness.

Reply: To PMID 25556115.

Incident retinal vein occlusions and estimated cerebrospinal fluid pressure. The Beijing Eye Study.

A higher estimated CSFP was associated with a higher incidence of RVOs originating at the optic nerve head (i.e.

Acute Peripapillary Retinal Pigment Epithelium Changes Associated with Acute Intraocular Pressure Elevation.

Eyes with an acute rise in IOP (>15 mmHg) showed a folding and centrifugal sliding of the peripapillary RPE and, after IOP reduction, centripetal RPE movement.

Glaucoma and the Role of Cerebrospinal Fluid Dynamics.

Fundus Tessellation: Prevalence and Associated Factors: The Beijing Eye Study 2011.

Fundus tessellation is a surrogate for choroidal thinness and may be a clinical sign for a leptochoroid.

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011.

The 10-year incidence of localized RNFLDs in adult Chinese is 4.7% ± 0.2%.

Axonal Transport in the Rat Optic Nerve Following Short-Term Reduction in Cerebrospinal Fluid Pressure or Elevation in Intraocular Pressure.

Both short-term lowering of CSFP and short-term rise in IOP were associated with a disturbance of both the orthograde and retrograde axonal transport.

Short-term effect of intravitreal ranibizumab on intraocular concentrations of vascular endothelial growth factor-A and pigment epithelium-derived factor in neovascular glaucoma.

Aqueous concentrations of VEGF-A and PEDF were significantly elevated in eyes with neovascular glaucoma.

Peripapillary Choroidal Thickness in Adult Chinese: The Beijing Eye Study.

Peripapillary choroidal thickness measurements were available for 3060 (88.2%) study participants with a mean age of 64.4 ± 9.6 years (range, 50-93 years).

Facts and myths of cerebrospinal fluid pressure for the physiology of the eye.

In summary, the CSFP may be an overlooked parameter in ocular physiology and pathology. Abnormal changes in the CSFP, in particular in relationship to the IOP, may have pathophysiologic importance.

Scleral Thickness in Chinese Eyes.

Scleral thickness increased up to an age of 2 years, while afterwards scleral thickness was independent of age and decreased with longer axial length.

Optic nerve head changes after short-term intraocular pressure elevation in acute primary angle-closure suspects.

Angle-closure suspect eyes showed a widening and deepening of the optic cup, decrease in neuroretinal rim width, and thinning of the LC after a darkness-induced IOP increase of >15 mmHg.

Reversibility of retinal pigment epithelium detachment parallel to acute intraocular pressure rise.

Slight detachments of the RPE may depend on acute IOP changes.

Estimated trans-lamina cribrosa pressure difference versus intraocular pressure as biomarker for open-angle glaucoma. The Beijing Eye Study 2011.

In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy.

Intracranial pressure fluctuations: a potential risk factor for glaucoma?

Choroidal Thickness in Open-angle Glaucoma.

After adjusting for age and refractive error, open-angle glaucoma was not significantly associated with a marked thinning or a thickening of the choroid in the foveal and parafoveal region.