Retinal Ganglion Cell Functional Recovery After Intraocular Pressure Lowering Treatment Using Prostaglandin Analogs in Glaucoma Suspects: A Prospective Pilot Study

Overview

Journal J Curr Glaucoma Pract

Date 2024 Jan 25

PMID 38269268

Authors

Andrew Tirsi

Vasiliki Gliagias

Hosam Sheha

Bhakti Patel

Julie Moehringer

Joby Tsai

Rohun Gupta

Stephen A Obstbaum

Celso Tello

Affiliations

Soon will be listed here.

Abstract

Aim And Background: To evaluate the ability of pattern electroretinogram (PERG) to detect improvement of retinal ganglion cell (RGC) function in glaucoma suspects (GS) after medically reducing intraocular pressure (IOP) using prostaglandin analog drops.

Materials And Methods: Six subjects (eight eyes) received topical IOP lowering treatment based on their clinical examination and were observed at Manhattan Eye, Ear & Throat Hospital over an average of 3.1 ± 2.2 months. During this time, participants underwent a full ophthalmologic exam and were evaluated with a Humphrey visual field analyzer (HFA) 24-2 [24-2 mean deviation (MD), 24-2 pattern standard deviation (PSD), and 24-2 visual field indices (VFI)], Diopsys NOVA PERG optimized for glaucoma [magnitude (Mag), magnitudeD (MagD), and magnitudeD/magnitude ratio (MagD/Mag ratio)] and optical coherence tomography (OCT)-derived average retinal nerve fiber layer thickness (avRNFLT) and average ganglion cell layer + inner plexiform layer (avGCL + IPL) thicknesses at baseline visit (pretreatment) and 3 months later (posttreatment). Goldman applanation tonometry was used to measure IOP at each visit. Paired sample -tests were conducted to determine the statistical significance of the change in IOP, HFA indices, PERG parameters, and OCT thickness measurements between the two visits.

Results: Lowering IOP by 22.29% resulted in a significant increase (32.98 and 15.49%) in MagD [ (7) = -3.174, 95% confidence interval (CI) = -0.53, -0.08, = 0.016] and MagD/Mag ratio [ (7) = -3.233, 95% CI = -0.20, -0.03, = 0.014], respectively. There was a positive percentage change for all variables of interest, however, 24-2 MD, Mag, avRNFLT, and GCL+ IPLT did not reach statistical significance.

Conclusion: After reducing IOP by 22.29% for a duration of 3.1 months, the PERG parameters, MagD and MagD/Mag ratio, significantly improved by 32.98 and 15.49%, respectively.

Clinical Significance: Pattern electroretinogram (PERG) may be a crucial tool for clinicians to locate a window of opportunity in which degenerating yet viable RGCs could be rescued from irreversible damage. We suggest consideration of PERG as a tool in early retinal ganglion cell (RGC) dysfunction detection as well as for monitoring IOP lowering treatment.

How To Cite This Article: Tirsi A, Gliagias V, Sheha H, Retinal Ganglion Cell Functional Recovery after Intraocular Pressure Lowering Treatment Using Prostaglandin Analogs in Glaucoma Suspects: A Prospective Pilot Study. J Curr Glaucoma Pract 2023;17(4):178-190.

Citing Articles

Diagnostic Capability of Pattern Electroretinogram and Three Circumpapillary Retinal Nerve Fiber Layer Thickness Circle Diameter Scans in Glaucoma Suspects.

Tirsi A, Tsai J, Abizadeh A, Kacaj D, Procyk O, Gliagias V Clin Ophthalmol. 2025; 19():235-247.

PMID: 39867350 PMC: 11766361. DOI: 10.2147/OPTH.S483055.

Intraocular pressure and optical coherence tomography concerning visual field outcomes in "green" patients: An observational study.

Chou J, Tseng P, Hu H, Yen C Medicine (Baltimore). 2024; 103(46):e40518.

PMID: 39560596 PMC: 11575967. DOI: 10.1097/MD.0000000000040518.

References

Kudrna J, Ferguson T, Swan R, Ferguson S, Baartman B, Bleeker A . Short-Term Steady-State Pattern Electroretinography Changes Using a Multi-Pressure Dial in Ocular Hypertensive, Glaucoma Suspect, and Mild Open-Angle Glaucoma Patients: A Randomized, Controlled, Prospective, Pilot Study. Ophthalmol Ther. 2020; 9(4):981-992. PMC: 7708609. DOI: 10.1007/s40123-020-00302-5. View

Colotto A, Falsini B, Salgarello T, Buzzonetti L, Cermola S, Porrello G . Transiently raised intraocular pressure reveals pattern electroretinogram losses in ocular hypertension. Invest Ophthalmol Vis Sci. 1996; 37(13):2663-70. View

Medeiros F, Zangwill L, Bowd C, Mansouri K, Weinreb R . The structure and function relationship in glaucoma: implications for detection of progression and measurement of rates of change. Invest Ophthalmol Vis Sci. 2012; 53(11):6939-46. PMC: 3466074. DOI: 10.1167/iovs.12-10345. View

Hare W, Ton H . Effects of APB, PDA, and TTX on ERG responses recorded using both multifocal and conventional methods in monkey. Effects of APB, PDA, and TTX on monkey ERG responses. Doc Ophthalmol. 2002; 105(2):189-222. DOI: 10.1023/a:1020553020264. View

Porciatti V . Electrophysiological assessment of retinal ganglion cell function. Exp Eye Res. 2015; 141:164-70. PMC: 4628896. DOI: 10.1016/j.exer.2015.05.008. View

Hood D, Frishman L, Viswanathan S, Robson J, Ahmed J . Evidence for a ganglion cell contribution to the primate electroretinogram (ERG): effects of TTX on the multifocal ERG in macaque. Vis Neurosci. 1999; 16(3):411-6. DOI: 10.1017/s0952523899163028. View

Wadhwani M, Bali S, Satyapal R, Angmo D, Sharma R, Pandey V . Test-retest variability of retinal nerve fiber layer thickness and macular ganglion cell-inner plexiform layer thickness measurements using spectral-domain optical coherence tomography. J Glaucoma. 2014; 24(5):e109-15. DOI: 10.1097/IJG.0000000000000203. View

Ventura L, Porciatti V . Restoration of retinal ganglion cell function in early glaucoma after intraocular pressure reduction: a pilot study. Ophthalmology. 2005; 112(1):20-7. PMC: 2756428. DOI: 10.1016/j.ophtha.2004.09.002. View

Kreft D, Doblhammer G, Guthoff R, Frech S . Prevalence, incidence, and risk factors of primary open-angle glaucoma - a cohort study based on longitudinal data from a German public health insurance. BMC Public Health. 2019; 19(1):851. PMC: 6604230. DOI: 10.1186/s12889-019-6935-6. View

10.

Celebi A, Mirza G . Age-related change in retinal nerve fiber layer thickness measured with spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2013; 54(13):8095-103. DOI: 10.1167/iovs.13-12634. View

11.

Kuang T, Zhang C, Zangwill L, Weinreb R, Medeiros F . Estimating Lead Time Gained by Optical Coherence Tomography in Detecting Glaucoma before Development of Visual Field Defects. Ophthalmology. 2015; 122(10):2002-9. PMC: 4581949. DOI: 10.1016/j.ophtha.2015.06.015. View

12.

Liu M, Duggan J, Salt T, Cordeiro M . Dendritic changes in visual pathways in glaucoma and other neurodegenerative conditions. Exp Eye Res. 2011; 92(4):244-50. DOI: 10.1016/j.exer.2011.01.014. View

13.

Tirsi A, Wong A, Zhu D, Stoffels G, Derr P, Tello Md C . Pattern Electroretinogram Parameters and their Associations with Optical Coherence Tomography in Glaucoma Suspects. J Curr Glaucoma Pract. 2022; 16(2):96-104. PMC: 9452702. DOI: 10.5005/jp-journals-10078-1365. View

14.

Shiga Y, Aizawa N, Tsuda S, Yokoyama Y, Omodaka K, Kunikata H . Preperimetric Glaucoma Prospective Study (PPGPS): Predicting Visual Field Progression With Basal Optic Nerve Head Blood Flow in Normotensive PPG Eyes. Transl Vis Sci Technol. 2018; 7(1):11. PMC: 5782826. DOI: 10.1167/tvst.7.1.11. View

15.

Fredette M, Anderson D, Porciatti V, Feuer W . Reproducibility of pattern electroretinogram in glaucoma patients with a range of severity of disease with the new glaucoma paradigm. Ophthalmology. 2007; 115(6):957-63. PMC: 2710310. DOI: 10.1016/j.ophtha.2007.08.023. View

16.

Sehi M, Grewal D, Goodkin M, Greenfield D . Reversal of retinal ganglion cell dysfunction after surgical reduction of intraocular pressure. Ophthalmology. 2010; 117(12):2329-36. DOI: 10.1016/j.ophtha.2010.08.049. View

17.

Banitt M, Ventura L, Feuer W, Savatovsky E, Luna G, Shif O . Progressive loss of retinal ganglion cell function precedes structural loss by several years in glaucoma suspects. Invest Ophthalmol Vis Sci. 2013; 54(3):2346-52. PMC: 3626526. DOI: 10.1167/iovs.12-11026. View

18.

Nesher R, Trick G, Kass M, Gordon M . Steady-state pattern electroretinogram following long term unilateral administration of timolol to ocular hypertensive subjects. Doc Ophthalmol. 1990; 75(2):101-9. DOI: 10.1007/BF00146546. View

19.

Sehi M, Grewal D, Feuer W, Greenfield D . The impact of intraocular pressure reduction on retinal ganglion cell function measured using pattern electroretinogram in eyes receiving latanoprost 0.005% versus placebo. Vision Res. 2010; 51(2):235-42. PMC: 3025061. DOI: 10.1016/j.visres.2010.08.036. View

20.

Gillmann K, Mansouri K, Rao H, Ouabas A, Chaudhary A, Bravetti G . A Prospective Evaluation of the Repeatability and Reliability of New Steady-state Pattern Electroretinogram Parameters. J Glaucoma. 2018; 27(12):1079-1085. DOI: 10.1097/IJG.0000000000001103. View