title: Factors associated with focal lamina cribrosa defects in glaucoma.
abstract: OBJECTIVE
  To assess factors associated with focal lamina cribrosa (LC) defects in glaucoma.
  
  
  METHODS
  Serial enhanced depth imaging (EDI) optical coherence tomography (OCT) B-scans of the optic nerve head were obtained from glaucoma patients. EDI OCT scans were reviewed for focal LC defects (laminar holes or disinsertions). Evaluated clinical factors included age, central corneal thickness, visual field (VF) mean deviation (MD), exfoliation syndrome, normal-tension glaucoma (NTG), disc hemorrhage, and intraocular pressure (IOP) during past follow-up.
  
  
  RESULTS
  One hundred forty-eight glaucomatous eyes (148 patients; mean age, 68 ± 12 years; mean VF MD, -11.63 ± 6.96 dB) were included. Sixty-seven (45%) eyes had focal LC defects and 81 (55%) did not. Eyes with focal LC defects had a higher prevalence of both disc hemorrhage (25% vs. 6%) and NTG (33% vs. 9%) and worse VF MD (-14.12 vs. -9.58 dB) than those without focal LC defects (P = 0.002, P < 0.001, and P < 0.001, respectively). In the multivariate logistic regression analysis, higher frequency of disc hemorrhage detection (odds ratio [OR], 3.63; P = 0.032), a diagnosis of NTG (OR, 4.23; P = 0.005), and worse VF MD (OR, 1.11; P < 0.001) were significant factors associated with the presence of focal LC defects. Disc hemorrhage developed in the same half of the disc as the largest or the second largest focal LC defect in 15 of 17 eyes (88.2%).
  
  
  CONCLUSIONS
  Disc hemorrhage, a diagnosis of NTG, and more advanced glaucoma status are associated with focal LC defects. Future studies are needed to elucidate the cause-and-effect relationships between focal LC defects and these factors.
authors.affiliation: Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, New York.
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Park
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Hsu
authors.forename: Daniel
authors.initials: D
authors.lastname: Su
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Simonson
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Jumayli
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Liu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D057066:Low Tension Glaucoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis; D014794:Visual Fields
keywords: glaucoma; lamina cribrosa; optical coherence tomography