title: Nailfold Capillary Abnormalities in Primary Open-Angle Glaucoma: A Multisite Study.
abstract: OBJECTIVE
  There is considerable evidence for systemic vascular dysfunction in primary open-angle glaucoma (POAG). We performed nailfold capillary video microscopy to observe directly the nature of nonocular microvasculature abnormalities in POAG.
  
  
  METHODS
  We enrolled 199 POAG patients and 124 control subjects from four sites. We used JH-1004 capillaroscopes to perform nailfold capillary video microscopy on the fourth and fifth digits of each subject's nondominant hand. Videos were evaluated for hemorrhages, dilated capillary loops > 50 μm, and avascular zones > 100 μm by graders masked to case status. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) for POAG were obtained by means of logistic regression analyses that were applied to data from all cases and controls. Corresponding estimates of moderate or severe POAG versus mild POAG (based on the Hodapp-Anderson-Parrish scale) were obtained among cases only.
  
  
  RESULTS
  After controlling for demographic factors, family history of glaucoma, systemic diseases, and use of anticoagulation and antiplatelet therapy, for each 100 nailfold capillaries assessed, all types of microvascular abnormalities were significantly associated with POAG. Specifically, the presence of any dilated capillaries (OR = 2.9; 95% CI, 1.6-5.6), avascular zones (OR = 4.4; 95% CI, 1.7-11.3) and hemorrhages (OR = 12.2; 95% CI, 5.9-25.1) were associated with POAG. Among cases, the frequency of microvascular abnormalities was not associated with glaucoma severity (P ≥ 0.43).
  
  
  CONCLUSIONS
  These data provided support for nonocular capillary bed abnormalities in POAG. Comparable vascular abnormalities in the optic nerve may render it susceptible to glaucomatous damage.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States 2Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.
authors.forename: Akiko
authors.initials: A
authors.lastname: Hanyuda
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Ai
authors.initials: A
authors.lastname: Ren
authors.affiliation: Department of Ophthalmology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Giovingo
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Greenstein
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Clara
authors.initials: C
authors.lastname: Cousins
authors.affiliation: Department of Ophthalmology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Patrianakos
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Tanna
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wanderling
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States.
authors.forename: William
authors.initials: W
authors.lastname: Norkett
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Janey L
authors.initials: JL
authors.lastname: Wiggs
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Green
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States 6Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Knepper
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D011379:Prognosis; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D014741:Video Recording; D058609:Visual Field Tests; D014794:Visual Fields