- Email: [email protected]
Effects of contact lenses on scanning laser polarimetry of the peripapillary retinal nerve fiber layer
FIGURE 2. Excised tissue included Descemet membrane (arrowhead) and the tip of trabeculum. Immunoreactivity for herpes simplex virus was identified in the trabeculum (large arrows) and in the keratocytes (small arrows) adjacent to Descemet membrane (hematoxylin and eosin, 340).
the surgery. Best-corrected visual acuity in the left eye recovered to 20/25 on June 23. Intraocular pressure remained under 10 mm Hg. Corneal edema completely resolved 2 weeks after the surgery. Microscopically, excised tissue included Descemet membrane and the tip of trabeculum (Figure 2). Corneal endothelium seemed to be removed during histologic preparation. Immunoreactivity for herpes simplex virus was examined with polyclonal antibody (Biomeda Corp, Foster, California) and immunoreactivity for varicellazoster virus was examined with monoclonal antibody (Chemicon International, Inc, Pittsburgh, Pennsylvania). Antigen-antibody reactions were visualized using the ABC kit (Vector, Burlingame, California) with diaminobenzidine. Immunoreactivity for herpes simplex virus was identified in trabeculum and in the keratocytes adjacent to Descemet membrane (Figure 2). No immunohistochemical staining was observed with antibody to varicella-zoster and control antibody (data not shown). The origin of herpes virus in corneal endotheliitis is unknown. Current findings suggest that herpes simplex virus might be secreted from the trabeculum, which is innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal edema usually begins from the periphery in patients with corneal endotheliitis.4 Identification of herpes simplex virus immunoreactivity in the trabeculum suggests that herpes simplex virus causes trabeculitis and an intraocular pressure increase in corneal endotheliitis. 722
AMERICAN JOURNAL
REFERENCES
1. Maudgal PC, Missotten L, DeClercq E, Descamps J. Varicella-zoster virus in the human corneal endothelium: a case report. Bull Soc Belge Ophthalmol 1980;190:71– 86. 2. Sundmacher R, Neumann-Haefelin D. Herpes simplex virus isolations from the aqueous of patients suffering from focal iritis, endotheliitis and prolonged disciform keratitis with glaucoma. Klin Monatsbl Augenheilkd 1979;175:488 –501. 3. Robin JB, Steigner JB, Kaufman HE. Progressive herpetic corneal endotheliitis. Am J Ophthalmol 1985;100:336 –337. 4. Ohashi Y, Yamamoto S, Nishida K, Okamoto S, Kinoshita S, Hayashi K, Manabe R. Demonstration of herpes simplex virus DNA in idiopathic corneal endotheliopathy. Am J Ophthalmol 1991;112:419 – 423. 5. Olsen TW, Hardten DR, Meiusi RS, Holland EJ. Linear endotheliitis. Am J Ophthalmol 1994;117:468 – 474.
Effects of Contact Lenses on Scanning Laser Polarimetry of the Peripapillary Retinal Nerve Fiber Layer Anuja Bhandari, FRCOphth, Philip P. Chen, MD, and Richard P. Mills, MD Accepted for publication Dec 11, 1998. From the Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington. This study was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York. Data from this study were presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1998. Inquiries to Philip P. Chen, MD, Department of Ophthalmology, University of Washington, Box 356485, Seattle, WA 98195-6485; fax: (206) 543-4414; e-mail: [email protected] OF
OPHTHALMOLOGY
JUNE 1999
TABLE. Mean (SD) Results of Scanning Laser Polarimetry of the Peripapillary Nerve Fiber Layer in Eyes With and Without Contact Lenses Nerve Fiber Layer Thickness (mm) Lens Type
Rigid gas permeable (n 5 12) With contact lenses Without contact lenses P value* Daily wear soft (n 5 12) With contact lenses Without contact lenses P value* Disposable daily wear (n 5 27) With contact lenses Without contact lenses P value*
Total
Superior
Nasal
Inferior
Temporal
71.96 (9.90) 73.03 (10.45) .45
87.98 (8.65) 90.32 (10.38) .11
48.96 (7.75) 50.93 (9.04) .15
83.68 (14.59) 82.83 (15.10) .63
41.64 (11.97) 42.73 (11.13) .54
81.16 (16.95) 81.53 (18.26) .79
93.48 (20.99) 93.72 (13.08) .89
59.19 (12.77) 61.95 (13.08) .27
92.82 (21.13) 94.93 (21.65) .20
51.76 (18.42) 49.62 (14.65) .22
76.75 (14.81) 77.42 (15.27) .43
88.41 (17.87) 89.37 (18.60) .38
56.14 (15.37) 55.70 (15.96) .71
89.43 (15.79) 90.27 (16.35) .44
49.88 (17.67) 50.91 (17.22) .38
Inferior 5 inferior quadrant (120 degrees); Nasal 5 nasal quadrant (50 degrees); Superior 5 superior quadrant (120 degrees); Temporal 5 temporal quadrant (70 degrees); Total 5 total ellipse circumference (360 degrees). *Paired Student t test, two-tailed.
PURPOSE:
To determine the effects of contact lenses on scanning laser polarimetry of the peripapillary nerve fiber layer. METHODS: In a prospective study using the Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, California), retinal nerve fiber layer thickness in 22 subjects (51 eyes) was imaged with and without contact lenses (disposable and nondisposable daily wear soft and rigid gas permeable). Measurements of the circumference and of each quadrant were compared using paired Student t test. RESULTS: Nerve Fiber Analyzer measurements with and without contact lenses were not significantly different for any of the contact lens types tested (P > .11), using either hyperopic (to 14 diopters) or myopic (to 28.5 diopters) lenses. CONCLUSION: Contact lens wear and refractive power of the eye within the range tested do not significantly affect scanning laser polarimetry of the peripapillary nerve fiber layer. (Am J Ophthalmol 1999;127:722–724. © 1999 by Elsevier Science Inc. All rights reserved.)
S
CANNING LASER POLARIMETRY PROVIDES IN VIVO MEA-
surements of retinal nerve fiber layer thickness by measuring the alteration of light polarization by the birefringent nerve fiber layer. Proprietary software compensates for corneal birefringence.1 Good reproducibility has been noted with Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, California) measurements obtained in both normal subjects and glaucoma patients.2–5 Current recommendations for Nerve Fiber Analyzer image acquisition include contact lens removal, which adds appreciable amounts of time and inconveVOL. 127, NO. 6
nience to testing, particularly during screening programs for glaucoma. We investigated the effect of contact lenses on Nerve Fiber Analyzer measurements because we were unable to obtain information on birefringence characteristics of materials used to manufacture contact lenses. Additionally, obtaining images with and without contact lenses requires refocusing of the Nerve Fiber Analyzer because of differences in the refractive power of the eye, which allows assessment of effects of refractive error on Nerve Fiber Analyzer measurements. Approval for this study was granted by the Human Subjects Division of the University of Washington. We calculated a sample size of 12 eyes per group based on 80% power to detect a 7% difference with an SD of 5%, with a (two-tail) 5 .05 and b 5 .15. Twenty-two subjects (refractive error range, 28.5 to 11.5 diopters) without ocular disease, except for refractive error, participated. Because a paired comparison (with and without contact lens) was intended, some subjects were used in more than one contact lens group, and one subject had both eyes used twice in the rigid gas-permeable group. An experienced operator obtained images with the GDx version of the Nerve Fiber Analyzer, using the standard 15 3 15-degree field centered on the optic disk through undilated pupils in ambient light. Three images of good quality of each eye tested were obtained with and without contact lenses, in random order. We occasionally encountered distorted images (edge effect) with rigid gas-permeable lenses, which degraded the image and made focusing difficult; however, the subject’s blink was sufficient to overcome this problem. A mean (baseline) image created from each set of three images was used for analysis. A customized ellipse, placed around the optic disk margin, was used to measure both
BRIEF REPORTS
723
Effects of Methotrexate Treatment on Serum Immunoreactivity of a Patient With Normal-Pressure Glaucoma
mean images of the same eye, in a band 10 pixels wide located 1.75 disk diameters from the optic disk margin. We examined the mean sector value (nerve fiber layer thickness in mm) for the total ellipse circumference (360 degrees) and the standard GDx quadrants: superior (120 degrees), temporal (50 degrees), inferior (120 degrees), and nasal (70 degrees). The subjects’ mean age was 35.0 6 8.4 years (range, 21 to 51 years), and the mean contact lens power was 21.20 6 3.60 diopters (range, 28.5 to 14.0 diopters). Twelve eyes of five subjects were tested with rigid gas-permeable lenses (various manufacturers; power range, 26.5 to 14.0 diopters, six hyperopic), 12 eyes of seven subjects with daily wear soft lenses (various manufacturers; power range, 25.0 to 21.0 diopter), and 27 eyes of 13 subjects with disposable daily wear lenses (Acuvue; Vistakon, Jacksonville, Florida; power range, 28.5 to 14.0 diopters; nine hyperopic). No significant difference between Nerve Fiber Analyzer measurements with or without contact lenses was found for any type of lens (Table) or lens subgroup (that is, hyperopic or myopic; data not shown) by two-tailed paired Student t test. Although the contact lens material was unknown for many subjects, wide variability in birefringent characteristics within types of contact lenses would be unexpected, particularly with soft contact lenses, which have a relatively high water content. We conclude that contact lenses (rigid gas permeable or soft) and refractive errors within the range tested do not interfere with nerve fiber layer measurements by the Nerve Fiber Analyzer.
Ronald L. Fellman, MD, Gu¨lgu¨n Tezel, MD, and Martin B. Wax, MD PURPOSE:
Increased serum immunoreactivity to retinal proteins may have a role in the disease process of some glaucoma patients. We describe a patient with normalpressure glaucoma whose serum immunoreactivity to retinal proteins regressed after methotrexate treatment for rheumatoid disease. METHOD: Case report. RESULTS: In a 66-year-old white female with normalpressure glaucoma and rheumatoid disease, sequential Western blots using patient sera against retinal proteins demonstrated a decrease in the immunoreactive bands after treatment. During the treatment period of 3 years, her visual fields appeared to have improved. Optic disk examination during the short periods without treatment, however, disclosed new, bilateral splinter hemorrhages on the optic disks. CONCLUSION: These observations suggest a potential role for immune-based intervention in similar patients. (Am J Ophthalmol 1999;127:724 –725. © 1999 by Elsevier Science Inc. All rights reserved.)
T
ACKNOWLEDGMENT
The authors thank James Toop, OD, PhD, for his assistance with recruitment of patients and use of contact lenses. REFERENCES
1. Weinreb RN, Dreher AW, Coleman A, Quigley HA, Shaw B, Reiter K. Histopathologic validation of Fourier-ellipsometry measurements of retinal fiber layer thickness. Arch Ophthalmol 1990;108:557–560. 2. Chi Q-M, Tomita G, Inazumi K, Hayakawa T, Ido T, Kitazawa Y. Evaluation of the effect of aging on the retinal nerve fiber layer thickness using scanning laser polarimetry. J Glaucoma 1995;4:406 – 413. 3. Niessen A, van den Berg T, Langerhorst C, Greve E. Retinal nerve fiber layer assessment by scanning laser polarimetry and standardized photography. Am J Ophthalmol 1996;121:484 – 493. 4. Hollo G, Suveges I, Nagymihaly A, Vargha P. Scanning laser polarimetry of the retinal nerve fibre layer in primary open angle and capsular glaucoma. Br J Ophthalmol 1997;81:857– 861. 5. Hoh ST, Ishikawa H, Greenfield DS, Liebmann JM, Chew SJ, Ritch R. Peripapillary nerve fiber layer thickness measurement reproducibility using scanning laser polarimetry. J Glaucoma 1998;7:12–15.
724
AMERICAN JOURNAL
HERE IS SOME EVIDENCE THAT A SUBSET OF PATIENTS
with normal-pressure glaucoma may have an autoimmune component to their disease, as suggested by an epidemiologic association of immune-related disease in 30% of these patients.1 In addition, an increased prevalence of monoclonal gammopathy and serum autoantibodies to extractable nuclear antigens as well as retinal antigens has been reported in some patients with glaucoma, especially with normal intraocular pressure.2,3 We report a case in which serum immunoreactivity against retinal antigens regressed after treatment of rheumatic disease with methotrexate. A 66-year-old woman with normal-pressure glaucoma had been followed up for the last 5 years. Her medical history was unremarkable, except for osteoarthritis and Sjo¨gren syndrome with a positive rheumatoid factor, antinuclear antibody, and Accepted for publication Dec 10, 1998. From the Glaucoma Associates of Texas, Dallas, Texas (R.L.F.), and the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri (G.T., M.B.W.). This study was supported in part by grant EY12314 (M.B.W.) from National Eye Institute, Bethesda, Maryland; the American Health Assistance Foundation, Washington, DC (M.B.W.); the Glaucoma Research Foundation, San Francisco, California (M.B.W.); and an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York. Inquiries to Martin B. Wax, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8096, 660 S Euclid Ave, St Louis, MO 63110; fax: (314) 362-3725; e-mail: [email protected]
OF
OPHTHALMOLOGY
JUNE 1999
the surgery. Best-corrected visual acuity in the left eye recovered to 20/25 on June 23. Intraocular pressure remained under 10 mm Hg. Corneal edema completely resolved 2 weeks after the surgery. Microscopically, excised tissue included Descemet membrane and the tip of trabeculum (Figure 2). Corneal endothelium seemed to be removed during histologic preparation. Immunoreactivity for herpes simplex virus was examined with polyclonal antibody (Biomeda Corp, Foster, California) and immunoreactivity for varicellazoster virus was examined with monoclonal antibody (Chemicon International, Inc, Pittsburgh, Pennsylvania). Antigen-antibody reactions were visualized using the ABC kit (Vector, Burlingame, California) with diaminobenzidine. Immunoreactivity for herpes simplex virus was identified in trabeculum and in the keratocytes adjacent to Descemet membrane (Figure 2). No immunohistochemical staining was observed with antibody to varicella-zoster and control antibody (data not shown). The origin of herpes virus in corneal endotheliitis is unknown. Current findings suggest that herpes simplex virus might be secreted from the trabeculum, which is innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal edema usually begins from the periphery in patients with corneal endotheliitis.4 Identification of herpes simplex virus immunoreactivity in the trabeculum suggests that herpes simplex virus causes trabeculitis and an intraocular pressure increase in corneal endotheliitis. 722
AMERICAN JOURNAL
REFERENCES
1. Maudgal PC, Missotten L, DeClercq E, Descamps J. Varicella-zoster virus in the human corneal endothelium: a case report. Bull Soc Belge Ophthalmol 1980;190:71– 86. 2. Sundmacher R, Neumann-Haefelin D. Herpes simplex virus isolations from the aqueous of patients suffering from focal iritis, endotheliitis and prolonged disciform keratitis with glaucoma. Klin Monatsbl Augenheilkd 1979;175:488 –501. 3. Robin JB, Steigner JB, Kaufman HE. Progressive herpetic corneal endotheliitis. Am J Ophthalmol 1985;100:336 –337. 4. Ohashi Y, Yamamoto S, Nishida K, Okamoto S, Kinoshita S, Hayashi K, Manabe R. Demonstration of herpes simplex virus DNA in idiopathic corneal endotheliopathy. Am J Ophthalmol 1991;112:419 – 423. 5. Olsen TW, Hardten DR, Meiusi RS, Holland EJ. Linear endotheliitis. Am J Ophthalmol 1994;117:468 – 474.
Effects of Contact Lenses on Scanning Laser Polarimetry of the Peripapillary Retinal Nerve Fiber Layer Anuja Bhandari, FRCOphth, Philip P. Chen, MD, and Richard P. Mills, MD Accepted for publication Dec 11, 1998. From the Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington. This study was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York. Data from this study were presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1998. Inquiries to Philip P. Chen, MD, Department of Ophthalmology, University of Washington, Box 356485, Seattle, WA 98195-6485; fax: (206) 543-4414; e-mail: [email protected] OF
OPHTHALMOLOGY
JUNE 1999
TABLE. Mean (SD) Results of Scanning Laser Polarimetry of the Peripapillary Nerve Fiber Layer in Eyes With and Without Contact Lenses Nerve Fiber Layer Thickness (mm) Lens Type
Rigid gas permeable (n 5 12) With contact lenses Without contact lenses P value* Daily wear soft (n 5 12) With contact lenses Without contact lenses P value* Disposable daily wear (n 5 27) With contact lenses Without contact lenses P value*
Total
Superior
Nasal
Inferior
Temporal
71.96 (9.90) 73.03 (10.45) .45
87.98 (8.65) 90.32 (10.38) .11
48.96 (7.75) 50.93 (9.04) .15
83.68 (14.59) 82.83 (15.10) .63
41.64 (11.97) 42.73 (11.13) .54
81.16 (16.95) 81.53 (18.26) .79
93.48 (20.99) 93.72 (13.08) .89
59.19 (12.77) 61.95 (13.08) .27
92.82 (21.13) 94.93 (21.65) .20
51.76 (18.42) 49.62 (14.65) .22
76.75 (14.81) 77.42 (15.27) .43
88.41 (17.87) 89.37 (18.60) .38
56.14 (15.37) 55.70 (15.96) .71
89.43 (15.79) 90.27 (16.35) .44
49.88 (17.67) 50.91 (17.22) .38
Inferior 5 inferior quadrant (120 degrees); Nasal 5 nasal quadrant (50 degrees); Superior 5 superior quadrant (120 degrees); Temporal 5 temporal quadrant (70 degrees); Total 5 total ellipse circumference (360 degrees). *Paired Student t test, two-tailed.
PURPOSE:
To determine the effects of contact lenses on scanning laser polarimetry of the peripapillary nerve fiber layer. METHODS: In a prospective study using the Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, California), retinal nerve fiber layer thickness in 22 subjects (51 eyes) was imaged with and without contact lenses (disposable and nondisposable daily wear soft and rigid gas permeable). Measurements of the circumference and of each quadrant were compared using paired Student t test. RESULTS: Nerve Fiber Analyzer measurements with and without contact lenses were not significantly different for any of the contact lens types tested (P > .11), using either hyperopic (to 14 diopters) or myopic (to 28.5 diopters) lenses. CONCLUSION: Contact lens wear and refractive power of the eye within the range tested do not significantly affect scanning laser polarimetry of the peripapillary nerve fiber layer. (Am J Ophthalmol 1999;127:722–724. © 1999 by Elsevier Science Inc. All rights reserved.)
S
CANNING LASER POLARIMETRY PROVIDES IN VIVO MEA-
surements of retinal nerve fiber layer thickness by measuring the alteration of light polarization by the birefringent nerve fiber layer. Proprietary software compensates for corneal birefringence.1 Good reproducibility has been noted with Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, California) measurements obtained in both normal subjects and glaucoma patients.2–5 Current recommendations for Nerve Fiber Analyzer image acquisition include contact lens removal, which adds appreciable amounts of time and inconveVOL. 127, NO. 6
nience to testing, particularly during screening programs for glaucoma. We investigated the effect of contact lenses on Nerve Fiber Analyzer measurements because we were unable to obtain information on birefringence characteristics of materials used to manufacture contact lenses. Additionally, obtaining images with and without contact lenses requires refocusing of the Nerve Fiber Analyzer because of differences in the refractive power of the eye, which allows assessment of effects of refractive error on Nerve Fiber Analyzer measurements. Approval for this study was granted by the Human Subjects Division of the University of Washington. We calculated a sample size of 12 eyes per group based on 80% power to detect a 7% difference with an SD of 5%, with a (two-tail) 5 .05 and b 5 .15. Twenty-two subjects (refractive error range, 28.5 to 11.5 diopters) without ocular disease, except for refractive error, participated. Because a paired comparison (with and without contact lens) was intended, some subjects were used in more than one contact lens group, and one subject had both eyes used twice in the rigid gas-permeable group. An experienced operator obtained images with the GDx version of the Nerve Fiber Analyzer, using the standard 15 3 15-degree field centered on the optic disk through undilated pupils in ambient light. Three images of good quality of each eye tested were obtained with and without contact lenses, in random order. We occasionally encountered distorted images (edge effect) with rigid gas-permeable lenses, which degraded the image and made focusing difficult; however, the subject’s blink was sufficient to overcome this problem. A mean (baseline) image created from each set of three images was used for analysis. A customized ellipse, placed around the optic disk margin, was used to measure both
BRIEF REPORTS
723
Effects of Methotrexate Treatment on Serum Immunoreactivity of a Patient With Normal-Pressure Glaucoma
mean images of the same eye, in a band 10 pixels wide located 1.75 disk diameters from the optic disk margin. We examined the mean sector value (nerve fiber layer thickness in mm) for the total ellipse circumference (360 degrees) and the standard GDx quadrants: superior (120 degrees), temporal (50 degrees), inferior (120 degrees), and nasal (70 degrees). The subjects’ mean age was 35.0 6 8.4 years (range, 21 to 51 years), and the mean contact lens power was 21.20 6 3.60 diopters (range, 28.5 to 14.0 diopters). Twelve eyes of five subjects were tested with rigid gas-permeable lenses (various manufacturers; power range, 26.5 to 14.0 diopters, six hyperopic), 12 eyes of seven subjects with daily wear soft lenses (various manufacturers; power range, 25.0 to 21.0 diopter), and 27 eyes of 13 subjects with disposable daily wear lenses (Acuvue; Vistakon, Jacksonville, Florida; power range, 28.5 to 14.0 diopters; nine hyperopic). No significant difference between Nerve Fiber Analyzer measurements with or without contact lenses was found for any type of lens (Table) or lens subgroup (that is, hyperopic or myopic; data not shown) by two-tailed paired Student t test. Although the contact lens material was unknown for many subjects, wide variability in birefringent characteristics within types of contact lenses would be unexpected, particularly with soft contact lenses, which have a relatively high water content. We conclude that contact lenses (rigid gas permeable or soft) and refractive errors within the range tested do not interfere with nerve fiber layer measurements by the Nerve Fiber Analyzer.
Ronald L. Fellman, MD, Gu¨lgu¨n Tezel, MD, and Martin B. Wax, MD PURPOSE:
Increased serum immunoreactivity to retinal proteins may have a role in the disease process of some glaucoma patients. We describe a patient with normalpressure glaucoma whose serum immunoreactivity to retinal proteins regressed after methotrexate treatment for rheumatoid disease. METHOD: Case report. RESULTS: In a 66-year-old white female with normalpressure glaucoma and rheumatoid disease, sequential Western blots using patient sera against retinal proteins demonstrated a decrease in the immunoreactive bands after treatment. During the treatment period of 3 years, her visual fields appeared to have improved. Optic disk examination during the short periods without treatment, however, disclosed new, bilateral splinter hemorrhages on the optic disks. CONCLUSION: These observations suggest a potential role for immune-based intervention in similar patients. (Am J Ophthalmol 1999;127:724 –725. © 1999 by Elsevier Science Inc. All rights reserved.)
T
ACKNOWLEDGMENT
The authors thank James Toop, OD, PhD, for his assistance with recruitment of patients and use of contact lenses. REFERENCES
1. Weinreb RN, Dreher AW, Coleman A, Quigley HA, Shaw B, Reiter K. Histopathologic validation of Fourier-ellipsometry measurements of retinal fiber layer thickness. Arch Ophthalmol 1990;108:557–560. 2. Chi Q-M, Tomita G, Inazumi K, Hayakawa T, Ido T, Kitazawa Y. Evaluation of the effect of aging on the retinal nerve fiber layer thickness using scanning laser polarimetry. J Glaucoma 1995;4:406 – 413. 3. Niessen A, van den Berg T, Langerhorst C, Greve E. Retinal nerve fiber layer assessment by scanning laser polarimetry and standardized photography. Am J Ophthalmol 1996;121:484 – 493. 4. Hollo G, Suveges I, Nagymihaly A, Vargha P. Scanning laser polarimetry of the retinal nerve fibre layer in primary open angle and capsular glaucoma. Br J Ophthalmol 1997;81:857– 861. 5. Hoh ST, Ishikawa H, Greenfield DS, Liebmann JM, Chew SJ, Ritch R. Peripapillary nerve fiber layer thickness measurement reproducibility using scanning laser polarimetry. J Glaucoma 1998;7:12–15.
724
AMERICAN JOURNAL
HERE IS SOME EVIDENCE THAT A SUBSET OF PATIENTS
with normal-pressure glaucoma may have an autoimmune component to their disease, as suggested by an epidemiologic association of immune-related disease in 30% of these patients.1 In addition, an increased prevalence of monoclonal gammopathy and serum autoantibodies to extractable nuclear antigens as well as retinal antigens has been reported in some patients with glaucoma, especially with normal intraocular pressure.2,3 We report a case in which serum immunoreactivity against retinal antigens regressed after treatment of rheumatic disease with methotrexate. A 66-year-old woman with normal-pressure glaucoma had been followed up for the last 5 years. Her medical history was unremarkable, except for osteoarthritis and Sjo¨gren syndrome with a positive rheumatoid factor, antinuclear antibody, and Accepted for publication Dec 10, 1998. From the Glaucoma Associates of Texas, Dallas, Texas (R.L.F.), and the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri (G.T., M.B.W.). This study was supported in part by grant EY12314 (M.B.W.) from National Eye Institute, Bethesda, Maryland; the American Health Assistance Foundation, Washington, DC (M.B.W.); the Glaucoma Research Foundation, San Francisco, California (M.B.W.); and an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York. Inquiries to Martin B. Wax, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8096, 660 S Euclid Ave, St Louis, MO 63110; fax: (314) 362-3725; e-mail: [email protected]
OF
OPHTHALMOLOGY
JUNE 1999