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Paul A Knepper, Geoffrey Hill, Anjali S Hawkins, Christopher Wanderling, Paulius V Kuprys, Sean Forte, Chetan Velagapudi, John R Samples, Michael C Giovingo, Nicholas J Volpe; Nailfold hemorrhages and dilated capillaries separate POAG from NTG. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4751.
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Primary open angle glaucoma (POAG) is an ocular disease causing the loss of vision; approximately half of POAG subjects are undiagnosed. The purpose of this study is to determine whether the incidence of nailfold hemorrhages and dilated capillaries correlate with POAG and normal tension glaucoma (NTG) visual field loss.
This study cohort consisted of NTG (n=8), POAG (n=17), and age matched caucasian control (n=29) subjects. Nailfold videos were recorded on the subjects’ third and fourth or fourth and fifth fingers of their non-dominant hand with a JH-1004 Capillaroscope. Subjects were excluded on the basis of connective tissue diseases (e.g. arthritis), autoimmune disorders, and malignancies. Videos were analyzed by a masked observer for hemorrhages, dilated capillary loops (>50um), and avascular areas (>500um). Additionally, hemorrhage count was compared to visual field loss: stage 1, normal; stage 2, early, arcuate defect; stage 3, moderate, abnormal in 1 hemifield and not within 5 degrees of fixation; and, stage 4, severe, abnormal in both hemifields or within 5 degrees of fixation. Statistical analyses were calculated using ANOVA analysis.
The findings of this study are presented in the table and displayed on the regression analysis graphs.
All POAG and NTG patients had video documented hemorrhages and the majority of patients had dilated capillaries. A positive correlation between hemorrhage count and visual field loss was observed in POAG patients; interestingly, hemorrhage count was highest in the early stage of visual loss in NTG patients. Video capillaroscopy may provide a quick and simple test to screen patients for NTG or POAG and it may serve as an ancillary test in the management of POAG.
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