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Andrew Tirsi, Joby Tsai, Danielle kacaj, Benny Wong, lukas Schwartz, Peter H Derr, Alberto Gonzalez, Sung Chul Park, Stephen Obstbaum, Celso Tello; Treating Obstructive Sleep Apnea in Patients with Low Tension Glaucoma Reverses Retinal Ganglion Cell dysfunction. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3869.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the effect of obstructive sleep apnea (OSA) treatment alone on retinal ganglion cell (RGC) dysfunction in patients with early low-tension glaucoma (LTG) using Pattern electroretinogram (PERG)
A pilot study was conducted at Manhattan Eye Ear & Throat Hospital, in which 2 subjects (4 eyes) with OSA and early LTG underwent comprehensive clinical examination and testing including PERG, visual field (VF), and Optical coherence Tomography (OCT). LTG Patients with normal VF and abnormal PERG were included. Patients underwent OSA treatment involving Continuous Positive Airway Pressure (CPAP) device with a mask. Patients were evaluated at baseline and after 4 months after the OSA treatment was started, to determine disease progression or improvement, based on RGC function measured by PERG testing. PERG parameters (Mag, MagD and MagD/Mag ratio) before and after the treatment were used in the analysis
One-way repeated measure ANOVA (Within-Subjects and between-subjects effects) was conducted to determine whether there was a statistically significant difference in PERG parameters over the course of 4 months after the OSA treatment was started. PERG parameters showed significant improvements in all eyes. Mag increased from (0.87 ± 0.81) to (1.19 ± 0.16), MagD improved from (0.57 ± 0.11) to (1.00 ± 0.16), and the MagD/Mag Ratio from (0.66 ± 0.99) to (0.84 ± 0.02), demonstrating an increase in those parameters by 36.78%, 73.68% and 27.27%, respectively. The OSA treatment intervention alone did elicit statistically significant improvement in Mag [F (1,3) = 11.02, p = 0.045, partial Eta2= 0.79], in MagD [F (1,3) = 10.93, p = 0.046, partial Eta2= 0.79], in MagD/Mag Ratio [F (1,3) = 10.07, p = 0.05, partial Eta2= 0.77]. Between subjects effects were also statistically significant for Mag [F (1,3) = 583.5, p < 0.001, partial Eta2= 0.99], for MagD [F (1,3) = 1613.39, p < 0.01, partial Eta2= 0.99], in MagD/Mag Ratio [F (1,3) = 1264.87, p <0.001, partial Eta2= 0.99]
Retinal ganglion cell dysfunction is present in early LTG glaucoma patients with OSA and treating OSA alone with CPAP device results in RGC function recovery, as demonstrated by improving PERG parameters. These results have important clinical implementations and health benefits from this therapy can be enormous in LTG management, especially when IOP is in the lower normal range.
This is a 2020 ARVO Annual Meeting abstract.
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