The Sample NECO Scientific Poster - Using Microsoft Office

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T. Farra ,
1 M. Jacisin 2
1New England College of Optometry, 2Harvard University, OFA, Cambridge, MA

Introduction Methods Results – con’t Results – con’t

Retinal ganglion cells (RGC) die by apoptosis in both high tension1 and • The sample was selected from patients aged 40 and older who • The NTG group used significantly less steroids then the control group Table 2: Conditions/Procedures Included in the Allergic, Inflammatory and Ant Seg surg Categories.
Allergic Inflammatory Ant. Seg. Surgeries
low tension2 glaucoma. Ischemia and neuronal compression may presented to the Division of Ophthalmology at Brigham and Women’s for all definitions of steroid exposure. Fig. 1 and 2 show the proportion Allergic Rhinitis Sarcoid *Cataract Extration (CE)
deprive the RGCs of essential trophic factors necessary for their Hospital from July 1998 to January 1999. Patients were required to of people taking steroids in the NTG and Control group for total steroid Atopic Dermatitis Crohn’s disease Trabeculectomy
survival3. When apoptosis occurs, the RGC cytoplasmic volume have electronic medical records dating back to at least 1996. use and steroid use excluding anterior segment surgery respectively. Eczema Graves disease CE with Trab
decreases and the cell membrane ruptures, while the nucleus Hayfever Polymyalgia Rheumatica
• All patients were examined by a `. * indicates a statistically significant difference between the NTG and Systemic Lupus Erythematosis
condenses4. RGC membrane lysis is mediated by phospholipases and • Each patient was questioned about their past ocular, medical and Control groups using 2. Unspecified granulomatous disease
oxidative enzymes. Leaky RGC may release other toxic substances surgical history, as well as current use of medications. An extensive Fig 2: Steroid Use excluding ocular surgery in
such as excitatory amino acids, which further damages neighboring history of past and present steroid use was obtained which included Fig 1: Steroid Use in NTG and Control groups NTG and Control groups
• Fig. 6 shows the proportion of different types of steroids used for
cells3. Glutamate, an excitatory amino acid, has been found in elevated Proportion of Steroid Users in NTG systemic conditions by patients in the NTG and Control groups
name of the steroid, dose, frequency of administration, duration, and Proportion of Steroid Users in NTG
concentrations in the vitreous body of glaucomatous eyes5. and Control Groups and Control Groups - Excluding Ant
time period of use. seg surgery respectively. Table 3 indicates the specific steroids included in the
• Subsequently, all patients underwent a complete eye examination. 0.35
* Inhaler, Topical and Oral categories.

Proprotion of Steroid
0.3 * 0.35
Steroids are known to be nonspecific blockers of cell membrane • Any patient suspected of having glaucomatous optic neuropathy 0.25 * 0.3
*

Proportion of
Steroid Users
0.25
* *

lipases6 which may inhibit apoptosis in this setting. Furthermore,
certain glucocorticoids are thought to intercalate into the cell membrane
and decrease neuronal and vascular membrane fluidity by inhibiting
oxygen free radical-induced lipid peroxidation7. Studies have shown
that RGC survival in vitro is dependent on the addition of steroids to the
culture8.
Finally there is data suggesting an immune deviation in patients with
NTG2 where serum antibodies directed to retinal elements have been
found. Exogenous steroids could prevent NTG by nonspecifically
blunting this aberrant response.
Purpose
• To study the association of steroid use and prevalence of NTG in a
clinic-based population.
Sample
The sample consisted of 154 patients:
• 72 NTG (mean age 69.0  10; 44-85; 25M, 47F)
• 82 controls (mean age 64.8  11; 44-86; 31M, 51F)
Definition of NTG Cases
• Patients with ONH or NFL appearance consistent with glaucoma.
• Maximum IOP less then 21mmHg.
• At least two reliable visual field examinations with reproducible
defects consistent with the nerve fiber layer pathology.
• No evidence of exfoliation or trauma on slit lamp examination and no
Users
0.2 Fig 6: Type of Steroids Used for systemic Table 3: Specific steroids included in the Inhaler,
based on the appearance of the optic nerve and nerve fiber layer 0.15 NTG
0.2
conditions in NTG and Control groups. Topical and Oral categories.
0.15 NTG
underwent visual field testing with either the Humphrey or Goldmann
0.1
0.05
Control 0.1
Control Control
0.05 NTG
perimeters. Patients with unreliable visual fields or no reproducible 0
Steroid Steroid Steroid
0
Steroid Steroid Steroid
visual field loss were excluded.
Ever Before After 7/97
7/97
Ever Before After 7/97
7/97
• Ophthalmic information regarding ocular conditions, surgeries and • Logistic regression predicted the Odd’s ratio to be 0.517 Model A
maximum IOP was corroborated from the patient’s eye records. (p=0.07), 0.408 Model B (p=0.02), and 0.81 Model C (p>0.05) for the
• Non-ophthalmic information was confirmed by a review of the patient’s development of NTG. The Odd’s ratios are plotted in Fig. 3 for the 3
electronic medical record. These records contained information
regarding the patient’s medical conditions, as well as the date of first
Models. Models A, B, and C are described in Table 2. Discussion
and filled prescription for all medications. • The speculation that steroids may prevent apoptosis is plausible
based on their ability to inhibit cell membrane lysis mediated by
• Steroid exposure was defined as a dichotomous variable in three
phospholipases and oxidative enzymes. In our study, univariate
ways relative to July 1, 1997 (1 year prior to the onset of the study). analysis suggests that steroid use was associated with a reduced
 Steroid use for a period of 1 month at any given time in the past. odds of having NTG.
 Steroid use prior to July 1, 1997 for at least 1 month. • Problems regarding confounding by indication make the univariate
 Steroid use after July 1, 1997 for at least 1 month. result of this study controversial. Larger scale prevalence studies
confirming our univariate finding are necessary. In these studies, very
• The Odds ratio for steroid use was calculated using logistic regression careful estimate of steroid exposure would be indicated.
analysis for each definition of steroid use. The results were adjusted
for age, race, gender, hypertension, diabetes and diseases that were
indications for steroid use.
Fig 6: Type of Steroids Used for systemic Fig 6: Type of Steroids Used for systemic
Conclusions
conditions in NTG and Control groups. conditions in NTG and Control groups.
• Univariate logistic regression analysis demonstrates a reduced odds
Results • Cataract extraction was significantly higher in the Control group
of NTG in steroid users.
• Controlling for age strengthens this association. Controlling by
• The demographic and clinical characteristics of NTG and Control compared to the NTG group. No difference was found in any systemic indication for steroid use produces a result that is not statistically
groups is described in Table 1. conditions between cases and controls. Fig. 4 and 5 show the significant.
breakdown of conditions requiring steroids in the NTG and Control • Larger numbers of cases and controls will be necessary to
group for systemic and ant. seg. ocular surgery respectively. Table 2 demonstrate the true relation between steroid use and NTG.
shows the conditions/procedures included in the Allergic, Inflammatory
Table 1: Demographic and Clinical Characteristics of NTG and Control groups.
and Total Ant. Seg. surgery categories. * indicates a statistically

•
evidence of an occludable angle or angle recession on gonioscopy.
Patients with pre-existing iridotomies were excluded form the study. Age
NTG
691.2
Control
651.2
p-value
P=0.01
significant difference between the NTG and control groups using 2. References
Fig 4: Breakdown of systemic conditions Fig 5: Breakdown of Ant. Seg. surgeries requiring
(meansd) requiring steroids for NTG and Control steroids for NTG and Control groups.
1 Quigley HA, Nickells RW, Kerrigan LA, Pease ME, Thibault DJ, Zack DJ. Retinal ganglion cell death in
Definition of Controls Female 66% 62%  groups.
Proportion of People with Conditions experimental glaucoma and after axotomy occurs by apoptosis. Invest Ophthalmol Vis Sci 1995;36:774-
• No evidence of glaucomatous optic neuropathy: Race Requiring Steroid Use Proportion of People with Ant. Seg.
Surgery Requiring Steroid Use
86.
2 Wax MB, Tezel G, Edward PD. Clinical and ocular histopathological findings in a patient with normal-
 cup/disc ratios < 0.6 OU White 55% 65%  0.35 pressure glaucoma. Arch Ophthalmol 1998; 116:993-1001.
3 Chew SJ, Ritch R. Neuroprotection: the next breakthrough in glaucoma? Proceedings of the Third
 cup/disc asymmetry < 0.2 Black 30% 21%  0.3
0.25 0.2 Annual Optic Nerve Rescue and Restoration Think Tank. J Glaucoma 1997; 6:263-6.
 * 4 Spaeth GL. Glaucoma, apoptosis, death, and life. Acta Ophthalmol Scand Suppl 1998; 227:9-15.
 unremarkable red-free ophthalmoscopic examinations. Hispanic 7% 5% 0.2 NTG
0.15 NTG 5 Dreyer EB, Zurakowski D, Schumer RA, Podos SM, Lipton SA. Elevated glutamate levels in the vitreous

0.15 Control
• No family history of glaucoma. Other 8% 6% 0.1 0.1
Control body of humans and monkeys with glaucoma. Arch Ophthalmol 1996; 114:299-305.
6 Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF. The role of steroids and their effects
• Maximum IOP less then 21mmHg. HTN 41% 44%
 indicates p>0.05
 0.05
0 0.05 on phospholipase A2 in an animal model of radiculopathy. Spine 1998; 23(11):1191-6.
7 Hall ED. Neuroprotective actions of glucocorticoid and nonglucocorticoid steroids in acute neuronal
Controls did not undergo visual field testing. DM 24% 19% 
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P=0.0053 8 Lindsey JD, Weinreb RN. Survival and differentiation of purified retinal ganglion cells in a chemically
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defined microenvironment. Invest Ophthalmol Vis Sci 1994; 35:3640-8.45

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