Corneal Hysteresis Predictive of Neuroretinal Rim Loss in Glaucoma

Optic disc affected by glaucoma.
Research suggests the metric is more sensitive than central corneal thickness.

Patients with glaucoma who have lower corneal hysteresis (CH) measurements experience faster neuroretinal rim loss, according to findings published in Ophthalmology Glaucoma.

Researchers evaluated 118 eyes of 70 patients with glaucoma who were recruited at Duke University in a longitudinal cohort study. Every 6 months, patients underwent a comprehensive eye examination to evaluate disease progression. The study compared CH findings, as monitored with the Ocular Response Analyzer (ORA, Reichert Instruments) with changes in theBruch’s membrane opening minimum rim width (BMO-MRW), as measured by spectral-domain optical coherence tomography (SD-OCT).

Patients were aged mean 71.2±10.0 years, 46% were women, 36% were Black, the baseline MRW was approximately 194.1±60.3 μm, CH was 8.7±1.4 mm Hg, central intraocular pressure (IOP) was 15.1±3.7 mm Hg, central corneal thickness (CCT) was 533.7±43.3 μm, BMO was 2.1±0.6 mm2, and median standard automated perimetry (SAP) mean deviation was -3.49 (interquartile range [IQR], -8.26 to -1.50) dB.

After a mean follow-up time of 3.9 years and 6.4 SD-OCT evaluations, researchers report the average MRW rate of change was -2.33 μm per year.

In the multivariate analysis, after adjusting for cofounders, MRW was associated with a -0.35 μm/year faster loss for every 1 mm Hg IOP increase (P <.001), a -0.38 μm/year faster loss for every 1 mm Hg CH decrease (P =.019), a -0.10 μm/year faster loss for every 1 dB SAP mean deviation decrease (P <.001), and a -0.39 μm/year faster loss for every 40 μm CCT decrease (P =.039).

Stratified by sectors of the optic disc, the impact of CH on MRW changes were greatest in the nasal (coefficient, -0.60; P <.001), nasal inferior (coefficient, -0.59; P <.001), nasal superior (coefficient, -0.42; P =.028), and temporal inferior (coefficient, -0.38; P =.015) regions.

This study may have been limited by including patients using differing glaucoma treatments. It was not possible to investigate the impact of treatment on CH changes in time.

The study authors explain that lower CH was associated with a faster loss of the neuroretinal rim among patients with glaucoma and may be a marker for disease progression. The rate of loss was more prevalent in the nasal sector of the optic disc.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. . Please refer to the original article for a full list of disclosures.


Jammal AA, Medeiros FA. Corneal Hysteresis and Rates of Neuroretinal Rim Change in Glaucoma. Ophthalmol Glaucoma. 2022;S2589-4196(22)00053-9. doi:10.1016/j.ogla.2022.03.006