2. OSA
• Repeated episodes of airflow reduction due
to upper airway obstruction.
• Polysomnography.
• Apnea– hypopnea index (AHI) : no of
Hyponea episodes / hour in sleep.
• Grading : Mild ( AHI 5-14) , Moderate (AHI
15-29) , Severe (AHI > 30).
• Daytime Sleepiness and fatigue.
3. OSA
• 4 percent of Caucasian men and 9 percent
of Caucasian women in the United States
have OSA ( Young et al 1993).
• Most cases are undiagnosed
• Rising obesity levels in Kuwait.
• Treatment : weight reduction, Continuous
positive airway pressure, or surgery
( uvulopalatopharyngoplasty).
4. Ophthalmologist Role
• Identify the problem (critical).
• Daytime symptoms ( Sleepiness, trouble
concentrating and memory , and
depression).
• Night time Symptoms ( insomnia,
frequent awakenings, and nocturia,
loud snoring, and witnessed apneas ).
7. Floppy Eyelid Syndrome
• Redundant upper eyelid tissue and papillary
conjunctivitis in obese middle-aged men.
• Incidence in OSA 2-5% (Karger et al 2006)
• Etiology: 1) upregulation of elastin-
degrading matrix metalloproteinases (Sériès F
et al. 2004) Similar elastin fiber disorganization
in distal uvula (Sekosan M et al 2004) 2) Ischemia-
reperfusion injury due to pressure.
13. Glaucoma
• Primary open-angle (27% Bendel at al.
2008) !
• Normal- tension glaucoma (5.7% Sergi
at al. 2007)
• Tsang et al. found that OSA patients
have 4 times risk of glaucomatous visual
field and optic disc changes than
controls. (Eye , 2006).
14. Glaucoma and OSA
• Lin at el. ( J Glucom 2011)
found
prevalence of NTG in moderate/severe
OSA patients was 7.1%.
• Using Optical coherence tomography
(OCT), the retinal nerve fiber layer
thickness was correlated with the
oxygen saturation.
15. NAION
• Sudden loss of vision usually in occurs in
patiens > 50 years.
• Vascular risk factors ( Diabetes, Hypertension,
Hyperlipedemia ).
16. Non-Arteritic Anterior
Ischemic Optic Neuropathy
• Many observational studies have linked
NAION to OSA.
• Odds ratio of 2.6 to have OSA in NAION
patients ( Li et al 2007).
• OSA is not a risk factor for NAION in
itself but is the contributing factor if
other risk factors are present ( Arda H
et al. 2013)
18. Papilledema in OSA
• High intracranial pressure resulting from
nocturnal oxygen desaturation.
19. Papilledema
• Idiopathic intracranial hypertension
(pseudotumor cerebri).
• Lee at al. reported 6 cases in men some of
whom symptoms improved with CPAP
with/without acetazolamide.
• Peter et al. prospectively evaluated 95 cases
of new OSA, and after screening none had
papilledema.
20. Dasman Institute Study
• To Study the pattern and prevalence of optic
neuropathies (galucoma, papilledema) in
patients with moderate-severe OSA and
determine if there is any effect of the
therapeutic intervention of OSA on these
conditions.
21. Dasman Inst. Study
• A cohort of patients with moderate-severe OSA who
will be assessed in the sleep medicine clinic of
Dasman Institute.
• Full ophthalmologic examination : visual acuity,
contrast sensitivity, color vision testing,
tonometry , corneal thickness
(pachymetry) , fundus examination,
automated humphrey visual field perimetry
and optical coherence tomography (OCT) of
the retinal nerve fiber layer and the macula.
22. Dasman Inst. Study
• patients will be-reassessed 6 months following
intervention.
• Effect can be reduction of the intra-ocular
pressure , improvement in the visual field,
clinical fundoscopic improvement or
reduction in the thickness of the retinal
nerve fiber layer in patients with papilledema .
