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Onishchenko AL, Kolbasko AV, Zakharova AV, Onishchenko EG, Zhilina NM. [Ocular hypotensive effect of systemic beta-blockers in patients with primary glaucoma and arterial hypertension]. Vestn Oftalmol 2017; 133:46-51. [PMID: 28524139 DOI: 10.17116/oftalma2017133246-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM to evaluate the ocular hypotensive efficacy of systemic beta-blockers in primary glaucoma patients suffering from arterial hypertension (AH). MATERIAL AND METHODS The study included 29 patients with POAG (58 eyes) aged from 47 to 83 years. Patients with stage I-III POAG received instillations of prostaglandin analogs and carbonic anhydrase inhibitors. All POAG patients also suffered from arterial hypertension and were prescribed selective beta-blockers (metoprolol, bisoprolol, or nebivalol) as monotherapy or as part of combination therapy (if the target arterial pressure had not been achieved under the initial treatment). After the start of oral beta-blockers therapy, the patients were re-examined at 2 and 4 weeks, 3 months, 6 months, and 1 year. RESULTS A clinically significant reduction of IOP in the most seriously affected eye - by 3.3 mmHg (p<0.05), or 14% - occurred four weeks after the start of selective beta-blockers. Over three months of combination therapy, IOP in the 'worst' eye decreased by 4.4 mmHg (18.5%). At 1 year, IOP in the 'worst' eye was 6.2 mmHg (26%) lower than at baseline (p<0.05). CONCLUSION Aged and senile patients with primary glaucoma usually suffer from polypathy (on average, they have 6.3±0.6 concurrent somatic diseases). To reduce the risk of polypharmacy and the frequency of side effects in the treatment of POAG and AH patients, it is advised that the treatment includes oral selective beta-blockers able to provide target levels of arterial pressure and IOP. In this study, oral beta-blockers in POAG and AH patients enabled IOP reduction as great as 18.5%-26% of baseline values over a 1-year follow-up period.
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Affiliation(s)
- A L Onishchenko
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - A V Kolbasko
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - A V Zakharova
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - E G Onishchenko
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - N M Zhilina
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
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Abstract
Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.
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Affiliation(s)
- Brian J Song
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02115, USA
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02215, USA
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Deb AK, Kaliaperumal S, Rao VA, Sengupta S. Relationship between systemic hypertension, perfusion pressure and glaucoma: a comparative study in an adult Indian population. Indian J Ophthalmol 2016; 62:917-22. [PMID: 25370392 PMCID: PMC4244736 DOI: 10.4103/0301-4738.143927] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. DESIGN Cross-sectional observational study. MATERIALS AND METHODS A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey's central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. STATISTICAL ANALYSIS Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. RESULTS There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1 times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13-45%, P = 0.001) and glaucoma suspect (95% CI = 2-21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. CONCLUSION Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.
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Affiliation(s)
- Amit K Deb
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Gorimedu, India
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Kadziauskiene A, Kuoliene K, Asoklis R, Lesinskas E, Schmetterer L. Changes in choroidal thickness after intraocular pressure reduction following trabeculectomy. Acta Ophthalmol 2016; 94:586-91. [PMID: 27145732 DOI: 10.1111/aos.13057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/15/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the changes of peripapillary and subfoveal choroidal thickness (CT) after trabeculectomy. METHODS Prospective longitudinal study included 37 eyes with open-angle glaucoma. The subfoveal and peripapillary CT was measured using enhanced depth imaging spectral domain optical coherence tomography before trabeculectomy and 1 week, 3 and 6 months postoperatively. The associations between changes in the CT, intraocular pressure (IOP) and axial length were analysed. RESULTS The medium subfoveal CT (IQR) increased from 182 (97) μm at baseline to 267 (107) μm 1 week, 213 (97) μm 3 months and 207 (91) μm 6 months postoperatively (p < 0.001). The peripapillary CT increased in all four quadrants at all follow-ups (p < 0.05). The subfoveal and peripapillary choroidal thickening correlated with the magnitude of IOP reduction (p < 0.05) and axial length shortening (p < 0.01) during whole follow-up period. There was a peripapillary CT increase of 2.9 μm per mmHg of IOP reduction (p < 0.001, CI 1.5-4.4) and 4.8 μm per mm of baseline axial length (p = 0.049, CI 0.03-9.6) 1 week postoperatively after adjustment for baseline IOP. Six months postoperatively, the decrease in axial length was the only factor associated with peripapillary choroidal thickening (p = 0.031; regression coefficient: 73.29 μm/mm, CI 7.1-139.5). CONCLUSION Intraocular pressure (IOP) reduction after trabeculectomy caused the increase in subfoveal and peripapillary CT for at least 6 months postoperatively correlating with greater IOP reduction and axial length shortening. In the long term, the decrease in axial eye length, but not IOP, was the only factor to be associated with peripapillary choroidal thickening.
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Affiliation(s)
- Aiste Kadziauskiene
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
- Centre of Eye Diseases; Vilnius University Hospital Santariskiu Klinikos; Vilnius Lithuania
| | - Kristina Kuoliene
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
- Centre of Eye Diseases; Vilnius University Hospital Santariskiu Klinikos; Vilnius Lithuania
| | - Rimvydas Asoklis
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
- Centre of Eye Diseases; Vilnius University Hospital Santariskiu Klinikos; Vilnius Lithuania
| | - Eugenijus Lesinskas
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
- Centre of Ear, Nose and Throat; Vilnius University Hospital Santariskiu Klinikos; Vilnius Lithuania
| | - Leopold Schmetterer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
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Twenty-four-hour intraocular pressure and ocular perfusion pressure characteristics in newly diagnosed patients with normal tension glaucoma. Eye (Lond) 2016; 30:1481-1489. [PMID: 27472211 DOI: 10.1038/eye.2016.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023] Open
Abstract
PurposeTo determine the mean 24-h intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) characteristics of newly diagnosed, previously untreated, Caucasian, normal tension glaucoma (NTG) patients and to identify relationships between these features and visual field (VF) loss at diagnosis.MethodsConsecutive newly diagnosed NTG patients underwent 24-h habitual IOP and blood pressure (BP) monitoring. Parameters from pooled measurements obtained in the sitting (0800-2200 hours) and supine (1200-0600 hours) positions were compared and associations were sought with VF mean deviation (MD) and pattern standard deviation (PSD).ResultsSixty-two Caucasian NTG patients (24 men and 38 women) successfully completed circadian IOP and BP monitoring. In habitual position, 8 subjects (12.9%) exhibited a diurnal acrophase, 42 subjects (67.7%) demonstrated a nocturnal acrophase, one subject (1.6%) showed a flat rhythm and 11 patients (17.7%) revealed a biphasic/polyphasic rhythm. Nighttime MOPP values (supine position) were significantly greater than diurnal values (sitting position); (P<0.001). No association could be demonstrated between glaucomatous damage, as indicated by VF parameters, and either mean habitual 24-h IOP (P=0.20 and P=0.12 for MD and PSD, respectively), or habitual 24-h MOPP (P=0.96 and 0.29, for MD and PSD, respectively).ConclusionsIn this cohort of Caucasian NTG patients, most patients exhibited a nocturnal IOP acrophase when evaluated in a habitual position. No association was found between 24-h IOP or MOPP and VF damage.
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Quigley HA. Understanding Glaucomatous Optic Neuropathy: The Synergy Between Clinical Observation and Investigation. Annu Rev Vis Sci 2016; 2:235-254. [PMID: 28532352 DOI: 10.1146/annurev-vision-111815-114417] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Glaucoma is a complex disorder of aging defined by the death of retinal ganglion cells and remodeling of connective tissues at the optic nerve head. Intraocular pressure-induced axonal injury at the optic nerve head leads to apoptosis. Loss of retinal ganglion cells follows a slowly progressive sequence. Clinical features of the disease have suggested and corroborated pathological events. The death of retinal ganglion cells causes secondary loss of neurons in the brain, but only as a by-product of injury to the retinal ganglion cells. Although therapy to lower intraocular pressure is moderately effective, new treatments are being developed to alter the remodeling of ocular connective tissue, to interrupt the injury signal from axon to soma, and to upregulate a variety of survival mechanisms.
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Affiliation(s)
- Harry A Quigley
- Glaucoma Center of Excellence, Wilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287;
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107
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Omodaka K, Takahashi S, Matsumoto A, Maekawa S, Kikawa T, Himori N, Takahashi H, Maruyama K, Kunikata H, Akiba M, Nakazawa T. Clinical Factors Associated with Lamina Cribrosa Thickness in Patients with Glaucoma, as Measured with Swept Source Optical Coherence Tomography. PLoS One 2016; 11:e0153707. [PMID: 27100404 PMCID: PMC4839731 DOI: 10.1371/journal.pone.0153707] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/03/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the influence of various risk factors on thinning of the lamina cribrosa (LC), as measured with swept-source optical coherence tomography (SS-OCT; Topcon). Methods This retrospective study comprised 150 eyes of 150 patients: 22 normal subjects, 28 preperimetric glaucoma (PPG) patients, and 100 open-angle glaucoma patients. Average LC thickness was determined in a 3 x 3 mm cube scan of the optic disc, over which a 4 x 4 grid of 16 points was superimposed (interpoint distance: 175 μm), centered on the circular Bruch’s membrane opening. The borders of the LC were defined as the visible limits of the LC pores. The correlation of LC thickness with Humphrey field analyzer-measured mean deviation (MD; SITA standard 24–2), circumpapillary retinal nerve fiber layer thickness (cpRNFLT), the vertical cup-to-disc (C/D) ratio, and tissue mean blur rate (MBR) was determined with Spearman's rank correlation coefficient. The relationship of LC thickness with age, axial length, intraocular pressure (IOP), MD, the vertical C/D ratio, central corneal thickness (CCT), and tissue MBR was determined with multiple regression analysis. Average LC thickness and the correlation between LC thickness and MD were compared in patients with the glaucomatous enlargement (GE) optic disc type and those with non-GE disc types, as classified with Nicolela’s method. Results We found that average LC thickness in the 16 grid points was significantly associated with overall LC thickness (r = 0.77, P < 0.001). The measurement time for this area was 12.4 ± 2.4 minutes. Average LC thickness in this area had a correlation coefficient of 0.57 with cpRNFLT (P < 0.001) and 0.46 (P < 0.001) with MD. Average LC thickness differed significantly between the groups (normal: 268 ± 23 μm, PPG: 248 ± 13 μm, OAG: 233 ± 20 μm). Multiple regression analysis showed that MD (β = 0.29, P = 0.013), vertical C/D ratio (β = -0.25, P = 0.020) and tissue MBR (β = 0.20, P = 0.034) were independent variables significantly affecting LC thickness, but age, axial length, IOP, and CCT were not. LC thickness was significantly lower in the GE patients (233.9 ± 17.3 μm) than the non-GE patients (243.6 ± 19.5 μm, P = 0.040). The correlation coefficient between MD and LC thickness was 0.58 (P < 0.001) in the GE patients and 0.39 (P = 0.013) in the non-GE patients. Conclusion Cupping formation and tissue blood flow were independently correlated to LC thinning. Glaucoma patients with the GE disc type, who predominantly have large cupping, had lower LC thickness even with similar glaucoma severity.
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Affiliation(s)
- Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seri Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shigeto Maekawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidetoshi Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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108
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Samsudin A, Isaacs N, Tai MLS, Ramli N, Mimiwati Z, Choo MM. Ocular perfusion pressure and ophthalmic artery flow in patients with normal tension glaucoma. BMC Ophthalmol 2016; 16:39. [PMID: 27079202 PMCID: PMC4832465 DOI: 10.1186/s12886-016-0215-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Vascular insufficiency has been reported to be a cause of normal tension glaucoma (NTG). The aim of this study was to compare ocular perfusion pressure (OPP) and ophthalmic artery flow (OAF) between patients with NTG and those without glaucoma. Methods We considered one eye each from 31 NTG and 15 non-glaucoma control patients. Blood pressure and intraocular pressure (IOP) were measured in the sitting position, for calculation of OPP. Humphrey visual field (HVF) assessment was then carried out on NTG patients. All patients then underwent Transcranial Doppler ultrasound measurements of OAF parameters, including mean flow velocity (MFV), end diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI). We looked at differences in OPP and OAF parameters between the two groups, and their correlations in NTG patients. T-tests, χ2, ANOVA and Pearson Correlation tests were performed, with p < 0.05 considered statistically significant. Results There were no statistically significant differences in OPP between the NTG and control groups (60.5+/-8.7 mmHg and 62.9+/-10.2 mmHg respectively, p = 0.393), and also no statistically significant differences in MFV, EDV, PSV and RI (all p > 0.05). In the NTG group, there were positive correlations between OPP and both MFV (r = 0.416, p = 0.020) and EDV (r = 0.369, p = 0.041). There were no statistically significant correlations between HVF mean deviation and OPP or OAF parameters (all p > 0.05). Conclusion There is no difference in OPP and OAF parameters between patients with NTG and non-glaucoma controls, suggesting that vascular insufficiency or dysregulation by themselves may not account for the pathogenesis of NTG.
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Affiliation(s)
- Amir Samsudin
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia.
| | - Nadine Isaacs
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlina Ramli
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Zahari Mimiwati
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - May May Choo
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
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Prada D, Harris A, Guidoboni G, Siesky B, Huang AM, Arciero J. Autoregulation and neurovascular coupling in the optic nerve head. Surv Ophthalmol 2016; 61:164-86. [DOI: 10.1016/j.survophthal.2015.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 12/23/2022]
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Exler RE, Guo X, Chan D, Livne-Bar I, Vicic N, Flanagan JG, Sivak JM. Biomechanical insult switches PEA-15 activity to uncouple its anti-apoptotic function and promote erk mediated tissue remodeling. Exp Cell Res 2016; 340:283-94. [DOI: 10.1016/j.yexcr.2015.11.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/27/2015] [Accepted: 11/21/2015] [Indexed: 11/15/2022]
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Abstract
Open-angle glaucoma (OAG) is characterized by optic nerve fiber atrophy and deterioration of the visual field, corresponding to damage to the optic nerve head. Intraocular pressure (IOP) is currently the only evidence-based, treatable risk factor for OAG. However, normal-tension glaucoma, the most common type of OAG in Asia, is a type of glaucoma with an unclear pathogenesis. Glaucoma is suspected to be a multifactorial disease with IOP-dependent and IOP-independent risk factors, including decreased ocular blood flow (OBF), oxidative stress, decreased axoplasmic flow, and genetic background. A number of epidemiological studies have generated strong evidence that OBF may be an especially important risk factor for the progression of glaucoma. Recent innovations in laser speckle flowgraphy and optical coherence tomography-based angiography have allowed us to noninvasively monitor changes in the microcirculation of the optic nerve head with high reproducibility. Laser speckle flowgraphy-derived measurement parameters include mean blur rate and pulse wave form parameters, whereas the main optical coherence tomography angiography-derived parameter is the vessel index. Decreases in these parameters are associated with the severity of glaucomatous damage, and changes are detectible even in the earliest, preperimetric stage of glaucoma. In the future, OBF analysis may improve significantly because of continuing progress in the development of the relevant instruments. This review will summarize possible connections between systemic and OBF abnormalities and OAG, describe the scientific rationale for these connections, and discuss their potential implications. Thus, this review will summarize the role of OBF in glaucoma pathogenesis and discuss the wide range of IOP-independent risk factors.
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Affiliation(s)
- Toru Nakazawa
- From the Department of Ophthalmology, Retinal Disease Control, Ophthalmology, and Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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112
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Hermida RC, Ayala DE. Presión arterial ambulatoria, cronoterapia de la hipertensión y glaucoma. Med Clin (Barc) 2016; 146:30-4. [DOI: 10.1016/j.medcli.2015.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/06/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
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113
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Ocular Blood Flow Autoregulation Mechanisms and Methods. J Ophthalmol 2015; 2015:864871. [PMID: 26576295 PMCID: PMC4631905 DOI: 10.1155/2015/864871] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/14/2015] [Indexed: 12/21/2022] Open
Abstract
The main function of ocular blood flow is to supply sufficient oxygen and nutrients to the eye. Local blood vessels resistance regulates overall blood distribution to the eye and can vary rapidly over time depending on ocular need. Under normal conditions, the relation between blood flow and perfusion pressure in the eye is autoregulated. Basically, autoregulation is a capacity to maintain a relatively constant level of blood flow in the presence of changes in ocular perfusion pressure and varied metabolic demand. In addition, ocular blood flow dysregulation has been demonstrated as an independent risk factor to many ocular diseases. For instance, ocular perfusion pressure plays key role in the progression of retinopathy such as glaucoma and diabetic retinopathy. In this review, different direct and indirect techniques to measure ocular blood flow and the effect of myogenic and neurogenic mechanisms on ocular blood flow are discussed. Moreover, ocular blood flow regulation in ocular disease will be described.
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114
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The Association between Primary Open-Angle Glaucoma and Blood Pressure: Two Aspects of Hypertension and Hypotension. BIOMED RESEARCH INTERNATIONAL 2015; 2015:827516. [PMID: 26557702 PMCID: PMC4628713 DOI: 10.1155/2015/827516] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022]
Abstract
Glaucoma is the second leading cause of blindness worldwide. Although the mechanism of the development of primary open-angle glaucoma (POAG) is not fully understood, elevated intraocular pressure (IOP) is considered the most important risk factor. Several vascular factors have also been identified as risk factors and can lead to hypoperfusion of the optic nerve head and thus may play an important role in the pathogenesis and progression of POAG. The results of the present study suggest that both high and low blood pressure (BP) are associated with an increased risk of POAG based on a comprehensive literature review. Elevated BP is associated with elevated IOP, leading to increased risk of glaucoma, but excessive BP lowering in glaucoma patients may cause a drop in ocular perfusion pressure (OPP) and subsequent ischemic injury. The relationship between IOP, OPP, and BP suggests that the relationship between BP and glaucoma progression is U-shaped.
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115
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Yamada MH, Takazawa T, Iriuchijima N, Horiuchi T, Saito S. Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia. J Clin Monit Comput 2015; 30:869-874. [PMID: 26439829 PMCID: PMC5081380 DOI: 10.1007/s10877-015-9787-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. This study investigated the effect of sevoflurane and propofol anesthesia on IOP in the LDP. A total of 28 patients undergoing surgery in the LDP were included. Patients were randomly allocated to sevoflurane or propofol groups. IOP in both eyes was recorded and compared between groups at five time points: after anesthesia induction, after endotracheal intubation, at 5 min and 1 h after a positional change to the LDP, and 5 min after returning to the supine position. In the sevoflurane group, IOP was significantly increased in both dependent and non-dependent eyes 1 h after changing to the LDP. In the propofol group, IOP decreased in both dependent and non-dependent eyes after tracheal intubation, but did not increase after changing to the LDP. The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications.
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Affiliation(s)
- Makiko Hardy Yamada
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
| | - Tomonori Takazawa
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan.
| | - Nobuhisa Iriuchijima
- Department of Anesthesiology, Kiryu Kosei General Hospital, 6-3 Orihime-cho, Kiryu, 376-0024, Japan
| | - Tatsuo Horiuchi
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
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116
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Abstract
Glaucoma is a progressive optic neuropathy that causes characteristic changes of the optic nerve and visual field in relation to intraocular pressure (IOP). It is now known that glaucoma can occur at statistically normal IOPs and prevalence studies have shown that normal tension glaucoma (NTG) is more common than previously thought. While IOP is believed to be the predominant risk factor in primary open angle glaucoma (POAG), IOP-independent risk factors, such as vascular dysregulation, are believed to play an important part in the pathogenesis of NTG. Though certain distinguishing phenotypic features of NTG have been reported, such as an increased frequency of disc hemorrhages, acquired pits of the optic nerve and characteristic patterns of disc cupping and visual field loss, there is much overlap of the clinical findings in NTG with POAG, suggesting that NTG is likely part of a continuum of open angle glaucomas. However, IOP modification is still the mainstay of treatment in NTG. As in traditional POAG, reduction of IOP can be achieved with the use of medications, laser trabeculoplasty or surgery. Studies now show that the choice of medication may also be important in determining the outcomes of these patients. Though it is likely that future treatment of NTG will involve modification of both IOP and IOP-independent risk factors, current efforts to develop IOP-independent neuroprotective treatments have not yet proven to be effective in humans.
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Affiliation(s)
| | - Joseph Caprioli
- Jules Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, USA
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117
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Shibeeb O, Chidlow G, Han G, Wood JPM, Casson RJ. Effect of subconjunctival glucose on retinal ganglion cell survival in experimental retinal ischaemia and contrast sensitivity in human glaucoma. Clin Exp Ophthalmol 2015. [PMID: 26211482 DOI: 10.1111/ceo.12581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aims to evaluate the effect of subconjunctival glucose on the retinal ganglion cells (RGCs) in experimental retinal ischaemia and contrast sensitivity in humans with primary open-angle glaucoma (POAG). METHODS First, we measured the intravitreal concentration of glucose at various time points after a subconjunctival injection of 100 μl of 50% glucose to Sprague-Dawley rats. Next, treatment and control groups received 50% subconjunctival glucose and iso-osmotic (8%) saline, respectively, 1 h prior to a unilateral ischaemic retinal injury; 7 days later, the damage profiles were compared using RGC and axon counts. Subsequently, we conducted a double-blind, crossover, pilot clinical study in seven eyes of five pseudophakic subjects with severe POAG. Subjects received either 0.3 mL of 50% glucose subconjunctivally or iso-osmotic (8%) saline, then vice versa after a 2-3 week 'wash-out' period; change in contrast sensitivity from baseline was the primary outcome. RESULTS Subconjunctival glucose preserved approximately 60% of Brn3a-positive RGCs in all retinal zones compared with an 80% loss in control retinas, and rescued approximately 40% of the axonal loss. In the human trial, the contrast sensitivity at 12 cycles/degree was 0.24 log units greater than baseline (95% confidence interval 0.12-0.36; P < 0.001). CONCLUSIONS Subconjunctival glucose partially protects RGC somata and axons against an ischaemic insult and temporarily recovers contrast sensitivity in patients with severe POAG. Although an unlikely therapeutic strategy for POAG, the findings motivate further bioenergetic-based research in glaucoma and other optic nerve and retinal diseases, where energy failure may be part of the pathogenesis.
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Affiliation(s)
- O'Sam Shibeeb
- Ophthalmic Research Laboratories, South Australian Institute of Ophthalmology, Centre for Neurological Diseases, Hanson Institute, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Glyn Chidlow
- Ophthalmic Research Laboratories, South Australian Institute of Ophthalmology, Centre for Neurological Diseases, Hanson Institute, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Guoge Han
- Ophthalmic Research Laboratories, South Australian Institute of Ophthalmology, Centre for Neurological Diseases, Hanson Institute, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - John P M Wood
- Ophthalmic Research Laboratories, South Australian Institute of Ophthalmology, Centre for Neurological Diseases, Hanson Institute, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Casson
- Ophthalmic Research Laboratories, South Australian Institute of Ophthalmology, Centre for Neurological Diseases, Hanson Institute, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
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118
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Chung SD, Ho JD, Chen CH, Lin HC, Tsai MC, Sheu JJ. Dementia is associated with open-angle glaucoma: a population-based study. Eye (Lond) 2015; 29:1340-6. [PMID: 26160529 DOI: 10.1038/eye.2015.120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/04/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Previous epidemiologic studies that focused on the association between open-angle glaucoma (OAG) and dementia showed inconsistent results. In the present study, we explored the association between OAG and dementia in an ethnic Chinese (i.e., Taiwanese) population using a population-based data set. METHODS We retrieved data on study subjects for this case-control study from the Longitudinal Health Insurance Database 2000. We identified 7770 patients who had a diagnosis of dementia as cases, and 7770 subjects matched in terms of sex and age, which were randomly extracted as controls. A conditional logistic regression conditioned on age group, sex, and index year was used to assess the association of dementia with previously diagnosed OAG among the sampled patients. RESULTS Of 15,540 patients, 1.70% had prior OAG, including 2.02% of the dementia group and 1.38% of the controls. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, dementia patients were more likely to have had prior OAG than controls (odds ratio (OR): 1.44; 95% confidence interval (CI): 1.12-1.85; P<0.01). In addition, female dementia patients were more likely to have had prior OAG than controls (OR: 1.93; 95% CI: 1.35-2.77; P<0.001), whereas no statistical difference in prior OAG between male dementia patients and controls was found. CONCLUSIONS Female dementia patients were associated with a higher proportion of prior OAG than were the controls.
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Affiliation(s)
- S-D Chung
- Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - J D Ho
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
| | - C H Chen
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
| | - H C Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - M C Tsai
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - J J Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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119
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Khachatryan N, Medeiros FA, Sharpsten L, Bowd C, Sample PA, Liebmann JM, Girkin CA, Weinreb RN, Miki A, Hammel N, Zangwill LM. The African Descent and Glaucoma Evaluation Study (ADAGES): predictors of visual field damage in glaucoma suspects. Am J Ophthalmol 2015; 159:777-87. [PMID: 25597839 DOI: 10.1016/j.ajo.2015.01.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate racial differences in the development of visual field (VF) damage in glaucoma suspects. DESIGN Prospective, observational cohort study. METHODS Six hundred thirty-six eyes from 357 glaucoma suspects with normal VF at baseline were included from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES). Racial differences in the development of VF damage were examined using multivariable Cox proportional hazard models. RESULTS Thirty one of 122 African-descent participants (25.4%) and 47 of 235 European-descent participants (20.0%) developed VF damage (P = .078). In multivariable analysis, worse baseline VF mean deviation, higher mean arterial pressure during follow-up, and a race ∗ mean intraocular pressure (IOP) interaction term were significantly associated with the development of VF damage, suggesting that racial differences in the risk of VF damage varied by IOP. At higher mean IOP levels, race was predictive of the development of VF damage even after adjusting for potentially confounding factors. At mean IOPs during follow-up of 22, 24, and 26 mm Hg, multivariable hazard ratios (95% confidence intervals) for the development of VF damage in African-descent compared to European-descent subjects were 2.03 (1.15-3.57), 2.71 (1.39-5.29), and 3.61 (1.61-8.08), respectively. However, at lower mean IOP levels (below 22 mm Hg) during follow-up, African descent was not predictive of the development of VF damage. CONCLUSION In this cohort of glaucoma suspects with similar access to treatment, multivariate analysis revealed that at higher mean IOP during follow-up, individuals of African descent were more likely to develop VF damage than individuals of European descent.
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120
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Wong M, Huang P, Li W, Li Y, Zhang SS, Zhang C. T-helper1/T-helper2 cytokine imbalance in the iris of patients with glaucoma. PLoS One 2015; 10:e0122184. [PMID: 25811482 PMCID: PMC4374700 DOI: 10.1371/journal.pone.0122184] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/08/2015] [Indexed: 12/19/2022] Open
Abstract
The mechanistic study of glaucoma pathogenesis has shifted to seeking to understand the effects of immune responses on retinal ganglion cell damage and protection. Cytokines mediate the biological effects of the immune system, and our previous study revealed an imbalance of T-helper (Th) 1-derived and Th2-derived cytokines in the serum of patients with glaucoma. In this study, we collected irises from normal individuals and patients with primary open-angle closure (POAG) or chronic angle-closure glaucoma (CACG). We used real-time polymerase chain reaction (PCR) to measure the expression of Th1 (interleukin (IL)-2, interferon-gamma (IFN-γ)), Th2 (IL-4, IL-6, IL-10), and Th3 (transforming growth factor-beta (TGF-β)) cytokines. We then performed immunohistochemical staining to characterize the localization of the upregulated cytokines in iris cryosections. We observed an upward trend in the expression of IL-2 and IFN-γ and a downward trend in IL-6 expression in the iris of POAG and CACG patients. Expression of TGF-β also increased. Immunohistochemistry revealed that IL-2 expression in POAG and CACG patients was localized in the anterior surface of the blood vessel wall in the stroma of the iris, in the cytoplasm of some cells, in the anterior epithelium, and in the posterior pigment epithelium. These findings indicate that immune status differed between the iris tissues of POAG and CACG patients and those of normal individuals. A T-helper cytokine imbalance may modulate the immune microenvironment in glaucomatous eyes and thus influence optic neuropathy.
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Affiliation(s)
- ManSin Wong
- Department of Ophthalmology, Peking University Third Hospital, Peking University Eye Center, Beijing, China
| | - Ping Huang
- Department of Ophthalmology, Peking University Third Hospital, Peking University Eye Center, Beijing, China
- * E-mail:
| | - Weiyi Li
- Department of Ophthalmology, Peking University Third Hospital, Peking University Eye Center, Beijing, China
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Li
- Department of Ophthalmology, Peking University Third Hospital, Peking University Eye Center, Beijing, China
| | - Samuel S. Zhang
- Department of Neural & Behavioral Sciences, Penn State University, Hershey, Pennsylvania, United States of America
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Peking University Eye Center, Beijing, China
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121
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Schmidl D, Schmetterer L, Garhöfer G, Popa-Cherecheanu A. Pharmacotherapy of glaucoma. J Ocul Pharmacol Ther 2015; 31:63-77. [PMID: 25587905 PMCID: PMC4346603 DOI: 10.1089/jop.2014.0067] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/31/2014] [Indexed: 12/25/2022] Open
Abstract
Glaucoma is a group of diseases involving the optic nerve and associated structures, which is characterized by progressive visual field loss and typical changes of the optic nerve head (ONH). The only known treatment of the disease is reduction of intraocular pressure (IOP), which has been shown to reduce glaucoma progression in a variety of large-scale clinical trials. Nowadays, a relatively wide array of topical antiglaucoma drugs is available, including prostaglandin analogues, carbonic anhydrase inhibitors, beta-receptor antagonists, adrenergic agonists, and parasympathomimetics. In clinical routine, this allows for individualized treatment taking risk factors, efficacy, and safety into account. A major challenge is related to adherence to therapy. Sustained release devices may help minimize this problem but are not yet available for clinical routine use. Another hope arises from non-IOP-related treatment concepts. In recent years, much knowledge has been gained regarding the molecular mechanisms that underlie the disease process in glaucoma. This also strengthens the hope that glaucoma therapy beyond IOP lowering will become available. Implementing this concept with clinical trials remains, however, a challenge.
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Affiliation(s)
- Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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122
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Rossetti L, Sacchi M, Karabatsas CH, Topouzis F, Vetrugno M, Centofanti M, Boehm A, Vorwerk C, Goldblum D, Fogagnolo P. Comparison of the effects of bimatoprost and a fixed combination of latanoprost and timolol on 24-hour blood and ocular perfusion pressures: the results of a randomized trial. BMC Ophthalmol 2015; 15:7. [PMID: 25613811 PMCID: PMC4320581 DOI: 10.1186/1471-2415-15-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the effect of bimatoprost and the fixed combination latanoprost-timolol (LTFC) on 24-hour systolic (SBP) and diastolic (DBP) blood pressure and on 24-hour ocular perfusion pressure (OPP). METHODS 200 patients with glaucoma or ocular hypertension, controlled on the unfixed combination of latanoprost and timolol or eligible for dual therapy being not being fully controlled on monotherapy were enrolled in a randomized, double-masked, placebo-controlled, multicentre clinical trial. They were randomized to LTFC (8 a.m.) or bimatoprost (8 p.m.) and received 24-hour IOP curve at baseline, 6 and 12 weeks (supine and sitting position IOPs were recorded at 8 p.m., midnight, 5 a.m., 8a.m., noon and 4 p.m.). Holter 24-hour blood pressure curve was obtained between weeks 2 and 12. SBP, DBP, OPP were calculated and compared with ANOVA. Rates of diastolic OPP (DPP)≤50, ≤40, ≤30 mmHg in the 2 groups were calculated and compared using Fisher's test. RESULTS Mean baseline SBP and DBP were 136.5±18.3 vs 134.2±20.1 mmHg (p=0.1) and 79.1±10.2 vs 78.2±10.1 mmHg (p=0.4) in the bimatoprost and LTFC groups respectively. Holter SBP was significantly higher for bimatoprost (135.1 mmHg vs 128.1 mmHg, p=0.04), while no statistically significant difference in DBP was found. DPP was similar in the 2 groups, and proportions of patients with at least one value of the 24-hour curve≤50, ≤40, ≤30 mmHg were 94%, 86%, 41% respectively. CONCLUSIONS Bimatoprost and LTFC had similar DBPs and OPPs; SBP was significantly lower with LTFC. In this study, the percentage of "dippers" was considerably higher than the one described in previous studies on the role of perfusion pressure in glaucoma. TRIAL REGISTRATION NCT02154217, May 21, 2014.
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Affiliation(s)
- Luca Rossetti
- Clinica Oculistica, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Ospedale San Paolo, Via di Rudinì 8, 20142, Milan, Italy.
| | - Matteo Sacchi
- Clinica Oculistica, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Ospedale San Paolo, Via di Rudinì 8, 20142, Milan, Italy
| | - Costas H Karabatsas
- Department of Ophthalmology, University of Thessaly School of Medicine, Larissa, Greece
| | - Fotis Topouzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, American Hellenic Educational Progressive Association (AHEPA) Hospital, Thessaloniki, Greece
| | | | - Marco Centofanti
- DSCMT Università di Roma 'Tor Vergata'; IRCCS Fondazione G.B. Bietti, Rome, Italy
| | - Andreas Boehm
- University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Christian Vorwerk
- Augenklinik der Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Paolo Fogagnolo
- Clinica Oculistica, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano, Ospedale San Paolo, Via di Rudinì 8, 20142, Milan, Italy
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123
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Kim NY, Seo HR, Rho SH. The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.1.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nam Yeong Kim
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Hong Ryung Seo
- Department of Ophthalmology, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Sae Heun Rho
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
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124
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Correlation of optic nerve microcirculation with papillomacular bundle structure in treatment naive normal tension glaucoma. J Ophthalmol 2014; 2014:468908. [PMID: 25574382 PMCID: PMC4276121 DOI: 10.1155/2014/468908] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/21/2014] [Indexed: 11/13/2022] Open
Abstract
Purpose. To assess the association between optic nerve head (ONH) microcirculation, central papillomacular bundle (CPB) structure, and visual function in eyes with treatment naive normal tension glaucoma (NTG). Methods. This study included 40 eyes of 40 patients with NTG and 20 eyes of 20 normal patients. We used laser speckle flowgraphy (LSFG) to measure mean blur rate (MBR) in all eyes and calculated the ratio of MBR in the horizontal quadrants of tissue area ONH (temporal/nasal ratio of MBR in the tissue area: T/N MT). Clinical findings also included retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) in the CPB and macular areas, best-corrected visual acuity (BCVA), mean deviation (MD), and refractive error. Results. T/N MT was correlated with both BCVA and MD. The OCT parameters most highly correlated with T/N MT were macular RNFLT and mid-CPB RNFLT. Furthermore, T/N MT, mid-CPB RNFLT, and macular RNFLT were higher in NTG than in normal eyes. A discrimination analysis revealed that T/N MT and refractive error were independent factors indicating NTG. Conclusions. Our results suggest that T/N MT is a candidate biomarker of NTG. Furthermore, T/N MT reflects visual function, including acuity and sensitivity, and CPB structure.
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125
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Kim M, Jeoung JW, Park KH, Oh WH, Choi HJ, Kim DM. Metabolic syndrome as a risk factor in normal-tension glaucoma. Acta Ophthalmol 2014; 92:e637-43. [PMID: 24836295 DOI: 10.1111/aos.12434] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/23/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine whether normal-tension glaucoma (NTG) is associated with metabolic syndrome and to evaluate which components of metabolic syndrome are related to NTG. METHODS This study included 18240 participants who underwent health check-ups including fundus photography and intraocular pressure measurements. For NTG diagnosis, all participants with findings suggestive of glaucoma completed a further glaucoma evaluation, including applanation tonometry, gonioscopy and standard automated perimetry. The National Cholesterol Education Program Adult Treatment Panel III guideline was used to characterize metabolic syndrome. RESULTS Of the 18240 participants, 3635 (19.9%) had metabolic syndrome and 300 (1.6%) were diagnosed with NTG. The prevalence of NTG was 1.5% in subjects without metabolic syndrome and 2.1% in subjects with metabolic syndrome. The presence of metabolic syndrome was not significantly associated with NTG (p = 0.067). There were significant associations of NTG with hypertension and impaired glucose tolerance (IGT) among the individual components of metabolic syndrome (OR, 1.53; 95% CI, 1.20-1.94; p = 0.001 and OR, 1.47; 95% CI, 1.12-1.94; p = 0.006). NTG was positively associated with the number of metabolic syndrome components (OR, 1.10; p = 0.040). Multivariable analysis showed the prevalence of NTG to be significantly higher in participants aged between 50 and 70 years relative to those aged 40 to 50 years, male gender, participants with higher baseline intraocular pressure, hypertension and IGT. CONCLUSIONS Of the metabolic syndrome components, hypertension and IGT contributed to an increased risk of NTG. These findings suggest that metabolic syndrome components may play a role in the pathogenesis of NTG.
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Affiliation(s)
- Mijin Kim
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul Korea
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul Korea
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Ki Ho Park
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul Korea
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Won Hyuck Oh
- Department of Ophthalmology; Inje University Sanggye Paik Hospital; Seoul Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul Korea
- Department of Ophthalmology; Healthcare System Gangnam Center; Seoul National University Hospital; Seoul Korea
| | - Dong Myung Kim
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul Korea
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
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126
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Aizawa N, Kunikata H, Shiga Y, Yokoyama Y, Omodaka K, Nakazawa T. Correlation between structure/function and optic disc microcirculation in myopic glaucoma, measured with laser speckle flowgraphy. BMC Ophthalmol 2014; 14:113. [PMID: 25252729 PMCID: PMC4194365 DOI: 10.1186/1471-2415-14-113] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022] Open
Abstract
Background It is difficult to identify glaucoma in myopic eyes because the configuration of the optic disc varies; yet it is important clinically. Here, we used laser speckle flowgraphy (LSFG) to measure mean blur rate (MBR), representing optic disc microcirculation, and assessed its ability to identify glaucoma in eyes with myopic optic discs. Methods 129 eyes (normal disc: 21 eyes; myopic disc: 108 eyes) were enrolled. The eyes were classified as normal or mildly, moderately, or severely glaucomatous with standard automated perimetry (SAP). We determined the relationship between optic nerve head (ONH) MBR, measured with LSFG, mean deviation (MD), measured with SAP, and circumpapillary retinal nerve fiber layer thickness (cpRNFLT), measured with optical coherence tomography (OCT). Results ONH MBR and cpRNFLT decreased significantly with the severity of glaucoma. MBR was significantly correlated with cpRNFLT and MD (r =0.65 and r =0.63, respectively). A multiple regression analysis revealed that MBR and cpRNFLT were independent factors indicating glaucoma severity. A logistic regression analysis revealed that MBR and cpRNFLT were also independent factors indicating the presence of glaucoma. In a receiver operating characteristic (ROC) analysis, MBR and cpRNFLT could both differentiate between normal and glaucomatous eyes (MBR area under the ROC curve: 0.86, with a cut-off score of 24.0 AU). Conclusion These results suggest that in addition to cpRNFLT, non-invasive and objective LSFG measurements of MBR may enable the identification of glaucoma and the classification of its severity in eyes with myopic optic discs.
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Affiliation(s)
| | | | | | | | | | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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127
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Effects of head elevation on intraocular pressure in healthy subjects: raising bed head vs using multiple pillows. Eye (Lond) 2014; 28:1328-33. [PMID: 25190537 DOI: 10.1038/eye.2014.211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/02/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effects of different methods of head elevation on intraocular pressure (IOP) in healthy young subjects. METHODS Twenty-four healthy young Korean subjects were included in this prospective observational study. The IOP measurements were taken with the subjects in the sitting position and in the supine positions with the head flat and 30° up using two different methods: (1) raising the bed head and (2) using multiple pillows. IOP was measured using Tonopen AVIA in both eyes 10 min after assuming each position in a randomized sequence. The Wilcoxon signed-rank test was used to compare the IOP by changing the methods of head elevation. RESULTS Mean IOP of both eyes when sitting was lower than that measured in the supine position with head flat (P=0.001). Compared with that measured in the supine position with head flat, the mean IOP was lower when measured in the supine position with the head kept 30 ° up by bed head elevation (P=0.001), whereas the mean IOP was not significantly different when measured in the supine position with the head elevated using multiple pillows (right eye, P=0.061; left eye, P=0.089). CONCLUSION In normal subjects, IOP was lower when measured in the supine position with the head kept up by the bed head elevation compared with that measured when lying flat. However, such head-up position-induced IOP reduction was not found when the head was kept up using multiple pillows. These findings suggest that elevating the head using multiple pillows may not help to reduce IOP in the supine posture.
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128
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Zhao D, Cho J, Kim MH, Guallar E. The association of blood pressure and primary open-angle glaucoma: a meta-analysis. Am J Ophthalmol 2014; 158:615-27.e9. [PMID: 24879946 DOI: 10.1016/j.ajo.2014.05.029] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular pressure endpoints. DESIGN Systematic review with quantitative meta-analysis. METHODS Studies were identified by searching the PubMed and EMBASE databases. Inverse-variance weighted random-effects models were used to summarize relative risks. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity across studies. RESULTS Sixty observational studies were included. The pooled relative risk for primary open-angle glaucoma comparing patients with hypertension to those without hypertension was 1.16 (95% CI = 1.05-1.28), with modest heterogeneity across studies (I(2) 34.5%). Virtually all studies reported a positive association between blood pressure and intraocular pressure (IOP). The pooled average increase in IOP associated with a 10 mm Hg increase in systolic blood pressure was 0.26 mm Hg (95% CI 0.23-0.28, I(2) 30.7%), and the average increase associated with a 5 mm Hg increase in diastolic blood pressure was 0.17 mm Hg (95% CI 0.11-0.23, I(2) 90.5%). CONCLUSIONS In this meta-analysis, hypertension was associated with increased intraocular pressure. The association between hypertension and primary open-angle glaucoma was stronger in cross-sectional compared with case-control and longitudinal studies. Our findings support a role of increased blood pressure in elevated intraocular pressure and possibly in the development of glaucoma.
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Affiliation(s)
- Di Zhao
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Juhee Cho
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea; Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung Hun Kim
- Saevit Eye Hospital, Goyang, Gyeonggi-do, South Korea; Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
| | - Eliseo Guallar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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129
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Ramm L, Jentsch S, Peters S, Augsten R, Hammer M. Investigation of blood flow regulation and oxygen saturation of the retinal vessels in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2014; 252:1803-10. [DOI: 10.1007/s00417-014-2766-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 12/29/2022] Open
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130
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Wang L, Cull GA, Fortune B. Optic nerve head blood flow response to reduced ocular perfusion pressure by alteration of either the blood pressure or intraocular pressure. Curr Eye Res 2014; 40:359-67. [PMID: 24911311 DOI: 10.3109/02713683.2014.924146] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To test the hypothesis that blood flow autoregulation in the optic nerve head has less reserve to maintain normal blood flow in the face of blood pressure-induced ocular perfusion pressure decrease than a similar magnitude intraocular pressure-induced ocular perfusion pressure decrease. MATERIALS AND METHODS Twelve normal non-human primates were anesthetized by continuous intravenous infusion of pentobarbital. Optic nerve blood flow was monitored by laser speckle flowgraphy. In the first group of animals (n = 6), the experimental eye intraocular pressure was maintained at 10 mmHg using a saline reservoir connected to the anterior chamber. The blood pressure was gradually reduced by a slow injection of pentobarbital. In the second group (n = 6), the intraocular pressure was slowly increased from 10 mmHg to 50 mmHg by raising the reservoir. In both experimental groups, optic nerve head blood flow was measured continuously. The blood pressure and intraocular pressure were simultaneously recorded in all experiments. RESULTS The optic nerve head blood flow showed significant difference between the two groups (p = 0.021, repeat measures analysis of variance). It declined significantly more in the blood pressure group compared to the intraocular pressure group when the ocular perfusion pressure was reduced to 35 mmHg (p < 0.045) and below. There was also a significant interaction between blood flow changes and the ocular perfusion pressure treatment (p = 0.004, adjusted Greenhouse & Geisser univariate test), indicating the gradually enlarged blood flow difference between the two groups was due to the ocular perfusion pressure decrease. CONCLUSIONS The results show that optic nerve head blood flow is more susceptible to an ocular perfusion pressure decrease induced by lowering the blood pressure compared with that induced by increasing the intraocular pressure. This blood flow autoregulation capacity vulnerability to low blood pressure may provide experimental evidence related to the hemodynamic pathophysiology in glaucoma.
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Affiliation(s)
- Lin Wang
- Devers Eye Institute, Legacy Research Institute , Portland, OR , USA
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131
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Abegão Pinto L, Vandewalle E, Willekens K, Marques-Neves C, Stalmans I. Ocular pulse amplitude and Doppler waveform analysis in glaucoma patients. Acta Ophthalmol 2014; 92:e280-5. [PMID: 24456194 DOI: 10.1111/aos.12340] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the correlation between ocular blood flow velocities and ocular pulse amplitude (OPA) in glaucoma patients using colour Doppler imaging (CDI) waveform analysis. METHOD A prospective, observer-masked, case-control study was performed. OPA and blood flow variables from central retinal artery and vein (CRA, CRV), nasal and temporal short posterior ciliary arteries (NPCA, TPCA) and ophthalmic artery (OA) were obtained through dynamic contour tonometry and CDI, respectively. Univariate and multiple regression analyses were performed to explore the correlations between OPA and retrobulbar CDI waveform and systemic cardiovascular parameters (blood pressure, blood pressure amplitude, mean ocular perfusion pressure and peripheral pulse). RESULTS One hundred and ninety-two patients were included [healthy controls: 55; primary open-angle glaucoma (POAG): 74; normal-tension glaucoma (NTG): 63]. OPA was statistically different between groups (Healthy: 3.17 ± 1.2 mmHg; NTG: 2.58 ± 1.2 mmHg; POAG: 2.60 ± 1.1 mmHg; p < 0.01), but not between the glaucoma groups (p = 0.60). Multiple regression models to explain OPA variance were made for each cohort (healthy: p < 0.001, r = 0.605; NTG: p = 0.003, r = 0.372; POAG: p < 0.001, r = 0.412). OPA was independently associated with retrobulbar CDI parameters in the healthy subjects and POAG patients (healthy CRV resistance index: β = 3.37, CI: 0.16-6.59; healthy NPCA mean systolic/diastolic velocity ratio: β = 1.34, CI: 0.52-2.15; POAG TPCA mean systolic velocity: β = 0.14, CI 0.05-0.23). OPA in the NTG group was associated with diastolic blood pressure and pulse rate (β = -0.04, CI: -0.06 to -0.01; β = -0.04, CI: -0.06 to -0.001, respectively). CONCLUSIONS Vascular-related models provide a better explanation to OPA variance in healthy individuals than in glaucoma patients. The variables that influence OPA seem to be different in healthy, POAG and NTG patients.
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Affiliation(s)
- Luís Abegão Pinto
- Department of Ophthalmology; Centro Hospitalar Lisboa Central; Lisbon Portugal
- Department of Pharmacology and Neurosciences; Faculty of Medicine; Lisbon University; Lisbon Portugal
| | - Evelien Vandewalle
- Department of Ophthalmology; University Hospitals Leuven (UZ Leuven); Leuven Belgium
| | - Koen Willekens
- Department of Ophthalmology; University Hospitals Leuven (UZ Leuven); Leuven Belgium
| | | | - Ingeborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven (UZ Leuven); Leuven Belgium
- Department of Neurosciences; Laboratory of Ophthalmology; Catholic University Leuven (KU Leuven); Leuven Belgium
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132
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Costa VP, Harris A, Anderson D, Stodtmeister R, Cremasco F, Kergoat H, Lovasik J, Stalmans I, Zeitz O, Lanzl I, Gugleta K, Schmetterer L. Ocular perfusion pressure in glaucoma. Acta Ophthalmol 2014; 92:e252-66. [PMID: 24238296 DOI: 10.1111/aos.12298] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/02/2013] [Indexed: 12/15/2022]
Abstract
This review article discusses the relationship between ocular perfusion pressure and glaucoma, including its definition, factors that influence its calculation and epidemiological studies investigating the influence of ocular perfusion pressure on the prevalence, incidence and progression of glaucoma. We also list the possible mechanisms behind this association, and discuss whether it is secondary to changes in intraocular pressure, blood pressure or both. Finally, we describe the circadian variation of ocular perfusion pressure and the effects of systemic and topical medications on it. We believe that the balance between IOP and BP, influenced by the autoregulatory capacity of the eye, is part of what determines whether an individual will develop optic nerve damage. However, prospective, longitudinal studies are needed to better define the role of ocular perfusion pressure in the development and progression of glaucoma.
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Affiliation(s)
- Vital P. Costa
- Department of Ophthalmology; University of Campinas; Campinas Brazil
| | - Alon Harris
- Department of Ophthalmology and Physiology; Indiana University School of Medicine; Indianapolis IN USA
| | - Douglas Anderson
- Department of Ophthalmology; Bascom Palmer Eye Institute; Miami FL USA
| | | | - Fernanda Cremasco
- Department of Ophthalmology; University of Campinas; Campinas Brazil
| | - Helene Kergoat
- École d'optométrie; Université de Montreal; Montreal QC Canadá
| | - John Lovasik
- École d'optométrie; Université de Montreal; Montreal QC Canadá
| | - Ingborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Oliver Zeitz
- Department of Ophthalmology; Technical University of Munich; Munich Germany
| | - Ines Lanzl
- Department of Ophthalmology; University of Hamburg; Bayer HealthCare AG; Hamburg Germany
| | | | - Leopold Schmetterer
- Department of Clinical Pharmacology; Center of Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
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133
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Kang JH, Loomis SJ, Yaspan BL, Bailey JC, Weinreb RN, Lee RK, Lichter PR, Budenz DL, Liu Y, Realini T, Gaasterland D, Gaasterland T, Friedman DS, McCarty CA, Moroi SE, Olson L, Schuman JS, Singh K, Vollrath D, Wollstein G, Zack DJ, Brilliant M, Sit AJ, Christen WG, Fingert J, Forman JP, Buys ES, Kraft P, Zhang K, Allingham RR, Pericak-Vance MA, Richards JE, Hauser MA, Haines JL, Wiggs JL, Pasquale LR. Vascular tone pathway polymorphisms in relation to primary open-angle glaucoma. Eye (Lond) 2014; 28:662-71. [PMID: 24603425 PMCID: PMC4058608 DOI: 10.1038/eye.2014.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/24/2014] [Indexed: 01/28/2023] Open
Abstract
AIMS Vascular perfusion may be impaired in primary open-angle glaucoma (POAG); thus, we evaluated a panel of markers in vascular tone-regulating genes in relation to POAG. METHODS We used Illumina 660W-Quad array genotype data and pooled P-values from 3108 POAG cases and 3430 controls from the combined National Eye Institute Glaucoma Human Genetics Collaboration consortium and Glaucoma Genes and Environment studies. Using information from previous literature and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, we compiled single-nucleotide polymorphisms (SNPs) in 186 vascular tone-regulating genes. We used the 'Pathway Analysis by Randomization Incorporating Structure' analysis software, which performed 1000 permutations to compare the overall pathway and selected genes with comparable randomly generated pathways and genes in their association with POAG. RESULTS The vascular tone pathway was not associated with POAG overall or POAG subtypes, defined by the type of visual field loss (early paracentral loss (n=224 cases) or only peripheral loss (n=993 cases)) (permuted P≥0.20). In gene-based analyses, eight were associated with POAG overall at permuted P<0.001: PRKAA1, CAV1, ITPR3, EDNRB, GNB2, DNM2, HFE, and MYL9. Notably, six of these eight (the first six listed) code for factors involved in the endothelial nitric oxide synthase activity, and three of these six (CAV1, ITPR3, and EDNRB) were also associated with early paracentral loss at P<0.001, whereas none of the six genes reached P<0.001 for peripheral loss only. DISCUSSION Although the assembled vascular tone SNP set was not associated with POAG, genes that code for local factors involved in setting vascular tone were associated with POAG.
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MESH Headings
- AMP-Activated Protein Kinases/genetics
- Aged
- Case-Control Studies
- Caveolin 1/genetics
- Dynamin II
- Dynamins/genetics
- Endothelium, Vascular/metabolism
- Female
- GTP-Binding Proteins/genetics
- Genetic Predisposition to Disease
- Genotype
- Glaucoma, Open-Angle/genetics
- Glaucoma, Open-Angle/physiopathology
- Humans
- Inositol 1,4,5-Trisphosphate Receptors/genetics
- Intraocular Pressure
- Male
- Middle Aged
- Muscle, Smooth, Vascular/physiology
- Nitric Oxide Synthase Type III/genetics
- Polymorphism, Single Nucleotide
- Receptor, Endothelin B
- Receptors, Endothelin/genetics
- Signal Transduction/genetics
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Affiliation(s)
- J H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S J Loomis
- Department of Ophthalmology, Mass Eye and Ear, Boston, MA, USA
| | | | - J C Bailey
- Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - R N Weinreb
- Department of Ophthalmology and Hamilton Glaucoma Center, University of California at San Diego, San Diego, CA, USA
| | - R K Lee
- Bascom Palmer Eye Institute and Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - P R Lichter
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - D L Budenz
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
| | - Y Liu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - T Realini
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, WV, USA
| | | | - T Gaasterland
- Scripps Genome Center, University of California at San Diego, San Diego, CA, USA
| | - D S Friedman
- Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, MD, USA
| | - C A McCarty
- Essentia Institute of Rural Health, Duluth, MN, USA
| | - S E Moroi
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - L Olson
- Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J S Schuman
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - K Singh
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - D Vollrath
- Department of Genetics, Stanford University, Palo Alto, CA, USA
| | - G Wollstein
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - D J Zack
- Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, MD, USA
| | - M Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - A J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - W G Christen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Fingert
- Departments of Ophthalmology and Anatomy/Cell Biology, University of Iowa, College of Medicine, Iowa City, IA, USA
| | - J P Forman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E S Buys
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P Kraft
- Department of Biostatistics and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - K Zhang
- Department of Ophthalmology and Hamilton Glaucoma Center, University of California at San Diego, San Diego, CA, USA
| | - R R Allingham
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - M A Pericak-Vance
- Bascom Palmer Eye Institute and Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J E Richards
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - M A Hauser
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - J L Haines
- Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J L Wiggs
- Department of Ophthalmology, Mass Eye and Ear, Boston, MA, USA
| | - L R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Mass Eye and Ear, Boston, MA, USA
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134
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Buys ES, Potter LR, Pasquale LR, Ksander BR. Regulation of intraocular pressure by soluble and membrane guanylate cyclases and their role in glaucoma. Front Mol Neurosci 2014; 7:38. [PMID: 24904270 PMCID: PMC4032937 DOI: 10.3389/fnmol.2014.00038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/21/2014] [Indexed: 01/01/2023] Open
Abstract
Glaucoma is a progressive optic neuropathy characterized by visual field defects that ultimately lead to irreversible blindness (Alward, 2000; Anderson et al., 2006). By the year 2020, an estimated 80 million people will have glaucoma, 11 million of which will be bilaterally blind. Primary open-angle glaucoma (POAG) is the most common type of glaucoma. Elevated intraocular pressure (IOP) is currently the only risk factor amenable to treatment. How IOP is regulated and can be modulated remains a topic of active investigation. Available therapies, mostly geared toward lowering IOP, offer incomplete protection, and POAG often goes undetected until irreparable damage has been done, highlighting the need for novel therapeutic approaches, drug targets, and biomarkers (Heijl et al., 2002; Quigley, 2011). In this review, the role of soluble (nitric oxide (NO)-activated) and membrane-bound, natriuretic peptide (NP)-activated guanylate cyclases that generate the secondary signaling molecule cyclic guanosine monophosphate (cGMP) in the regulation of IOP and in the pathophysiology of POAG will be discussed.
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Affiliation(s)
- Emmanuel S Buys
- Department of Anesthesia, Critical Care, and Pain Medicine, Anesthesia Center for Critical Care Research, Harvard Medical School, Massachusetts General Hospital Boston, MA, USA
| | - Lincoln R Potter
- Department of Pharmacology, University of Minnesota Medical School Minneapolis, MN, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Glaucoma Service Mass Eye and Ear Infirmary and Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital Boston, MA, USA
| | - Bruce R Ksander
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, Harvard Medical School Boston, MA, USA
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135
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Association of the optic disc structure with the use of antihypertensive medications: the thessaloniki eye study. J Glaucoma 2014; 22:526-31. [PMID: 22411020 DOI: 10.1097/ijg.0b013e31824d1e12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the association of antihypertensive medications with optic disc structure by blood pressure (BP) level, in nonglaucoma subjects. DESIGN Cross-sectional, population-based study. METHODS A subset of Thessaloniki Eye Study participants was included in this study. Subjects were interviewed for medical history and underwent extensive ophthalmic examination, BP measurement, and optic disc imaging with the Heidelberg retinal tomograph. Subjects treated for hypertension were grouped in the following groups: (1) angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers; (2) beta blockers and/or calcium-channel blockers; (3) diuretics alone or combined with others; and (4) other combinations. Cup size and cup-to-disc (C/D) ratio in the above groups were compared with the untreated group, using regression models. Analyses were rerun for subjects with systolic BP (SBP)<140 mm Hg, SBP≥140 mm Hg, diastolic BP (DBP)<90 mm Hg, and DBP≥90 mm Hg. RESULTS Among 232 subjects, 131 were receiving antihypertensive medications. In subjects with DBP<90 mm Hg, all medications groups were associated with larger cup size and higher C/D ratio compared with the untreated group. Results were similar in subjects with SBP<140 mm Hg, with the exception of the beta blockers and/or calcium-channel blockers group. None of the medications groups were associated with the Heidelberg retinal tomograph parameters in those with DBP≥90 mm Hg or SBP≥140 mm Hg. CONCLUSIONS All classes of antihypertensive medications were associated with larger cup size and higher C/D ratio in subjects with either DBP<90 mm Hg or SBP<140 mm Hg. These results suggest that there is no specific medication-related effect on optic disc structure, and the associations found are mediated through the hypotensive effect of antihypertensive medications.
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136
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The role of epigenetics in the fibrotic processes associated with glaucoma. J Ophthalmol 2014; 2014:750459. [PMID: 24800062 PMCID: PMC3988735 DOI: 10.1155/2014/750459] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/16/2014] [Indexed: 12/23/2022] Open
Abstract
Glaucoma is an optic neuropathy that affects 60 million people worldwide. The main risk factor for glaucoma is increased intraocular pressure (IOP), this is currently the only target for treatment of glaucoma. However, some patients show disease progression despite well-controlled IOP. Another possible therapeutic target is the extracellular matrix (ECM) changes in glaucoma. There is an accumulation of ECM in the lamina cribrosa (LC) and trabecular meshwork (TM) and upregulation of profibrotic factors such as transforming growth factor β (TGFβ), collagen1α1 (COL1A1), and α-smooth muscle actin (αSMA). One method of regulating fibrosis is through epigenetics; the study of heritable changes in gene function caused by mechanisms other than changes in the underlying DNA sequence. Epigenetic mechanisms have been shown to drive renal and pulmonary fibrosis by upregulating profibrotic factors. Hypoxia alters epigenetic mechanisms through regulating the cell's response and there is a hypoxic environment in the LC and TM in glaucoma. This review looks at the role that hypoxia plays in inducing aberrant epigenetic mechanisms and the role these mechanisms play in inducing fibrosis. Evidence suggests that a hypoxic environment in glaucoma may induce aberrant epigenetic mechanisms that contribute to disease fibrosis. These may prove to be relevant therapeutic targets in glaucoma.
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137
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Association between risk factors and glaucomatous damage in untreated primary open-angle glaucoma. J Glaucoma 2014; 22:501-5. [PMID: 22274672 DOI: 10.1097/ijg.0b013e3182447d9b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze an association between the presumed risk factors for glaucoma and the actual extent of glaucomatous damage in untreated primary open-angle glaucoma. PATIENTS AND METHODS In 50 untreated open-angle glaucoma patients, we analyzed an association between the level of glaucomatous damage and presumed glaucoma risk factors: mean untreated intraocular pressure (IOP) and short-term IOP variability, ocular pulse amplitude, corneal thickness, acral and corneal temperature, retinal arterial diameter and retinal venous diameter, choroidal blood flow (laser Doppler flowmetry flow, velocity, volume), heart rate, and ocular perfusion pressure. Morphologic damage (mean retinal nerve fiber layer thickness, measured by ocular coherence tomography) and functional damage (visual field mean defect) were evaluated separately in 2 forward-stepwise multiple regression models. RESULTS The mean retinal nerve fiber layer thickness was significantly (P<0.05) associated with IOP (r=-0.35), retinal arterial diameter (r=0.36), and choroidal blood flow (r=0.30); mean defect was associated with ocular perfusion pressure (r=-0.30), laser Doppler flowmetry volume (r=-0.33), and IOP variability (0.36). CONCLUSIONS Despite small differences between the morphologic and functional glaucomatous damage, IOP and perfusion parameters seem to contribute, at least in part, independently to both.
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138
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Wang L, Burgoyne CF, Cull G, Thompson S, Fortune B. Static blood flow autoregulation in the optic nerve head in normal and experimental glaucoma. Invest Ophthalmol Vis Sci 2014; 55:873-80. [PMID: 24436190 DOI: 10.1167/iovs.13-13716] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To characterize the static blood flow autoregulation in the optic nerve head (ONH), and to investigate its role in hemodynamic changes in experimental glaucoma (EG). METHODS Unilateral elevation of intraocular pressure (IOP) was induced in 15 adult rhesus macaques by laser treatment to the trabecular meshwork. Prior to and after laser treatment, retinal nerve fiber layer thickness (RNFLT) was assessed, biweekly, by spectral-domain optical coherence tomography. Optic nerve head static autoregulation was assessed by determining the percentage blood flow (BF) change after the IOP was acutely increased from 10 to 30, 40, or 50 mm Hg manometrically, utilizing a laser speckle flowgraphy device. RESULTS Postlaser IOP (measured during average 7.7 ± 2.6 months) was 20.2 ± 5.9 mm Hg in EG eyes and 12.3 ± 2.6 mm Hg in control eyes (P < 0.0001). Retinal nerve fiber layer thickness was reduced by 33 ± 22% of the baseline values (P < 0.001) on average in EG eyes and by 0.4 ± 2.3% in control eyes (P > 0.05). The ONH BF remained at a constant level within a range of ocular perfusion pressure (OPP), 41 mm Hg and above. The autoregulation curves, created by all 723 tests in control and 352 tests in EG, were not significantly different (P = 0.71). CONCLUSIONS Optic nerve head BF in normal nonhuman primate (NHP) eyes is effectively regulated within a range of OPP approximately 41 mm Hg and above. Chronic IOP elevation causes no remarkable change to the static autoregulation within the ONH of EG eyes.
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Affiliation(s)
- Lin Wang
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon
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139
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Casson RJ, Han G, Ebneter A, Chidlow G, Glihotra J, Newland H, Wood JPM. Glucose-induced temporary visual recovery in primary open-angle glaucoma: a double-blind, randomized study. Ophthalmology 2014; 121:1203-11. [PMID: 24491639 DOI: 10.1016/j.ophtha.2013.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/30/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate the effect of topical glucose on visual parameters in individuals with primary open-angle glaucoma (POAG). DESIGN Double-blind, randomized, crossover study. PARTICIPANTS Nondiabetic pseudophakic patients with definite POAG were recruited; 29 eyes of 16 individuals participated in study 1. A follow-up study (study 2) included 14 eyes of 7 individuals. INTERVENTION Eyes were randomly allocated to receive 50% glucose or saline eye drops every 5 minutes for 60 minutes. MAIN OUTCOME MEASURES The contrast sensitivity and best-corrected logarithm of the minimum angle of resolution (logMAR). RESULTS The 50% glucose reached the vitreous in pseudophakic but not phakic individuals. Glucose significantly improved the mean contrast sensitivity at 12 cycles/degree compared with 0.9% saline by 0.26 log units (95% confidence interval [CI], 0.13-0.38; P < 0.001) and 0.40 log units (95% CI, 0.17-0.60; P < 0.001) in the follow-up study. The intraocular pressure, refraction, and central corneal thickness were not affected by glucose; age was not a significant predictor of the response. CONCLUSIONS Topical glucose temporarily improves psychophysical visual parameters in some individuals with POAG, suggesting that neuronal energy substrate delivery to the vitreous reservoir may recover function of "sick" retinal neurons.
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Affiliation(s)
- Robert J Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia.
| | - Guoge Han
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
| | - Andreas Ebneter
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
| | - Glyn Chidlow
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
| | - Jagjit Glihotra
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
| | - Henry Newland
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
| | - John P M Wood
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia
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140
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Boltz A, Told R, Napora KJ, Palkovits S, Werkmeister RM, Schmidl D, Popa-Cherecheanu A, Garhöfer G, Schmetterer L. Optic nerve head blood flow autoregulation during changes in arterial blood pressure in healthy young subjects. PLoS One 2013; 8:e82351. [PMID: 24324774 PMCID: PMC3855769 DOI: 10.1371/journal.pone.0082351] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 12/21/2022] Open
Abstract
AIM In the present study the response of optic nerve head blood flow to an increase in ocular perfusion pressure during isometric exercise was studied. Based on our previous studies we hypothesized that subjects with an abnormal blood flow response, defined as a decrease in blood flow of more than 10% during or after isometric exercise, could be identified. METHODS A total of 40 healthy subjects were included in this study. Three periods of isometric exercise were scheduled, each consisting of 2 minutes of handgripping. Optic nerve head blood flow was measured continuously before, during and after handgripping using laser Doppler flowmetry. Blood pressure was measured non-invasively in one-minute intervals. Intraocular pressure was measured at the beginning and the end of the measurements and ocular perfusion pressure was calculated as 2/3*mean arterial pressure -intraocular pressure. RESULTS Isometric exercise was associated with an increase in ocular perfusion pressure during all handgripping periods (p < 0.001). By contrast no change in optic nerve head blood flow was seen. However, in a subgroup of three subjects blood flow showed a consistent decrease of more than 10% during isometric exercise although their blood pressure values increased. In addition, three other subjects showed a consistent decline of blood flow of more than 10% during the recovery periods. CONCLUSION Our data confirm previous results indicating that optic nerve head blood flow is autoregulated during an increase in perfusion pressure. In addition, we observed a subgroup of 6 subjects (15%) that showed an abnormal response, which is in keeping with our previous data. The mechanisms underlying this abnormal response remain to be shown.
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Affiliation(s)
- Agnes Boltz
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria ; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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141
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Regulation of optic nerve head blood flow during combined changes in intraocular pressure and arterial blood pressure. J Cereb Blood Flow Metab 2013; 33:1850-6. [PMID: 23921903 PMCID: PMC3851895 DOI: 10.1038/jcbfm.2013.137] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 12/14/2022]
Abstract
In the choroid, there is evidence that blood flow does not only depend on ocular perfusion pressure (OPP), but also on absolute mean arterial pressure (MAP) and intraocular pressure (IOP). The present study included 40 healthy subjects to investigate whether such behavior is also found in the optic nerve head (ONH). The ONH blood flow (ONHBF) was studied using laser Doppler flowmetry during a separate increase in IOP and MAP as well as during a combined elevation. Mean arterial pressure was increased by isometric exercise and IOP by the suction method. During both, the change in ONHBF was less pronounced than the change in OPP indicating autoregulation. Correlation analysis was performed for the combined experiments after pooling all data according to IOP and MAP values. A correlation between ONHBF and MAP was found at IOPs 25 mm Hg (P<0.001), but not at IOPs>25 mm Hg (P=0.79). Optic nerve head blood flow and IOP were significantly correlated (P<0.001), and ONHBF was only slightly dependent on MAP. The data of the present study indicate a complex regulation of ONHBF during combined changes in MAP and IOP. Our results may be compatible with myogenic mechanisms underlying autoregulation, and indicate better ONHBF regulation during an increase in MAP than during an increase in IOP.
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142
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Janssen SF, Gorgels TG, Ramdas WD, Klaver CC, van Duijn CM, Jansonius NM, Bergen AA. The vast complexity of primary open angle glaucoma: Disease genes, risks, molecular mechanisms and pathobiology. Prog Retin Eye Res 2013; 37:31-67. [DOI: 10.1016/j.preteyeres.2013.09.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/26/2013] [Accepted: 09/03/2013] [Indexed: 12/21/2022]
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143
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Role of nitric oxide in optic nerve head blood flow regulation during an experimental increase in intraocular pressure in healthy humans. Exp Eye Res 2013; 116:247-53. [PMID: 24060346 DOI: 10.1016/j.exer.2013.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 08/27/2013] [Accepted: 09/11/2013] [Indexed: 12/31/2022]
Abstract
The present study set out to investigate whether nitric oxide, a potent vasodilator, is involved in the regulatory processes in optic nerve head blood flow during an experimental increase in intraocular pressure (IOP). The study was conducted in a randomized, double-masked, placebo-controlled, three way cross-over design. 12 healthy subjects were scheduled to receive either L-NMMA (an unspecific nitric oxide synthase inhibitor), phenylephrine (an α-adrenoceptor agonist) or placebo on three different study days. Optic nerve head blood flow was measured using laser Doppler flowmetry and IOP was increased stepwise with a suction cup. Mean arterial pressure (MAP) and IOP were measured non-invasively and ocular perfusion pressure (OPP) was calculated as OPP = 2/3 MAP-IOP. Administration of L-NMMA and phenylephrine significantly increased MAP and therefore OPP at rest (p < 0.01). L-NMMA significantly reduced baseline blood flow in the optic nerve head (p < 0.01). Application of the suction cup induced a significant increase in IOP and a decrease in OPP (p < 0.01). During the stepwise increase in IOP, some autoregulatory potential was observed until OPP decreased approximately -30% below baseline. None of the administered substances had an effect on this autoregulatory behavior (p = 0.49). The results of the present study confirm that the human optic nerve head shows some regulatory capacity during a decrease in OPP. Nitric oxide is involved in the regulation of basal vascular tone in the optic nerve head but does not seem to be involved in the regulatory mechanisms during an acute increase in IOP in young healthy subjects.
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144
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Abegão Pinto L, Vandewalle E, De Clerck E, Marques-Neves C, Stalmans I. Lack of spontaneous venous pulsation: possible risk indicator in normal tension glaucoma? Acta Ophthalmol 2013; 91:514-20. [PMID: 22776135 DOI: 10.1111/j.1755-3768.2012.02472.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Recently, the absence of spontaneous venous pulsation (SVP) has been suggested as a vascular risk factor for primary open-angle glaucoma (POAG). As the mechanism behind this phenomenon is still unknown, the authors have studied this vascular component using colour Doppler imaging (CDI). METHODS A total of 236 patients were divided into three diagnostic groups: healthy controls (81), POAG (86) and normal tension glaucoma (NTG; 69). All subjects were submitted to CDI studies of the retrobulbar circulation, intraocular pressure measurements and assessment of SVP existence. Mann-Whitney, chi-square contingency tables and Spearman correlations were used to explore differences and correlations between variables in the diagnostic groups. RESULTS Eighty-two percent of healthy controls had SVP (66/81), while a smaller numbers were registered in both glaucoma groups: POAG - 50% (43/86); NTG - 51% (35/69). In NTG patients, but not in POAG patients, the prevalence of the SVP phenomenon decreases with increased glaucoma damage (p = 0.04; p = 0.55, respectively). Overall glaucoma patients from both groups had lower central retinal vein (CRV) velocities than the healthy controls (p < 0.05). NTG patients with SVP had less severe visual field defects (mean defect -6.92 versus -11.1, p < 0.05), higher [correction added after online publication 21 September 2012; the word 'higher' has been inserted to replace the word 'lower'] peak systolic and mean flow velocities in the central retinal artery (p < 0.01; p < 0.05, respectively) as well as higher [correction added after online publication 21 September 2012; the word higher has been inserted to replace the word lower] maximal velocities and RI of the CRV (p < 0.02; p < 0.05, respectively). CONCLUSIONS Glaucoma patients have a decrease in CRV velocities. SVP is less prevalent in glaucoma patients than in healthy individuals. This phenomenon apparently reflects different hemodynamic patterns in the central retinal vessels. This variable may be of particular importance in NTG patients, where it may be associated with more advanced functional damage.
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Affiliation(s)
- Luís Abegão Pinto
- Department of Ophthalmology, Centro Hospitalar de Lisboa Central, Portugal
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145
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Lee TE, Yoo C, Kim YY. Effects of Different Sleeping Postures on Intraocular Pressure and Ocular Perfusion Pressure in Healthy Young Subjects. Ophthalmology 2013; 120:1565-70. [DOI: 10.1016/j.ophtha.2013.01.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/04/2012] [Accepted: 01/08/2013] [Indexed: 11/15/2022] Open
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146
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Celojevic D, Nilsson S, Kalaboukhova L, Tasa G, Juronen E, Sjölander A, Zetterberg H, Zetterberg M. Genetic Variation of Superoxide Dismutases in Patients with Primary Open-angle Glaucoma. Ophthalmic Genet 2013; 35:79-84. [DOI: 10.3109/13816810.2013.793364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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147
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Topouzis F, Wilson MR, Harris A, Founti P, Yu F, Anastasopoulos E, Pappas T, Koskosas A, Salonikiou A, Coleman AL. Association of open-angle glaucoma with perfusion pressure status in the Thessaloniki Eye Study. Am J Ophthalmol 2013; 155:843-51. [PMID: 23394905 DOI: 10.1016/j.ajo.2012.12.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the association of open-angle glaucoma (OAG), primary open-angle glaucoma (POAG), and pseudoexfoliative glaucoma (PEXG) with ocular perfusion pressure status (ocular perfusion pressure with or without antihypertensive treatment). DESIGN Cross-sectional, population-based study. METHODS A total of 2554 randomly selected, ≥ 60-year old subjects participated in the Thessaloniki Eye Study. Only clinic-visit participants (n = 2261), who had uniformly collected data, were included in the analyses. A logistic regression model was run for OAG in all clinic-visit participants; covariates included age, sex, diastolic ocular perfusion pressure, antihypertensive treatment, intraocular pressure (IOP), IOP-lowering treatment, pseudoexfoliation, and vascular factors identified as risk factors for glaucoma in a previous analysis. Similar logistic regression models were run separately for POAG and PEXG. In addition, logistic regression models were run for OAG, POAG, and PEXG in subjects with and without antihypertensive treatment. Also, logistic regression models were run to assess the role of systolic ocular perfusion pressure in OAG, POAG, and PEXG. RESULTS Among clinic-visits, 1212 subjects (53.7%) were using antihypertensive treatment. An association of borderline significance was found between low diastolic ocular perfusion pressure and POAG (OR = 0.84 per 10 mm Hg, 95% CI = 0.70-1.01, P = .059). The effect of antihypertensive treatment on POAG was not statistically significant (OR = 1.20, 95% CI = 0.75-1.91, P = .45). In subgroup analyses, diastolic ocular perfusion pressure was significantly associated with POAG in subjects using antihypertensive treatment (OR = 0.78 per 10 mm Hg, 95% CI = 0.62-0.97, P = .028). No association was found between diastolic ocular perfusion pressure and PEXG, regardless of the use of antihypertensive treatment. No associations were found between systolic ocular perfusion pressure and OAG, POAG, or PEXG, regardless of the use of antihypertensive treatment. CONCLUSIONS Low diastolic ocular perfusion pressure may be associated with increased risk for POAG. This association was confirmed in subjects treated for systemic hypertension in subgroup analysis. This may support the hypothesis that the concept of ocular perfusion pressure status may be more relevant to glaucoma pathogenesis than ocular perfusion pressure alone.
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Affiliation(s)
- Fotis Topouzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, American Hellenic Educational Progressive Association (AHEPA) Hospital, Thessaloniki, Greece.
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Katsi V, Marketou M, Vlachopoulos C, Tousoulis D, Souretis G, Papageorgiou N, Stefanadis C, Vardas P, Kallikazaros I. Impact of arterial hypertension on the eye. Curr Hypertens Rep 2013; 14:581-90. [PMID: 22673879 DOI: 10.1007/s11906-012-0283-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Systemic hypertension has been linked to a wide range of major eye diseases. High arterial blood pressure (BP) decreases choroidal circulatory flow, increases intraocular pressure, and is associated with retinal microvascular abnormalities and prevalence of retinal vein occlusion (RVO) and retinopathy. This review offers a comprehensive overview of ocular diseases associated with hypertension and emphasizes their importance as predictors to future cardiovascular events. It also gives evidence-based clinical data for the therapeutic approach of eye disease in hypertensive patients.
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Affiliation(s)
- Vasiliki Katsi
- Cardiology Department, Hippokration Hospital, Athens, Greece.
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Abstract
PURPOSE OF REVIEW To discuss issues that affect development of new glaucoma treatments known as neuroprotection. RECENT FINDINGS There are barriers to neuroprotection trials for glaucoma. SUMMARY With design features discussed in the review, neuroprotection trials can be effectively carried out.
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150
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Soluble guanylate cyclase α1-deficient mice: a novel murine model for primary open angle glaucoma. PLoS One 2013; 8:e60156. [PMID: 23527308 PMCID: PMC3603933 DOI: 10.1371/journal.pone.0060156] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/21/2013] [Indexed: 12/29/2022] Open
Abstract
Primary open angle glaucoma (POAG) is a leading cause of blindness worldwide. The molecular signaling involved in the pathogenesis of POAG remains unknown. Here, we report that mice lacking the α1 subunit of the nitric oxide receptor soluble guanylate cyclase represent a novel and translatable animal model of POAG, characterized by thinning of the retinal nerve fiber layer and loss of optic nerve axons in the context of an open iridocorneal angle. The optic neuropathy associated with soluble guanylate cyclase α1-deficiency was accompanied by modestly increased intraocular pressure and retinal vascular dysfunction. Moreover, data from a candidate gene association study suggests that a variant in the locus containing the genes encoding for the α1 and β1 subunits of soluble guanylate cyclase is associated with POAG in patients presenting with initial paracentral vision loss, a disease subtype thought to be associated with vascular dysregulation. These findings provide new insights into the pathogenesis and genetics of POAG and suggest new therapeutic strategies for POAG.
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