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Tavakoli K, Sidhu S, Saseendrakumar BR, Weinreb RN, Baxter SL. Long Term Systemic Use of Calcium Channel Blockers and Incidence of Primary Open Angle Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00098-X. [PMID: 38901799 DOI: 10.1016/j.ogla.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/25/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the association between the systemic use of calcium channel blockers (CCBs) and primary open-angle glaucoma (POAG) using a diverse nationwide dataset. DESIGN Retrospective cohort study SUBJECTS: 213,424 individuals aged 40 years and older in the National Institutes of Health (NIH) All of Us dataset, notable for its demographic, geographic and medical diversity and inclusion of historically underrepresented populations. Patients with a diagnosis of POAG prior to use of any kind of anti-hypertensive medication were excluded. METHODS Bivariate and multivariable regression analyses were performed to evaluate associations between CCB use and POAG. CCB use was further divided into exposure to dihydropyridine CCBs and non-dihydropyridine CCBs, and subgroup analyses were performed using Chi-square and Fisher's tests. MAIN OUTCOME MEASURES Diagnosis of POAG RESULTS: Within our cohort, 2,772 participants (1.3%) acquired a diagnosis of POAG, while 210,652 (98.7%) did not. Among patients who developed POAG, the mean age was 73.3 years, 52.5% were female, and 48.2% identified as White. Among POAG patients, 32.6% used one or more CCB, 28.2% used a dihydropyridine CCB, and 2.2% used a non-dihydropyridine CCB. In bivariate analysis, use of any CCBs was associated with an increased risk of POAG (OR: 1.29, 95% CI: 1.27-1.31, p<0.001). In multivariable analysis adjusting for age, gender, race, ethnicity, and comorbidities such as diabetes, hyperlipidemia, and hypertension, use of any CCBs remained associated with an increased risk of developing POAG (OR: 1.52, 95% CI: 1.33-1.74, p<0.001). When stratified by type of CCB, the use of dihydropyridine CCBs (OR: 1.31, 95% CI: 1.14-1.50, p<0.001) was associated with increased POAG risk. CONCLUSIONS Use of dihydropyridine calcium channel blockers was associated with a significantly higher risk of developing POAG, both before and while adjusting for demographic factors and comorbid medical conditions.
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Affiliation(s)
- Kiana Tavakoli
- Division of Ophthalmology Informatics and Data Science and Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Sophia Sidhu
- Division of Ophthalmology Informatics and Data Science and Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science and Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Robert N Weinreb
- Division of Ophthalmology Informatics and Data Science and Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science and Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA.
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Van Eijgen J, Melgarejo JD, Van Laeken J, Van der Pluijm C, Matheussen H, Verhaegen M, Van Keer K, Maestre GE, Al-Aswad LA, Vanassche T, Zhang ZY, Stalmans I. The Relevance of Arterial Blood Pressure in the Management of Glaucoma Progression: A Systematic Review. Am J Hypertens 2024; 37:179-198. [PMID: 37995334 PMCID: PMC10906067 DOI: 10.1093/ajh/hpad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood. OBJECTIVES This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients. METHODS A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles. RESULTS 80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h. CONCLUSIONS We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.
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Affiliation(s)
- Jan Van Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Jana Van Laeken
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Claire Van der Pluijm
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hanne Matheussen
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Micheline Verhaegen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Karel Van Keer
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, USA
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Lee JS, Cha HR, Bae HW, Lee SY, Choi W, Lee SW, Kim CY. Effect of antihypertensive medications on the risk of open-angle glaucoma. Sci Rep 2023; 13:16224. [PMID: 37758842 PMCID: PMC10533509 DOI: 10.1038/s41598-023-43420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/23/2023] [Indexed: 09/29/2023] Open
Abstract
The purpose of this study was to identify the effect of antihypertensive medication on risks of open-angle glaucoma (OAG) among patients diagnosed with hypertension (HTN). A total of 5,195 patients, who were diagnosed with HTN between January 1, 2006 and December 31, 2015, and subsequently diagnosed with OAG, were selected for analysis. For each OAG patient, 5 non-glaucomatous, hypertensive controls were matched (n = 25,975) in hypertension diagnosis date, residential area, insurance type and economic status. Antihypertensive medications were stratified into 5 types: angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), β-blockers and diuretics. Relative risks were calculated. After adjusting for age, sex, body mass index, lifestyle, comorbidities, blood pressure (BP), follow-up duration, and use of other types of antihypertensive drugs, ARB and CCB were found to slightly increase OAG risks (RR 1.1087 (95% CI 1.0293-1.1942); 1.0694 (1.0077-1.1349), respectively). Combinations of ARB with diuretics (1.0893 (1.0349-1.1466)) and CCB (1.0548 (1.0122-1.0991)) also increased OAG risks. The risks for OAG were found to increase by antihypertensive medication use, but the effects appeared to be small. Further studies are necessary to identify the associations of increased BP, medication and therapeutic effect with OAG.
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Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sunkyunkwan University, Suwon, Republic of Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Sang Yeop Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-Si, Republic of Korea
| | - Wungrak Choi
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-Gu, Suwon, 16419, Republic of Korea.
| | - Chan Yun Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Gonzalez-Hernandez M, Betancor-Caro N, Mesa-Lugo F, Rodriguez-Talavera I, Pareja-Rios A, Guedes-Guedes I, Estevez-Jorge B, Trujillo-Blanco M, Cordova-Villegas R, Espinoza-Gonzalez J, Siguero-Martin L, Goya-Gonzalez C, Rodriguez-Dominguez M, Gonzalez-Hernandez D, Gonzalez de la Rosa M. Identification of Glaucoma in Diabetics Using the Laguna-ONhE Colourimetric Method and OCT Spectralis. J Clin Med 2023; 12:5876. [PMID: 37762816 PMCID: PMC10531930 DOI: 10.3390/jcm12185876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Previous retrospective results are evaluated prospectively and blinded. METHODS A total of 221 eyes previously classified as normal (G1), 279 as moderate risk of glaucoma (G2) and 217 as high risk (G3) according to the Globin Discriminant Function (GDF) Laguna-ONhE index were examined with OCT Spectralis- Results: In G1, the Bruch's Membrane Opening Minimum Rim Width (BMO-MRW) was 332 ± 55 microns; in G2, it was 252 ± 47 (p < 0.0001); and in G3, 231 ± 44 (p < 0.0001). In G1, the 1% and 5% percentiles were 233 and 248, respectively; in G2, they were lower in 28.80% and 42.29% of cases, respectively; and in G3, in 50.23% and 63.59% of cases, respectively. Most of the cases were normal-tension glaucomas. Laguna-ONhE indices showed a curvilinear correlation with BMO-MRW results. The Retinal Nerve Fibre Layer (RNFL) showed a poor relationship with BMO. Assuming G1 to be truly normal, BMO-MRW would have a Receiver operating characteristic (ROC) curve area of 0.901 for G2 and G3 and 0.651 for RNFL. A significant reduction in pixels corresponding to vessels was found in G2 and G3 vs. G1 (p < 0.0001). CONCLUSIONS In some cases, these defects appear to be mainly glaucomatous, and in others, they are associated with diabetic microangiopathy. In normal tension glaucoma, RNFL defects may be less severe than those inside the nerve.
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Affiliation(s)
- Marta Gonzalez-Hernandez
- Instrumentacion y Oftalmologia, INSOFT S.L., 38004 Santa Cruz de Tenerife, Spain; (D.G.-H.); (M.G.d.l.R.)
| | - Nisamar Betancor-Caro
- Hospital Universitario de Canarias, 38320 La Laguna, Spain; (N.B.-C.); (F.M.-L.); (I.R.-T.); (A.P.-R.)
| | - Fatima Mesa-Lugo
- Hospital Universitario de Canarias, 38320 La Laguna, Spain; (N.B.-C.); (F.M.-L.); (I.R.-T.); (A.P.-R.)
| | - Ivan Rodriguez-Talavera
- Hospital Universitario de Canarias, 38320 La Laguna, Spain; (N.B.-C.); (F.M.-L.); (I.R.-T.); (A.P.-R.)
| | - Alicia Pareja-Rios
- Hospital Universitario de Canarias, 38320 La Laguna, Spain; (N.B.-C.); (F.M.-L.); (I.R.-T.); (A.P.-R.)
| | - Isabel Guedes-Guedes
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
- Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran, Spain
| | - Beatriz Estevez-Jorge
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Maricela Trujillo-Blanco
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Roberto Cordova-Villegas
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Juan Espinoza-Gonzalez
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Leticia Siguero-Martin
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Carolina Goya-Gonzalez
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Maria Rodriguez-Dominguez
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canarias, Spain; (I.G.-G.); (B.E.-J.); (M.T.-B.); (J.E.-G.); (L.S.-M.); (C.G.-G.); (M.R.-D.)
| | - Daniel Gonzalez-Hernandez
- Instrumentacion y Oftalmologia, INSOFT S.L., 38004 Santa Cruz de Tenerife, Spain; (D.G.-H.); (M.G.d.l.R.)
| | - Manuel Gonzalez de la Rosa
- Instrumentacion y Oftalmologia, INSOFT S.L., 38004 Santa Cruz de Tenerife, Spain; (D.G.-H.); (M.G.d.l.R.)
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Kaplan TM, Hammer JD, Kohli D, Pacheco JM, Hodge DO, Khanna CL, Sit AJ, Roddy GW. Efficacy of Selective Laser Trabeculoplasty in Patients on Systemic Immunosuppressive Therapy. J Glaucoma 2023; 32:762-768. [PMID: 37406302 PMCID: PMC10528063 DOI: 10.1097/ijg.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
PRCIS When comparing patients on systemic immunosuppressive therapy to those without, there was no difference in intraocular pressure (IOP) early after SLT; however, at 1 year following SLT, IOP was higher in the immunosuppression group compared with controls. PURPOSE To determine whether patients taking systemic immunosuppressive medications have a different IOP-lowering response to selective laser trabeculoplasty (SLT) compared with a control group of patients. METHODS All patients who underwent SLT at Mayo Clinic 2017-2021 were identified. Patients on systemic immunosuppressive medications at the time of SLT were compared with control patients not receiving systemic immunosuppressive medications. The primary endpoints of this study were the percentage IOP reduction at 1 to 2, 3 to 6, and 12 months. Additional analyses included the percentage of patients who did not require additional therapy at each time point. RESULTS There were 108 eyes of 72 patients that underwent SLT in the immunosuppressed group and 1997 eyes of 1417 patients in the control group. There was no significant difference in age-adjusted change in IOP between groups at the first postoperative visit 1 to 2 months following SLT (-18.8±20.7% vs. -16.0±16.5%, P =0.256) or 3-6 months following SLT (-15.2±21.6% vs. -18.3±23.2%, P =0.062). However, at 12 months following SLT, the IOP reduction in the immunosuppressive therapy group was significantly less compared with the control group (-15.1±21.2% vs. -20.3±22.9%, P =0.045). There was no difference between groups in the number of additional treatments during the study intervals. CONCLUSION Patients in the systemic immunosuppressive therapy group showed equivalent early IOP-lowering after SLT compared with a control group, but the treatment response was diminished at 1 year. Further studies investigating IOP regulation after SLT in immunosuppressed patients are needed.
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Affiliation(s)
- Tyler M. Kaplan
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - Jon D. Hammer
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - Darrel Kohli
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - Johann M. Pacheco
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224
| | - Cheryl L. Khanna
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - Arthur J. Sit
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
| | - Gavin W. Roddy
- Department of Ophthalmology, Mayo Clinic 200 First St SW, Rochester, MN, 55905
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Lee JS, Kim YJ, Kim S, Bae HW, Kim SS, Lee SW, Kim CY. Increased Risks of Open-Angle Glaucoma in Untreated Hypertension. Am J Ophthalmol 2023; 252:111-120. [PMID: 37030496 DOI: 10.1016/j.ajo.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Hypertension (HTN) has been associated with open-angle glaucoma (OAG), but whether elevated blood pressure (BP) alone is associated with OAG is unknown. Whether stage 1 hypertension, as per the 2017 American College of Cardiology/American Heart Association (ACC/AHA) BP guidelines, increases the risk of the disease is uncertain. DESIGN Retrospective, observational, cohort study. METHODS A total of 360,330 subjects who were ≥40 years of age and not taking antihypertensive or antiglaucoma drugs at the time of health examinations between January 1, 2002, and December 31, 2003, were included. Subjects were categorized based on their untreated BP, into normal BP (systolic BP [SBP] <120 and diastolic BP [DBP] <80 mm Hg; n = 104,304), elevated BP (SBP 120-129 and DBP <80 mm Hg; n = 33,139), stage 1 HTN (SBP 130-139 or DBP 80-89 mm Hg; n = 122,534), or stage 2 HTN (SBP ≥140 or DBP ≥90mm Hg; n = 100,353). Cox regression analysis was performed to calculate hazard ratios (HR) of OAG risk. RESULTS The mean age of the subjects was 51.17 ± 8.97 years, and 56.2% were male. During a mean follow-up period of 11.76 ± 1.37 years, 12,841 subjects (3.56%) were diagnosed with OAG. Multivariable-adjusted HRs (95% CIs) were 1.056 (0.985-1.132) for elevated BP, 1.101(1.050-1.155) for stage 1 HTN, and 1.114(1.060-1.170) for stage 2 HTN with normal BP as the reference. CONCLUSIONS The risk for OAG becomes greater with increases in untreated BP. Stage 1 HTN per the 2017 ACC/AHA BP guidelines is a significant risk factor for OAG.
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Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, South Korea
| | - Yong Joon Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, South Korea
| | - Sunyeup Kim
- Department of Data Science, Sejong University, College of Software convergence, Seoul, Korea; Department of Precision MEdicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, South Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, South Korea
| | - Seung Won Lee
- Department of Precision MEdicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University, South Korea.
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Hsueh CM, Yeh JS, Ho JD. Effect of myopia on the progression of normal tension glaucoma. PLoS One 2023; 18:e0287661. [PMID: 37352291 PMCID: PMC10289344 DOI: 10.1371/journal.pone.0287661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023] Open
Abstract
PURPOSE Identify risk factors of progression in treated normal-tension glaucoma (NTG) in highly myopic and non-highly myopic eyes. METHODS This retrospective, observational case series study included 42 highly myopic glaucoma (HMG, <-6D) eyes and 39 non-highly myopic glaucoma (NHG,≧-6D) eyes. Glaucoma progression was determined by serial visual field data. Univariate and multivariate logistic regression method were used to detect associations between potential risk factors and glaucoma progression. RESULTS Among 81 eyes from 81 normal-tension glaucoma patients (mean follow-up, 3.10 years), 20 of 42 eye (45.24%) in the HMG and 14 of 39 eyes (35.90%) in the NHG showed progression. The HMG group had larger optic disc tilt ratio (p = 0.007) and thinner inferior macular thickness (P = 0.03) than the NHG group. Changes in the linear regression values for MD for each group were as follows: -0.652 dB/year for the HMG and -0.717 dB/year for the NHG (P = 0.298). Basal pattern standard deviation (PSD) (OR: 1.55, p = 0.016) and post treatment IOP (OR = 1.54, p = 0.043) were risk factors for visual field progression in normal tension glaucoma patients. In subgroup analysis of HMG patients, PSD (OR: 2.77, p = 0.017) was a risk factor for visual field progression. CONCLUSION Reduction IOP was postulated to be contributing in the prevention of visual field progression, especially in highly myopic NTG patients with large basal pattern standard deviation.
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Affiliation(s)
- Chun-Mei Hsueh
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jong-Shiuan Yeh
- Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jau-Der Ho
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Banou L, Dastiridou A, Giannoukas A, Kouvelos G, Baros C, Androudi S. The Role of Color Doppler Imaging in the Diagnosis of Glaucoma: A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13040588. [PMID: 36832076 PMCID: PMC9954817 DOI: 10.3390/diagnostics13040588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Glaucoma is a progressive optic neuropathy and one of the leading causes of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is the major risk factor for the onset and progression of glaucoma. In addition to elevated IOP, impaired intraocular blood flow is also considered to be involved in the pathogenesis of glaucoma. Various techniques have been used to assess ocular blood flow (OBF), including Color Doppler Imaging (CDI), a technique used in ophthalmology in recent decades. This article reviews the role of CDI in both the diagnosis and effective monitoring of glaucoma progression, presenting the protocol for imaging and its advantages, as well as the limitations of its use. Moreover, it analyzes the pathophysiology of glaucoma, focusing on vascular theory and its role in the onset and progression of the disease.
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Affiliation(s)
- Lamprini Banou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
- Correspondence:
| | | | - Georgios Kouvelos
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Christos Baros
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
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Wostyn P, Killer HE. Normal-Tension Glaucoma: A Glymphopathy? Eye Brain 2023; 15:37-44. [PMID: 37056720 PMCID: PMC10086217 DOI: 10.2147/eb.s401306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 04/15/2023] Open
Abstract
Glaucoma is one of the main causes of irreversible blindness in the world. The most common form, primary open-angle glaucoma, is an optic neuropathy that is characterized by a progressive loss of retinal ganglion cells and their axons, leading to structural changes in the optic nerve head and associated visual field defects. Elevated intraocular pressure remains the most important modifiable risk factor for primary open-angle glaucoma. However, a significant proportion of patients develop glaucomatous damage in the absence of increased intraocular pressure, a condition known as normal-tension glaucoma (NTG). The pathophysiology underlying NTG remains unclear. Several studies have revealed that vascular and cerebrospinal fluid (CSF) factors may play significant roles in the development of NTG. Vascular failure caused by functional or structural abnormalities, and compartmentation of the optic nerve subarachnoid space with disturbed CSF dynamics have been shown to be associated with NTG. In the present article, based on the concept of the glymphatic system and observations in patients with NTG, we hypothesize that failure of fluid transport via the glymphatic pathway in the optic nerve may be involved in the pathogenesis of some if not many cases of NTG. According to this hypothesis, vascular and CSF factors may share reduced glymphatic transport and perivascular waste clearance in the optic nerve as a final common pathway leading to the development of NTG. In addition, we speculate that some cases of NTG may reflect glymphatic dysfunction in natural brain aging and central nervous system diseases, such as Alzheimer's disease. Clearly, further studies are needed to gain additional insight into the relative contribution of these factors and conditions to reduced glymphatic transport in the optic nerve.
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Affiliation(s)
- Peter Wostyn
- Department of Psychiatry, PC Sint-Amandus, Beernem, Belgium
- Correspondence: Peter Wostyn, Department of Psychiatry, PC Sint-Amandus, Reigerlostraat 10, Beernem, 8730, Belgium, Tel +32-472713719, Fax +32-50-819720, Email
| | - Hanspeter Esriel Killer
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Augenärzte Zentrum Aarau, Aarau, Switzerland
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Nakakura S, Oogi S, Tanoue A, Miyoshi T. Case report: Findings of automated perimetry during a migraine episode in a patient with glaucoma. Front Med (Lausanne) 2022; 9:950148. [PMID: 36388929 PMCID: PMC9649920 DOI: 10.3389/fmed.2022.950148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Comorbidities like glaucoma and migraine are often observed among middle-aged individuals, especially women. Herein, we report a rare case of a patient who underwent automated perimetry during a migraine attack. A 52-year-old woman with a 1-year history of blurred vision in the nasal field of her right eye visited Miyoshi Eye Clinic. The intraocular pressures of the right and left eyes were 22 and 24 mm Hg, respectively. Retinal imaging revealed a retinal nerve fiber defect in the temporal superior macula with corresponding thinning of the superior ganglion cell complex in the right eye. The left eye appeared normal. Primary open-angle glaucoma was suspected, and the patient underwent a visual field examination on the same day. Perimetry showed that the mean deviations in the right and left eyes were −5.00 and −7.68 dB, respectively. A visual field defect in the inferior nasal aspect of the right eye corresponded to the retinal nerve fiber defect. However, right-sided homonymous hemianopia–like visual field defects were observed in both eyes. After the examination, the patient stated that a migraine attack had started 5 min before the examination and continued till after its end (attack duration was ∼20 min). In the follow-up examinations without migraine, homonymous hemianopia-like visual field defects disappeared, and only a glaucomatous visual field defect in the right eye was observed. Hence, the initial visual field examination findings reflected the effects of a migraine attack alongside glaucoma. Detailed interviews with patients may be beneficial for understanding visual field findings and preventing their untimely examination.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
- *Correspondence: Shunsuke Nakakura,
| | - Satomi Oogi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Asaya Tanoue
- Miyoshi Eye Clinic, Department of Ophthalmology, Fukuyama, Japan
| | - Teruyuki Miyoshi
- Miyoshi Eye Clinic, Department of Ophthalmology, Fukuyama, Japan
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Saks D, Schulz A, Sheriff S, Shen T, Gupta V, Qassim A, Ridge B, Pham R, Craig J, Graham S. Quantification of localised vascular wedge-shaped defects in glaucoma. Clin Exp Ophthalmol 2022; 50:724-735. [PMID: 35796092 PMCID: PMC9796144 DOI: 10.1111/ceo.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Vascular dysfunction plays a considerable role in glaucoma pathogenesis. Previous glaucoma case studies described localised wedge-shaped vascular defects, similar to retinal nerve fibre layer (RNFL) wedge defects. This study investigates the prevalence and quantification of this vessel loss, in relation to primary open angle glaucoma (POAG) parameters. METHODS This study included 608 eyes (351 participants): 192 PROGRESSA study participants (342 eyes) with suspect, preperimetric or early manifest POAG, observed for vascular wedge defect presence (cohort one); an additional 114 individuals (cohort two-208 eyes) with POAG at various stages of progression for wedge characterisation; and 38 controls (56 eyes). Vascular wedge defects were observed using optical coherence tomography angiography (OCTA). Wedge parameters and vessel densities were quantified using ImageJ software. RNFL and ganglion cell layer inner plexiform layer (GCLIPL) from OCT scans, and mean deviation (Humphrey visual field 24-2) were also assessed. RESULTS Vascular wedge defects were found in 45/342 eyes (13.2%) in cohort one, in 41/208 eyes (19.7%) in cohort two and were not found in controls. Wedge defects were mostly inferotemporal (80%), and present at all disease stages. They were associated with visual field loss in the opposite hemisphere, thinner RNFL (p < 0.001), thinner GCLIPL (p = 0.003), and focal RNFL loss corresponding with the vascular defect region. CONCLUSION Vascular wedge defects are present at all POAG stages even before functional change and are strongly concordant with focal RNFL loss. Further research is needed to explore these defects in particular their temporal relationship with clinical measures of POAG.
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Affiliation(s)
- Danit Saks
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Angela Schulz
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Samran Sheriff
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Ting Shen
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Vivek Gupta
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Ayub Qassim
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Ryan Pham
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jamie Craig
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Stuart Graham
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
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