Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019

Abstract

Glaucoma is one of the leading causes of blindness worldwide, and as the proportion of those over age 40 increases, so will the prevalence of glaucoma. The pathogenesis of primary open angle glaucoma (POAG) is unclear and multiple ocular risk factors have been proposed, including intraocular pressure, ocular perfusion pressure, ocular blood flow, myopia, central corneal thickness, and optic disc hemorrhages. The purpose of this review was to analyze the association between systemic vascular risk factors (including hypertension, diabetes, age, and migraine) and POAG, based on major epidemiological studies. Reports presenting the association between POAG and systemic vascular risk factors included a total of over 50,000 patients. Several epidemiological studies confirmed the importance of vascular risk factors, particularly hypertension and blood pressure dipping, in the pathogenesis and progression of glaucomatous optic neuropathy. We found that diabetes mellitus is associated with elevated intraocular pressure, but has no clear association with POAG. No significant correlation between migraine and POAG was found, however, the definition of migraine varied between studies.

Neuroinflammation in Primary Open-Angle Glaucoma

“…The vascular theory is based on evidence of either primary (vasospastic syndrome) or secondary vascular dysregulation found in some glaucomatous patients. The chronic impairment of ONH blood flow, which may result from an imbalance in the ocular blood flow auto-regulation and oxidative stress (vasospastic syndrome) or from systemic levels of vasoconstrictive peptides (i.e., endothelin-1), seems to be responsible for ischaemia-reperfusion nerve injury [ 9 , 10 , 11 ].…”

Curcumin Metabolite Tetrahydrocurcumin in the Treatment of Eye Diseases

“…Systemic factors, such as systemic hypertension, type 2 diabetes mellitus, and lipid dysregulation may also increase glaucoma risks. Moreover, age, smoking, family history, and genetic factors could also be risk factors [ 33 ]. Although glaucoma may occur at any age, a relationship was found between open-angle glaucoma and increasing age due to other age-related diseases.…”

Glaucoma in diabetic patients and the need for further research

“…15 Three systematic reviews examined the associations between diabetes and glaucoma. [7][8][9] Pooled analysis from those studies reported different OR 1.37, (95% CI=0.72-2.02), OR=1.36, (95% CI=1.25-1.50) and OR=1.48, (95% CI=1.29-1.71). Alhough the results seem close and suggest an increased risk in the diabetic population, the systematic reviews report significant heterogenicity and come short in explaining causality.…”

“…4 Patients with diabetes are also at risk of developing cataract, uveitis, and glaucoma. [5][6][7][8][9]…”