Vascular considerations in glaucoma patients of <scp>A</scp>frican and <scp>E</scp>uropean descent

Huck, Andrew; Harris, Alon; Siesky, Brent; Kim, Nathaniel; Muchnik, Michael; Kanakamedala, Priyanka; Amireskandari, Annahita; Abrams-Tobe, Leslie

doi:10.1111/aos.12354

Cited by 34 publications

(33 citation statements)

References 76 publications

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“…; Huck et al. ), a cross‐sectional analysis such as the LES is cannot address this issue. However, the data that arise from this study may help guiding a future prospective study on OBF and glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Ocular blood flow in glaucoma – the Leuven Eye Study

Pinto

Willekens

Keer

et al. 2016

Acta Ophthalmologica

111

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ABSTRACT.Purpose: Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood floworiented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Method: Prospective, cross-sectional, case-control hospital-based study.Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. Results: A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. Conclusions: The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma.

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Section: Discussionmentioning

confidence: 99%

Ocular blood flow in glaucoma – the Leuven Eye Study

Pinto

Willekens

Keer

et al. 2016

Acta Ophthalmologica

111

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“…There are differences among populations in stroke rates, with individuals of African descent having a 2.5-fold higher rate than those of European descent in stroke incidence. 34 This difference may be attributable to higher systemic blood pressure and poorer control of arterial blood pressure. Patients who have had ischemic strokes have higher cupto-disc ratios than age-matched healthy individuals.…”

Section: Strokementioning

confidence: 99%

Ocular Blood Flow and Influencing Factors for Glaucoma

Nakazawa

2016

Asia-Pacific Journal of Ophthalmology

102

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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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“…Vascular factors are another important group of risk factors. They can lead to hypoperfusion of the optic nerve head and thus may play an important role in the pathogenesis and progression of POAG (Phelps & Corbett 1985;Hayreh 1997;Anderson 1999;Drance 2001;Huck et al 2014). Among those factors, arterial blood pressure (BP) and its association with glaucoma and IOP have been studied thoroughly in large epidemiological surveys.…”

Section: Introductionmentioning

confidence: 99%

Nocturnal blood pressure in primary open‐angle glaucoma

Pillunat

Spoerl

Jasper

et al. 2015

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate the nocturnal blood pressure (BP) dipping-pattern in patients with manifest primary open-angle glaucoma (POAG) and to find possible associations with the severity of visual field damage. Methods: A number of 314 patients suffering from POAG were consecutively enrolled in this cross-sectional hospital-based study. Each patient had diurnal intraocular pressure (IOP) measurements, 24-hr BP monitoring and computerized perimetry with the Humphrey 30-2 SITA Standard program. Inclusion criteria were a mean IOP of less than 15 mmHg with fluctuations of less than 5 mmHg and a visual acuity of at least 20/40. One eye was randomly selected. Based on the night-day BP ratio, a mean arterial nocturnal BP drop of less than 10% was considered as non-dipping, between 10% and 20% as physiological dipping and of more than 20% as over-dipping. Results: Glaucoma patients with daytime systemic normotension on the average had more visual field loss in the over-dipper group (MD = À 16.6 dB, IQR = À18.9 to À2.7 dB) than glaucoma patients with daytime systemic hypertension, who had less visual field defects in the over-dipper group (MD = À3.9 dB, IQR = À6.2 to À1.9 dB) (p = 0.004). This result was also found taking age, glaucoma duration, visual acuity, gender, systemic and topical medication as covariates into account. Conclusions: To judge the nocturnal BP situation of an individual patient, it is important to do this in relation to the daytime BP level. Twenty-four-hour BP evaluation might be important for all patients with POAG, as nocturnal BP could be a modifiable risk factor for glaucoma severity and progression.Key words: 24-hr ambulatory blood pressure -nocturnal blood pressure dipping -nocturnal safety range -ocular perfusion pressure -open-angle glaucoma -systemic hypertension -visual field severity Acta Ophthalmol. 2015: 93: e621-e626

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Vascular considerations in glaucoma patients of African and European descent

Cited by 34 publications

References 76 publications

Ocular blood flow in glaucoma – the Leuven Eye Study

Ocular blood flow in glaucoma – the Leuven Eye Study

Ocular Blood Flow and Influencing Factors for Glaucoma

Nocturnal blood pressure in primary open‐angle glaucoma

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