Heterogeneity in arterial hypertension and ocular perfusion pressure definitions: Towards a consensus on blood pressure‐related parameters for glaucoma studies

Barbosa‐Breda, João; Abegão‐Pinto, Luis; Keer, Karel Van; Jesus, Danilo Andrade De; Lemmens, Sophie; Vandewalle, Evelien; Rocha‐Sousa, Amândio; Stalmans, Ingeborg

doi:10.1111/aos.13942

Cited by 22 publications

(14 citation statements)

References 82 publications

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“…study population, types of glaucoma, use of topical drugs). Moreover, various BP-and OPP-related parameters (e.g., MOPP, systolic OPP, diastolic OPP, MAP, SBP, DBP) were used, which rendered interpretation of the effect of OPP on glaucoma more complex, in line with the study by Barbosa-Breda et al 63 Therefore, to address the gap in consideration of heterogeneity between studies, we conducted systematic review and meta-analysis and confirmed that OAG patients had significantly lower MOPP than controls.…”

Section: Discussionmentioning

confidence: 88%

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis

Kim

Baek

et al. 2020

Sci Rep

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Low ocular perfusion pressure (opp) has been proposed as an important risk factor for glaucoma development and progression, but controversy still exists between studies. therefore, we conducted a systematic review and meta-analysis to analyze the association between opp and open-angle glaucoma (OAG). Studies were identified by searching PubMed and EMBASE databases. The pooled absolute and standardised mean difference in OPP between OAG patients and controls were evaluated using the random-effects model. Meta-regression analysis was conducted to investigate the factors associated with OPP difference between OAG patients and controls. A total of 43 studies were identified including 3,009 OAG patients, 369 patients with ocular hypertension, and 29,502 controls. The pooled absolute mean difference in OPP between OAG patients and controls was −2.52 mmHg (95% CI −4.06 to −0.98), meaning significantly lower OPP in OAG patients (P = 0.001). Subgroup analyses showed that oAG patients with baseline iop > 21 mmHg (P = 0.019) and ocular hypertension patients also had significantly lower OPP than controls (P < 0.001), but such difference in OPP was not significant between oAG patients with baseline iop of ≤21 mmHg and controls (P = 0.996). In conclusion, although no causal relationship was proven in the present study, our findings suggest that in patients with high baseline iop, who already have a higher risk of glaucoma, low opp might be another risk factor. Glaucoma, the second worldwide leading cause of blindness 1 , is a progressive and chronic disease characterized by the degeneration of retinal ganglion cell and its axon with corresponding visual field defect 2. Although therapeutic risk factors for preventing development and progression of glaucoma have been under wide investigation, lowering intraocular pressure (IOP) currently is the only effective treatment 3-5. Ocular perfusion pressure (OPP), the pressure to drive blood throughout the intraocular vasculature, with the degree of perfusion being influenced by the flow resistance, represents the blood flow and oxygen supplying the optic nerve head (ONH) 6,7. Thus, it has long been proposed that a decrease in OPP may increase the vulnerability of optic disc, leading to an increased risk of glaucoma development or progression 8-12. However, the association between OPP level and the risk of glaucoma has been debatable between studies. Some studies reported a significant association between low OPP and an increased risk of glaucoma 8-12. In contrast, others have reported the statistically non-significant or limited impact of OPP on the risk of glaucoma 13,14. Another hindrance when referring to OPP in clinic is that as various levels of OPP have been reported depending on the study design, glaucoma type, and patient characteristics (e.g. presence of hypertension, use of anti-hypertensive medication), this has led to controversy over the significant difference in the level of OPP between glaucoma patients and controls. In light of these, we performed a systematic review a...

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Section: Discussionmentioning

confidence: 88%

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis

Kim

Baek

et al. 2020

Sci Rep

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“…Automated oscillometry (Infinity Delta; Dräger, Vienna, Austria) on the upper arm was used to measure systolic, diastolic, and mean arterial blood pressures (systolic blood pressure[SBP], diastolic blood pressure[DBP], and mean arterial pressure [MAP]) and pulse rate. As proposed previously, ocular perfusion pressure (OPP) in the sitting position was calculated as OPP = 2/3*MAP-IOP34 taking into account the pressure drop between the upper arm and the eye.…”

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confidence: 99%

Repeatability and Reproducibility of Total Retinal Blood Flow Measurements Using Bi-Directional Doppler OCT

Szegedi

Hommer

Kallab

et al. 2020

Trans. Vis. Sci. Tech.

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To investigate the repeatability and reproducibility of total retinal blood flow measurements using a custom-built dual-beam bidirectional Doppler optical coherence tomography (OCT) system in healthy subjects. Methods: Repeatability and reproducibility were analyzed in 10 and 34 healthy subjects, respectively. For repeatability, measurements were taken twice within 30 minutes, for reproducibility, twice within two to five weeks. Two analysis approaches were compared for calculation of absolute blood velocities: a previously published approach resulting in values for total arterial (Q A,abs) and total venous blood flow (Q V,abs) and a novel approach taking into account that there is a fixed relation between the phase shift in the two OCT channels (Q A,new, Q V,new). Repeatability and reproducibility were quantified using intraclass correlation coefficients (ICCs). Results: For Q A,abs and Q V,abs , ICC values between 0.78 and 0.84 were obtained. Q A,new and Q V,new values revealed better repeatability and reproducibility as compared to the convential appoach. Repeatability ICCs for Q A,new and Q V,new were between 0.91 and 0.93, and reproducibility ICCs were between 0.87 and 0.91 indicating excellent reproducibility. Good agreement was observed between total retinal blood flow values as measured from retinal arteries and retinal veins. Conclusions: Measurement of total retinal blood flow using dual-beam Doppler OCT shows excellent reproducibility, which can further be improved by using a novel algorithm for calculating blood velocities in retinal vessels. Translational Relevance: Our data indicate that dual-beam Doppler OCT can be used for longitudinal studies. Hence, quantitative retinal blood flow may be established as a biomarker for progression vascular eye diseases.

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“…It should be noted that we did not actually measure blood flow of retina using OCTA, but the imaging technique could be a useful tool to show the vascular changes by the index of VD. Hence our results of reduction in both RPC-and SVP-VD could be explained by decrease of MOPP according to the formula which leads to a drop in ocular perfusion and microvascular networks are of primary interest in glaucoma [19]. On the other hand, high-level evidence has shown that treatments decreasing IOP improve the retinal circulation and reduce the risk of development of glaucoma in OHT [27].…”

Section: Discussionmentioning

confidence: 53%

The evaluation of juvenile ocular hypertension by optical coherence tomography angiography

Chen

Wang

et al. 2020

Preprint

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Background: We wish to evaluate the vessel density using optical coherence tomography angiography (OCTA) in juvenile ocular hypertension (JOHT). In addition, we investigate the potential risk parameters of intraocular pressure (IOP) and vertical cup/disc ratio (CDR) with OCTA for observing the development of JOHT. Methods: We examined 86 eyes in 45 healthy subjects and 65 eyes in 34 patients with JOHT using OCTA at the glaucoma clinic of the Eye, Nose, and Throat Hospital of Fudan University. The vessel density (VD) of radial peripapillary capillaries (RPC) and perifoveal superficial vascular plexus (SVP) was compared between healthy and JOHT group. Other basic study factors such as: age, sex, blood pressure, best-corrected visual acuity, central corneal thickness, IOP, CDR, the thickness of retinal nerve fiber layer, ganglion cell complex, visual field mean deviation, and pattern standard deviation were also recorded. Results: Temporal RPC-VD was negatively associated with IOP (p=0.043). Additional five sections of nasal, inferior-nasal, inferior-temporal, superior-temporal and superior-nasal of RPC-VD showed positive correlation with CDR. SVP-VD in superior and nasal regions were affected by high IOP (p=0.023 and p=0.049). No other difference was uncovered between healthy and JOHT subjects. Conclusions: Peripapillary temporal perfusion had negative correlation with IOP in JOHT subjects. And regions were positively correlated with large CDR. Perfusion of perifoveal regions were only affected by IOP. We conclude that OCTA could be used as an effective technique to monitor the development of JOHT.

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Heterogeneity in arterial hypertension and ocular perfusion pressure definitions: Towards a consensus on blood pressure‐related parameters for glaucoma studies

Cited by 22 publications

References 82 publications

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis

Repeatability and Reproducibility of Total Retinal Blood Flow Measurements Using Bi-Directional Doppler OCT

The evaluation of juvenile ocular hypertension by optical coherence tomography angiography

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