Is Symptomatic Atherosclerotic Cerebrovascular Disease a Risk Factor for Normal-Tension Glaucoma?

Abstract

Objective: To compare the incidence of glaucomatous optic disk appearance between patients with symptomatic atherosclerotic stroke and healthy individuals with normal intraocular pressures (IOP). Subjects and Methods: 46 patients with ischemic stroke with evident lacunar infarction or large vessel atherosclerosis, and 93 age- and sex-matched healthy individuals, all with normal IOP, were included. Patients and controls were examined for the presence of high cup-to-disk ratios (>0.5). Results: Seven patients (15.22%) in the ischemic cerebrovascular disease (CVD) group and 3 controls (3.23%) had glaucomatous optic disk appearance. All subjects with glaucomatous optic disk appearance in the control group and 3 patients in the study group had visual field defects in concordance with normal-tension glaucoma (NTG). The incidence of glaucomatous optic disk appearance was significantly higher in the group with symptomatic atherosclerotic CVD. Conclusion: Atherosclerotic CVD is a risk factor for having glaucomatous optic disk appearance. Symptomatic atherosclerosis involving the brain vasculature may also affect the eye and lead to NTG. Patients with ischemic strokes due to large artery atherosclerosis or small artery occlusion must be examined and followed for NTG.

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

“…Arterial stiffness is considered an independent predictor of cardiovascular disease, 65 and increased IMT has been suggested as an indirect measure of generalized atherosclerosis and cardiovascular risk. 66 The presence of cardiovascular disease and structural vascular wall changes has been variably linked to the presence of GON during recent years, with some studies identifying strong associations in POAG [67][68][69] and NTG 39,70,71 patients individually and others revealing no such associations. [72][73][74][75] The variability in results between these previous studies could in part be accounted for by differences in the inclusion/exclusion of patients with already diagnosed systemic vascular disease, especially because arterial stiffness is a measure of vascular function.…”

The role of lipid dysregulation and vascular risk factors in glaucomatous retrobulbar circulation

“…Apart from lipid-related factors, the role of disturbances in the level of vasodilatory nitric oxide (NO) and vasoconstrictive endothelin-1 (ET-1) agents affecting the retino-choroidal microcirculation is emphasized in the literature. The results of decreased NO and increased ET-1 levels in glaucoma patients have been widely described [18,22,[26][27][28][29][30][31].…”

“…Atherosclerosis is hardly ever taken into account as a risk factor for glaucoma incidence [18][19][20]. Damage to the vessel wall (hypertension, bacterial toxins, atherogenic lipoproteins aggregation) and uncontrolled smooth muscle cell proliferation facilitate the process of atherosclerotic plaque formation.…”

Is normal-tension glaucoma a risk factor for stroke?—A 10-year follow-up study

“…The incidence of a glaucomatous optic disk appearance is significantly higher in patients with symptomatic atherosclerotic cerebrovascular diseases, and it leads to NTG [53]. In addition, the presence of a silent cerebral infarct is reported to be an independent risk factor for visual field progression in patients with newly diagnosed NTG [54].…”