Multiple Systemic Vascular Risk Factors Are Associated With Low-Tension Glaucoma

Funk, Robert O.; Hodge, David O.; Kohli, Darrell; Roddy, Gavin W.

doi:10.1097/ijg.0000000000001964

Cited by 23 publications

(19 citation statements)

References 64 publications

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“…Multiple vascular risk factors including systemic hypotension and hypertension, diabetes mellitus, peripheral vascular disease, Raynaud syndrome, and migraine headache have been shown to be associated with NTG. 10 The vascular theory of glaucomatous optic neuropathy (GON) in NTG considers it as a consequence of insufficient blood supply due to risk factors that reduce ocular blood flow and ocular perfusion pressure, leading to RGC death. 30 Here, we propose an additional alternate mechanism to explain how vascular factors may contribute to the pathogenesis of NTG.…”

Section: Discussionmentioning

confidence: 99%

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Normal-Tension Glaucoma: A Glymphopathy?

Wostyn¹,

Killer²

2023

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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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Section: Discussionmentioning

confidence: 99%

“…Several studies have revealed that non-IOP factors, including vascular and cerebrospinal fluid (CSF) factors, may play significant roles in the development of NTG. 10–12 …”

Section: Introductionmentioning

confidence: 99%

Normal-Tension Glaucoma: A Glymphopathy?

Wostyn¹,

Killer²

2023

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“…Specifically, RNFL defects have been associated with vascular disease, in particular multiple RNFL defects has been linked to hypertension, end‐stage renal disease and cerebrovascular disease 29,30 . Various systemic vascular‐related conditions, including diabetes and hypertension have also been associated with low tension glaucoma 31,32 . We explored the notion that vascular wedge defects may be attributable to systemic vascular disease (self‐reported hypertension and diabetes) however since no statistical relationship was found, we have no reason to suggest that they were not glaucomatous in origin.…”

Section: Discussionmentioning

confidence: 99%

“…29,30 Various systemic vascular-related conditions, including diabetes and hypertension have also been associated with low tension glaucoma. 31,32 We explored the notion that vascular wedge defects may be attributable to systemic vascular disease (self-reported hypertension and diabetes) however since no statistical relationship was found, we have no reason to suggest that they were not glaucomatous in origin.…”

Section: Discussionmentioning

confidence: 99%

Quantification of localised vascular wedge‐shaped defects in glaucoma

Saks,

Schulz,

Sheriff

et al. 2022

Clinical Exper Ophthalmology

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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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“…In 2020, glaucoma was responsible for 11% of all cases of blindness globally in adults aged ≥ 50 years ( 3 ). Some studies ( 4 – 6 ) have suggested that migraine increases the risk of developing glaucoma. However, there have been studies reporting no such findings ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: Findings of automated perimetry during a migraine episode in a patient with glaucoma

Nakakura¹,

Oogi²,

Tanoue

et al. 2022

Front. Med.

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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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Multiple Systemic Vascular Risk Factors Are Associated With Low-Tension Glaucoma

Cited by 23 publications

References 64 publications

Normal-Tension Glaucoma: A Glymphopathy?

Normal-Tension Glaucoma: A Glymphopathy?

Quantification of localised vascular wedge‐shaped defects in glaucoma

Case report: Findings of automated perimetry during a migraine episode in a patient with glaucoma

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