Retinal venous pressure in chronic smokers

Vahedian, Zakieh; Amini, Heydar; Tehrani, Mehdi Hosseini; Zarei, Reza; Moghimi, Sasan; Mozaffarieh, Maneli; Fakhraie, Ghasem

doi:10.1186/s13167-015-0031-5

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…5b ,c). RVP was not higher in chronic smokers than in non-smokers [ 318 ] but was increased in subjects with FS [ 319 ], and CCBs reduced RVP in these FS-positive subjects [ 320 ]. Based on these observations, we considered an increased RVP less a consequence of structural alterations but more of a dysregulation of retinal veins.…”

Section: Retinal Venous Pressurementioning

confidence: 99%

The discovery of the Flammer syndrome: a historical and personal perspective

Flammer

Konieczka

2017

EPMA Journal

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This review describes the clinical and basic research that led to the description of Flammer syndrome. It is narrated from a personal perspective. This research was initiated by the observation of an increased long-term fluctuation of visual fields in a subgroup of glaucoma patients. As these patients had strikingly cold hands, peripheral blood flow was tested with a capillary microscopy, and vasospastic syndrome (VS) was diagnosed. Further studies on these patients revealed frequently weakened autoregulation of ocular blood flow and increased flow resistivity in retroocular vessels. Their retinal vessels were more rigid and irregular and responded less to flickering light. Holistic investigation demonstrated low blood pressure, silent myocardial ischaemia, altered beat-to-beat variation, altered gene expression in the lymphocytes, slightly increased plasma endothelin level and increased systemic oxidative stress. This combination of signs and symptoms was better described by the term primary vascular dysregulation (PVD) than by VS. Subsequent studies showed additional symptoms frequently related to PVD, such as low body mass index, cold extremities combined with slightly increased core temperature, prolonged sleep onset time, reduced feelings of thirst, increased sensitivity to smell and also for certain drugs and increased retinal venous pressure. To better characterise this entire syndrome, the term Flammer syndrome (FS) was introduced. Most subjects with FS were healthy. Nevertheless, FS seemed to increase the risk for certain eye diseases, particularly in younger patients. This included normal-tension glaucoma, anterior ischaemic optic neuropathy, retinal vein occlusions, Susac syndrome and central serous chorioretinopathy. Hereditary diseases, such as Leber’s optic neuropathy or retinitis pigmentosa, were also associated with FS, and FS symptoms and sings occurred more frequent in patients with multiple sclerosis or with acute hearing loss. Further research should lead to a more concise definition of FS, a precise diagnosis and tools for recognizing people at risk for associated diseases. This may ultimately lead to more efficient and more personalised treatment.

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Section: Retinal Venous Pressurementioning

confidence: 99%

The discovery of the Flammer syndrome: a historical and personal perspective

Flammer

Konieczka

2017

EPMA Journal

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“…Smoking reduces retinal blood flow, and the capacity of the retinal vessels to autoregulate to hyperoxia [109] more than doubles the levels of systemic oxidative stress in the body [3] (Fig. 6) and increases heart rate without affecting retinal venous pressure [4]. People with FS should take care to drink enough during the day as they tend to have a lack of thirst due to high levels of plasma endothelin-1 which upregulates the hormone prostaglandin E-2, thereby suppressing the centre of thirst in the brain [110].…”

Section: Lifestylementioning

confidence: 99%

“…Thus, the way an individual eats affects the health of their eyes. Many individuals, including those with the Flammer syndrome (FS) [1,2] are aware that their nutritional habits and lifestyle affect the health of their eyes, [3,4] but may not know what they should be eating to support their eye health. The term 'Flammer Syndrome' refers to a clinical entity comprising a complex of clinical features caused mainly by dysregulation of the blood supply which has previously been called vascular dysregulation [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

Nutritional recommendations for individuals with Flammer syndrome

et al. 2017

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The Flammer syndrome (FS) describes the phenotype of people with a predisposition for an altered reaction of the blood vessels to stimuli like coldness or emotional stress.The question whether such people should be treated is often discussed. On the one hand, most of these subjects are healthy; on the other hand, FS seems to predispose to certain eye diseases such as normal tension glaucoma or retinitis pigmentosa or systemic diseases such as multiple sclerosis or tinnitus. A compromise between doing nothing and a drug treatment is the adaption of nutrition. But what do we mean by healthy food consumption for subjects with FS? The adaption of nutrition depends on the health condition. Whereas patients with e.g. a metabolic syndrome should reduce their calorie intake, this can be counterproductive for subjects with FS, as most subjects with FS have already a low body mass index (BMI) and the lower the BMI the stronger the FS symptoms. Accordingly, while fasting is healthy e.g. for subjects with metabolic syndrome, fasting can even dangerously aggravate the vascular dysregulation, as it has been nicely demonstrated by the loss of retinal vascular regulation during fasting. To give another example, while reducing salt intake is recommended for subjects with systemic hypertensions, such a salt restriction can aggravate systemic hypotension and thereby indirectly also the vascular regulation in subjects with FS. This clearly demonstrates that such a preventive adaption of nutrition needs to be personalized.

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“…Verursachende Moleküle können aus dem Kreislauf via die fenestrierten Kapillaren der Chorioidea in die Umgebung der Papille diffundieren oder bei Hypoxie auch lokal gebildet werden [31]. Interessanterweise ist der retinale Venendruck bei FS höher [32], während er bei Rauchern nicht erhöht ist, sondern sogar eher tiefer ist [33]. Wir nehmen an, dass der Venendruck eben nicht nur aus mechanischen Gründen ansteigt, wie etwa erhöhter Hirndruck oder Veränderungen der Lamina cribrosa, sondern auch durch lokale funktionelle Kontraktionen der Venen [34], was im Extremfall bis zum klinischen Bild eines retinalen Venenverschlusses führen kann.…”

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Phänomenologie und klinische Bedeutung des Flammer-Syndroms

Konieczka

2016

Klin Monatsbl Augenheilkd

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The Flammer syndrome (FS) describes the phenotype of people with a predisposition for an altered reaction of the blood vessels to stimuli like coldness, emotional stress or high altitude. Frequent symptoms are: cold hands and/or feet, low blood pressure, prolonged sleep onset time, reduced feeling of thirst, increased sensitivity to odour, pain, vibration and certain drugs. SF subjects are often ambitious and successful but also perfectionistic and sometimes brooding. Frequent signs are: altered gene expression, prolonged blood flow cessation in nailfold capillaroscopy after cold provocation, reduced autoregulation of ocular blood flow, and reduced vasodilation after stimulation with flickering light. Retinal venous pressure is on the average higher and retinal astrocytes are more often activated. FS occurs more often in females than in males, in thin than in obese subjects, in young than in old people, in graduates than in blue collar workers, in subjects with indoor than outdoor jobs. Associated diseases are: normal tension glaucoma, occlusion of ocular vessels, retinitis pigmentosa, multiple sclerosis, tinnitus or even sudden hearing loss.

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Retinal venous pressure in chronic smokers

Cited by 5 publications

References 40 publications

The discovery of the Flammer syndrome: a historical and personal perspective

The discovery of the Flammer syndrome: a historical and personal perspective

Nutritional recommendations for individuals with Flammer syndrome

Phänomenologie und klinische Bedeutung des Flammer-Syndroms

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