The association of primary aldosteronism with glaucoma-related fundus abnormalities

Abstract

Purpose To elucidate glaucoma-related fundus abnormalities in patients with primary aldosteronism (PA). Methods The study compared 272 eyes from 137 PA patients and 352 eyes from 177 control subjects selected randomly from 1173 participants of a public glaucoma screening. The presence of glaucomatous optic disc appearance (rim thinning and cup enlargement) and retinal nerve fiber layer defects (RNFLDs) was determined independently from fundus photographs. The results were compared between the PA and control groups. Results There were 9 patients (6.6%) with glaucomatous optic disc abnormalities in the PA group and 10 cases (5.6%) identified in the control group (p = 0.92). RNFLDs were detected more frequently in the PA group (55 eyes, 20.2%) than in the control group (26 eyes, 7.4%; p<0.001). The two types of RNFLDs were classified as either having their central ends at the disc margin (D) or away from the disc margin and around the retinal vessels (V). Type D and V RNFLDs were detected in 35 (12.9%) and 26 (9.6%) eyes in the PA group and in 25 (7.1%) and 4 (1.1%) eyes in the control group, respectively. Both types of RNFLDs were more frequent in the PA group than in the control group (Type D and V, p = 0.03, <0.001, respectively). Conclusion Although the prevalence of glaucomatous optic disc appearance did not differ between the two groups, RNFLDs were more frequent in PA patients than in the control group. Moreover, RNFLDs with their central ends located around retinal vessels were characteristic of PA patients.

Genetic variation reveals the influence of steroid hormones on the risk of retinal neurodegenerative diseases

“…administered Aldo (40, 80, or 160 μg/kg/day) to rats and found that the RGC number was significantly reduced ( 49 ). Different from the animal experiment, compared with the control group, the patients with aldosteronism have no significant difference in their prognosis of glaucomatous optic disc appearance ( 11 ). Our MR results also found no causal relationship between aldosterone and glaucoma.…”

“…After systemic administration of Aldo, Nitta et al (10) found progressive loss of retinal ganglion cells (RGCs) without elevated intraocular pressure (IOP), which means that PA will increase the glaucoma risk. Ohshima et al compared 137 glaucoma patients with PA and 177 controls and found no difference in the prevalence of glaucoma optic disc appearance between the two groups (11). Hao et al found that E2 can protect RGCs under a high glucose environment through the mitochondrial pathway (12).…”

“…Ohshima et al. compared 137 glaucoma patients with PA and 177 controls and found no difference in the prevalence of glaucoma optic disc appearance between the two groups ( 11 ). Hao et al.…”

Mineralocorticoid pathway in retinal health and diseases

“…Preclinical evidence showed that ischaemic ganglion cell death is enhanced by mineralocorticoid receptor pathway activation, that aldosterone causes ganglion cell loss and that spironolactone prevents excitotoxic ganglion cell death. In addition, a recent study showed that retinal nerve fibre layer defects were more frequent in patients with primary aldosteronism than in controls (Ohshima et al, 2020).…”