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Efficacy of antioxidants for oxidative stress may depend on age
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The relationship between oxidative stress and visual field loss may be strongest in relatively young patients with open-angle glaucoma, according to a study in the British Journal of Ophthalmology.
The prospective study of 251 consecutive Japanese patients who were previously diagnosed with bilateral open-angle glaucoma included 176 patients with normal tension glaucoma and 75 patients with primary open-angle glaucoma.
Subjects underwent a complete ophthalmic examination including best-corrected visual acuity, axial length, slit lamp biomicroscopy, gonioscopy, funduscopy, optical coherence tomography, retinal nerve fiber layer thickness and evaluation of the optic disc with a 90-D lens by a glaucoma specialist.
Researchers assessed systemic oxidative stress with skin autofluorescence (SAF), an indicator of advanced glycogen products, they wrote.
Researchers selected the youngest patients (58 years) and oldest patients ( 4 years) by quartile and determined the univariate correlation between SAF and mean deviation.
The younger subjects with open-angle glaucoma (OAG) with high SAF had significantly lower better-eye mean deviation than the younger subjects with normal SAF, but the older subjects had similar better-eye mean deviation regardless of SAF, according to researchers.
SAF was negatively correlated with mean deviation in the youngest subjects but not in the older ones.
The researchers suggest that they made the new finding that relatively young patients with OAG with high SAF had significantly lower mean deviation than similarly aged patients with normal SAF.
They said it has been suggested that oxidative stress levels may be risk factors for glaucoma, but these study results suggest that treatment with antioxidants may depends on the patient’s age.
“Although we found that SAF was a suitable biomarker for this study, owing to its association with systemic oxidative stress and with glaucoma severity, it remains unclear precisely how systemic oxidative stress is involved in glaucomatous optic neuropathy,” the researchers concluded. –by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
The presence of factors other than elevated intraocular pressure that contribute to glaucoma pathogenesis has always been recognized, but not fully understood.
IOP-independent factors include conditions that cause poor optic nerve perfusion from systemic abnormalities, such as low blood pressure, or poor localized perfusion from a dysfunctional autoregulation.
A third IOP independent factor may be conditions that disrupt the cellular environment of retinal ganglion cells (RGC). For instance, an inability to neutralize molecular free radicals (e.g., oxidative stress), either systemically or locally, could detrimentally alter RGC homeostasis. In this study, researchers analyzed the relationship between higher systemic oxidative stress and glaucoma.
Ultimately, clinicians are looking for alternative treatments for glaucoma that work on IOP-independent factors, as none currently exist. Recognizing and neutralizing oxidative stress would be a new treatment paradigm in glaucoma if and when its connection is validated.
It is always exciting to see researchers come up with new ways to discover the elusive IOP-independent factors that could be driving glaucoma degeneration for some of our patients. There is great progress occurring in research and we look forward to that translating into treatments that could be coupled with ocular hypotensive agents.
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