This article is more than 5 years old. Information may no longer be current.
Cardiovascular disease may help speed glaucoma progression
Click Here to Manage Email Alerts
Cardiovascular disease is an important risk factor for rapid progression of glaucoma disease, regardless of IOP, according to a study.
Two cohorts of patients with glaucoma, respectively defined as rapid and non-rapid progressors based on the annual rate of visual field change (decline of mean deviation more or less than 1 dB/year), were retrospectively reviewed and compared to determine the demographic, intraocular and systemic risk factors potentially contributing to progression.
Looking at the clinical and visual field data of 11,254 eyes collected between 1991 and 2015, the authors of the study selected 54 eyes that satisfied the criteria for rapid progression. A total of 486 eyes were selected as non-rapid progressors for the control group.
Cardiovascular disease emerged as a highly significant risk factor for rapid progression. Patients with a cardiovascular history had double the chance to be rapid progressors as compared with controls.
This would confirm, according to the authors, the primary importance of the vascular component in the pathogenesis of glaucoma. Because patients with cardiovascular disease in the rapid progressors group had significantly lower baseline IOP than controls, cardiovascular disease appears to be a risk factor regardless of IOP.
“Our results support clinicians managing glaucoma taking a comprehensive past medical history and highlight the importance of optimizing cardiovascular risk factors so as to reduce the risk of rapidly progressive disease,” the authors concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
Back to Top
Derek MacDonald, OD, FAAO
Detecting disease progression is of paramount importance in the management of glaucoma. By carefully monitoring intraocular pressure with a focus on its stability and relationship to target IOP, assessing structure subjectively and objectively, and analyzing function by leveraging both 24- and 10-2 automated visual field strategies, clinicians can position themselves to recognize progression and appropriately intervene as early as possible.
In identifying cardiovascular disease as a risk factor for rapid disease progression irrespective of IOP, Chan and colleagues add to our evolving understanding of risk assessment both pre- and post-diagnosis. Given the unpredictable nature of glaucoma and the consequences of progression, vigilance is always warranted but heightened in the presence of these factors:
--older age
--African or Hispanic ethnicity (primary open angle glaucoma), Asian ethnicity (normal tension glaucoma and angle closure glaucoma)
--family history (first-degree relative)
--severe or rapidly progressing disease at presentation
--high myopia (POAG), high hyperopia (ACG)
--elevated and/or variable IOP
--thin central corneal thickness
--exfoliation (OAG)
--disc hemorrhages (NTG) and/or parapapillary atrophy
--low blood pressure, which may be due to aggressive treatment of hypertension
--longstanding diabetes
--vascular dysregulation (migraine, Raynaud’s phenomenon)
--sleep apnea
--cardiovascular disease
Ongoing risk assessment is a crucial step in detecting progression, which is the foundation of effective glaucoma management.
Click Here to Manage Email Alerts