| Blood pressure, perfusion pressure, and glaucoma. | |
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MedLine Citation:
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PMID: 20399924 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To provide a critical review of the relationships between blood pressure, ocular blood flow, and glaucoma and the potential for glaucoma treatment through modulation of ocular perfusion. DESIGN: Summaries of the pertinent literature and input from glaucoma researchers and specialists with relevant experience. METHODS: Review and interpretation of selected literature and the results of a 1-day group discussion involving glaucoma researchers and specialists with expertise in epidemiology, blood flow measurements, and cardiovascular physiology. RESULTS: Accurate, reproducible, and clinically relevant measurements of blood flow within the optic nerve head and associated capillary beds are not fully achievable with current methodology. Autoregulation of blood flow in the retina and optic nerve head occurs over a large range of intraocular pressures and blood pressures. Regulation of choroidal blood flow is provided by a mix of neurohumoral and local mechanisms. Vascular factors may be important in a subgroup of patients with primary open-angle glaucoma, and particularly in patients with normal-tension glaucoma and evidence of vasospasm. Low ocular perfusion pressure and low blood pressure are associated with an increased risk of glaucoma in population-based studies. The physiologic nocturnal dip in blood pressure is protective against systemic end-organ damage, but its effects on glaucoma are not well elaborated or understood. Large-scale longitudinal studies would be required to evaluate the risk of glaucomatous progression in non-dippers, dippers, and extreme nocturnal blood pressure dippers. CONCLUSIONS: Decreases in perfusion pressure and blood pressure have been associated with glaucoma. However, there is no evidence to support the value of increasing a patient's blood pressure as therapy for glaucoma. Such recommendations are not currently warranted, since we lack crucial information about the microvascular beds in which perfusion is important in glaucoma, and the appropriate methods to evaluate their blood flow. There are also cardiovascular safety concerns associated with treatments designed to increase ocular perfusion pressure and blood flow by increasing blood pressure, especially in elderly patients. For these reasons and with present evidence it is unlikely that safe and effective glaucoma treatments based on altering optic nerve perfusion will soon be available. |
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Authors:
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Joseph Caprioli; Anne L Coleman; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: American journal of ophthalmology Volume: 149 ISSN: 1879-1891 ISO Abbreviation: Am. J. Ophthalmol. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-19 Completed Date: 2010-05-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370500 Medline TA: Am J Ophthalmol Country: United States |
Other Details:
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Languages: eng Pagination: 704-12 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. Caprioli@ucla.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Blood Pressure / physiology* Glaucoma, Open-Angle / physiopathology* Homeostasis Humans Intraocular Pressure / physiology* Ophthalmodynamometry Optic Disk / blood supply* Regional Blood Flow / physiology Retinal Artery / physiology* |
| Investigator | |
Investigator/Affiliation:
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Albert Alm / ; Arash Bereliani / ; Balwantray Chauhan / ; Paul Kaufman / ; Jeffrey Kiel / ; Theodore Krupin / ; Cristina Leske / ; Stuart McKinnon / ; Larry Wheeler / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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