The Hettinger hand vibration test, vasospasm, and glaucoma.
Ocular vasospasm in response to local and/or systemic stimuli may contribute to ischemia of the optic nerve. The Hettinger hand vibration test was applied to patients with and without glaucoma to identify subgroups with a high systemic vasospastic tendency. A total of 580 subjects were tested (113 controls, 86 glaucoma suspects, 270 with primary open-angle glaucoma, 71 with secondary open-angle glaucoma, 30 with normal-tension glaucoma, and 10 with angle-closure glaucoma). The frequency distribution curve of Hettinger scores (HS) was bimodal, suggesting two distinct groups. Within each diagnostic group, a subpopulation with a high HS could be identified. Multivariate analysis demonstrated a significant association between the nonselective topical beta-blocker timolol and higher mean HS (P = 0.04) and a significantly higher proportion of subjects with HS of 1.5 or more (P = 0.01). Although subjects taking systemic beta1-selective blockers had significantly lower mean HS (P = 0.04), the proportion of patients with HS of 1.5 or more was not affected significantly by topical and systemic beta1-selective blocker use. Whereas topical nonselective beta-blockers may have an adverse effect on vasospastic tendency, systemic beta1-selective blockers may be partially protective against this effect.
Department of Ophthalmology, and Sydney Eye Hospitals and Save Sight Institute, Sydney University, NSW, Australia.
I
I
Goldberg
E
E
Chai
A
A
Chia
C
C
Benscher
A
A
Bauman
J
J
Chen
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015784:Betaxolol / Q000627:therapeutic use; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006225:Hand; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D009898:Optic Disk / Q000098:blood supply; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015203:Reproducibility of Results; D012161:Retinal Artery / Q000187:drug effects / Q000503:physiopathology*; D012720:Severity of Illness Index; D013999:Timolol / Q000627:therapeutic use; D014661:Vasoconstriction / Q000187:drug effects; D014732:Vibration
D000319:Adrenergic beta-Antagonists; D009883:Ophthalmic Solutions; D013999:Timolol; D015784:Betaxolol