title: Coexistence of macro- and micro-vascular abnormalities in newly diagnosed normal tension glaucoma patients.
abstract: OBJECTIVE
  To investigate the coexistence of ocular microvascular and systemic macrovascular abnormalities in early stage, newly diagnosed and previously untreated normal tension glaucoma patients (NTG).
  
  
  METHODS
  Retinal vascular reactivity to flickering light was assessed in 19 NTG and 28 age-matched controls by means of dynamic retinal vessel analysis (IMEDOS GmbH, Jena, Germany). Using a newly developed computational model, the entire dynamic vascular response profile to flicker light was imaged and used for analysis. In addition, assessments of carotid intima-media thickness (IMT) and pulse wave analysis (PWA) were conducted on all participants, along with blood pressure (BP) measurements and blood analyses for lipid metabolism markers.
  
  
  RESULTS
  Patients with NTG demonstrated an increased right and left carotid IMT (p = 0.015, p = 0.045) and an elevated PWA augmentation index (p = 0.017) in comparison with healthy controls, along with an enhanced retinal arterial constriction response (p = 0.028), a steeper retinal arterial constriction slope (p = 0.031) and a reduced retinal venous dilation response (p = 0.026) following flicker light stimulation.
  
  
  CONCLUSIONS
  Early stage, newly diagnosed, NTG patients showed signs of subclinical vascular abnormalities at both macro- and micro-vascular levels, highlighting the need to consider multi-level circulation-related pathologies in the development and progression of this type of glaucoma.
authors.affiliation: Vascular Research Laboratory, Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mroczkowska
authors.forename: Aniko
authors.initials: A
authors.lastname: Ekart
authors.forename: Velota
authors.initials: V
authors.lastname: Sung
authors.forename: Anil
authors.initials: A
authors.lastname: Negi
authors.forename: Lu
authors.initials: L
authors.lastname: Qin
authors.forename: Sunni R
authors.initials: SR
authors.lastname: Patel
authors.forename: Sarita
authors.initials: S
authors.lastname: Jacob
authors.forename: Carole
authors.initials: C
authors.lastname: Atkins
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benavente-Perez
authors.forename: Doina
authors.initials: D
authors.lastname: Gherghel
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002343:Carotid Artery, Internal / Q000473:pathology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D050356:Lipid Metabolism; D057066:Low Tension Glaucoma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012171:Retinal Vessels / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology