title: Systemic and Ocular Hemodynamic Risk Factors in Glaucoma.
abstract: Primary open angle glaucoma (POAG) is a multifactorial disease characterized by progressive retinal ganglion cell death and visual field loss. It is known that alterations in intraocular pressure (IOP), blood pressure (BP), and ocular perfusion pressure (OPP) can play a significant role in the pathogenesis of the disease. Impaired autoregulatory capacity of ocular blood vessels may render tissues vulnerable to OPP changes and potentially harmful tissue ischemia-reperfusion damage. Vascular risk factors should be considered more important in a subgroup of patients with POAG, and especially in patients with normal tension glaucoma (NTG) with evidence of unphysiological BP response. For example, reduction of BP during the nighttime has an influence on OPP, and increased circadian OPP fluctuation, which might stand for unstable ocular blood flow, has been found to be the consistent risk factor for NTG development and progression. Central visual field may be affected more severely than peripheral visual field in NTG patients with higher 24-hour fluctuation of OPP. This review will discuss the current understanding of allegedly major systemic and ocular hemodynamic risk factors for glaucoma including systemic hypertension, arterial stiffness, antihypertensive medication, exaggerated nocturnal hypotension, OPP, and autonomic dysregulation.
authors.affiliation: Central Seoul Eye Center, 224 Ichon-ro, Yongsan-gu, Seoul 04427, Republic of Korea.
authors.forename: Jaewan
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Ophthalmology, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kook
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005902:Glaucoma, Open-Angle / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D057066:Low Tension Glaucoma / Q000503:physiopathology*; D012165:Retinal Ganglion Cells / Q000473:pathology; D012307:Risk Factors; D014794:Visual Fields / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents