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Editors Selection IGR 19-3
Blood Flow Measurements: Perfusion pressure and increased risk of OAG
Comment by George Lambrou on:
47070 Perfusion pressure in glaucoma, Founti P; Topouzis F, Expert Review of Ophthalmology, 2011; 6: 339-346
The decades-old hypothesis that low-perfusion pressure (PP) is one of the villains in glaucoma pathogenesis, while never formally proven, has been gathering increasing evidence from large epidemiologic studies over the years. It is true that various problems have contrib- uted to our limited understanding of the exact role of this variable so far, including limitations in the definition of PP, inconsistent criteria for 'high' versus 'low' PP in the various studies and the fact that IOP probably acts both as a component of PP and as a risk factor in itself. However, the consistent association between low PP and glaucoma shows beyond a shadow of a doubt that this is a parameter to be further studied and taken into consideration in the future to improve visual outcomes for our patients. In their expert-review article, Founti and Topouzis (1374) are taking a deep dive into the accumulated evidence, and provide a useful synthesis of the learnings so far, finishing with a five-year outlook into the areas that need to be further explored so that the issue may move from the realm of scientific and academic interest into the 'real world' of patient management. They report the evidence from cross-sectional as well as longitudinal studies, review the complexities of PP definition, speculate on the individual role of Blood Pressure and IOP (the only clinically measurable parameters from which we can infer PP), discuss confounding factors of the PP-glaucoma relation and outline the areas of further research that needs to be undertaken.
Is adjustment of systemic hypertensive treatment justified in specific patient subpopulations?
Probably the most important question that will need to be explored is whether adjustment of systemic anti-hypertensive treatment is justified in specific patient subpopulations (such as extreme sleep BP dippers) knowing that the potential benefit for glaucoma is speculative, whereas the risks of high BP are well-established. This question, as well as the overall role of ocular perfusion pressure in development and progression of glaucoma can only be elucidated, as the authors conclude, through carefully designed, large and long-term randomized clinical trials.
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