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Editors Selection IGR 13-2

Diagnostic Methods: Fluorescein Angiography: Fluorecein leakage of the disc and IOP levels

Comment by Alon Harris on:

50373 Optic disc fluorescein leakage and intraocular pressure in primary open-angle glaucoma, Plange N; Bienert M; Remky A et al., Current Eye Research, 2012; 37: 508-512

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The physiological mechanisms involved in the development and progression of open-angle glaucoma (OAG) continue to be identified as heterogeneous in different patient populations while the treatment of OAG remains solely the reduction of intraocular pressure (IOP). To further advance treatment options, endpoint targets proven to be related to glaucoma pathology need further elucidation. Plange and associates contribute to this effort by investigating fluorescein leakage of the optic-nerve head in relation to IOP, visual-field defect, vertical cup-to-disc ratio, disc size and systemic blood pressure. The authors found increased fluorescein leakage of the optic disc was associated with higher IOP levels in patients with OAG. The authors suggest a link between vascular damage and increased permeability and uncontrolled IOP. The study was a pilot analysis involving 15 control subjects and 27 patients with OAG and, although the correlation of fluorescein leakage to IOP in patients with OAG was significant (p = 0.029), the strength of the correlation was not high (r = 0.42). The addition of more patients and especially controls may strengthen these findings as it would allow for a larger spread of IOP values to be considered, especially in the control group. Despite these limitations, the findings are well presented and the utilization of a scanning laser ophthalmoscope produces exceptional blood vessel detail. The data suggest that IOP and vascular events are not always mutually exclusive and as more emphasis is placed on vascular deficits in glaucoma, studies such as these are welcome discussion points for direction of future investigations. One final consideration for future investigations would be exploring the gender and racial differences in fluorescein leakage of the optic-nerve head as we continue to uncover glaucomatous risk may differ in various OAG patient populations.

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