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Editors Selection IGR 12-1

Clinical Forms of Glaucoma: Normal Tension Glaucoma

Comment by Alon Harris on:

51244 Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma: The Vascular Perspective, Mroczkowska S; Benavente-Perez A; Negi A et al., Archives of Ophthalmology, 2012; 0: 1-8

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Ocular blood flow abnormalities have been long associated with primary open-angle glaucoma (POAG), although their primary or secondary status to elevated intraocular pressure (IOP) remains in debate. Mroczkowska and colleagues contribute to this concept in their analysis of ocular and systemic vascular function in patients with newly-diagnosed and previously untreated POAG vs. normal-tension glaucoma (NTG), both with comparable early-stage functional loss. The authors found patients with POAG and NTG both exhibited similarly increased nocturnal systemic blood pressure variability, peripheral arterial stiffness, carotid intima-media thickness, and reduced ocular perfusion pressure compared to healthy controls. Both glaucoma groups also exhibited steeper retinal arterial constriction slopes and increased fluctuation in arterial and venous baseline diameter, suggesting similar alterations in both ocular and systemic circulations in the early stages of their disease process. The study is well designed with ambulatory blood pressure recordings over the 24-hour period to capture diurnal and nocturnal fluctuations, as well as multiple vascular tissue bed assessments. Statistically similar (p > 0.05) age, blood pressure, body-mass index and visual field outcomes further strength the comparisons between groups. One limitation of the current data, which the authors acknowledge, is a lack of 24-hour ocular perfusion pressure readings, as IOP assessment was not collected during the entire period. Furthermore, the study does not identify the contribution of these vascular deficits to glaucomatous progression, which remains largely underreported in both POAG and NTG patients. Mroczkowska and colleagues are therefore encouraged to follow up with these patients over a longitudinal period, to clarify if their vascular abnormalities, both systemic and localized, contribute to their disease progression.

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