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Editors Selection IGR 15-1

Ocular Blood Flow: Telemedicine

Comment by Leopold Schmetterer on:

51761 Relationship of systemic blood pressure with ocular perfusion pressure and intraocular pressure of glaucoma patients in telemedical home monitoring, Jürgens C; Grossjohann R; Tost FH, Medical Science Monitor, 2012; 18: MT85-9

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The present study was performed as part of the Teletonometry Mecklenburg– Vorpommern (TTMV) project. The authors report on measurements of diurnal blood pressure (systolic blood pressure = SBP, diastolic blood pressure = DBP in 70 patients with primary open–angle glaucoma. In addition, intraocular pressure was measured over 24 hours and the authors calculated ocular perfusion pressure (OPP) as OPP=[2/3*(2/3*DBP+1/3*SBP)]–IOP. The authors report that systolic and diastolic blood pressures as well as ocular perfusion pressure are lowest between 7 am and 12 am. Intraocular pressure was found to be lowest between 6 pm and 10 pm and OPP was accordingly highest during this period of the day. The authors conclude that the observed fluctuations in OPP strengthen the evidence that systemic blood pressure fundamentally influences ocular circulation and consequently glaucoma progression. This conclusion is not fully supported by the data. On the one hand the study lacks a control group. It would be required to have a group of age- and sex-matched control subjects and show that glaucoma patients have an increased diurnal variability. In addition, the authors have not measured any parameters of the ocular circulation making any conclusions on ocular perfusion problematic. Finally, conclusions regarding progression of glaucoma require a longitudinal approach. The relation between OPP and its fluctuation to the prevalence, incidence and progression of glaucoma is in principle relevant. One of the reasons is that abnormalities in OPP can in principle be treated although no adequate treatment regimen has been found until now. Indeed, studies have reported that glaucoma patients have reduced OPP and increased fluctuations in OPP. In addition, evidence has been provided that both reduced OPP and increased fluctuations in OPP are associated with progression of the disease. In addition, there is evidence from some small scale studies that also ocular perfusion shows increased variability in glaucoma patients. Due to the significant flaws of this study the results do, however, add little to this topic.

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