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Editors Selection IGR 17-3

Glaucoma and Systemic Diseases: Vascular Diseases and Glaucoma

Comment by Ingeborg Stalmans & Luís Abegão Pinto on:

73417 Vascular and metabolic comorbidities in open-angle glaucoma with low- and high-teen intraocular pressure: a cross-sectional study from South Korea, Lee SH; Kim GA; Lee W et al., Acta Ophthalmologica, 2017; 95: e564-e574

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Understanding why glaucoma develops in patients with otherwise normal intraocular pressure (IOP) has been the focus of research for decades now. While vascular-related variables have long been associated with disease, data from epidemiological studies has been scarce in providing evidence for this relationship (and hopefully determining how those parameters affect the disease).

Lee et al. have presented a cross-sectional study, resorting to subjects from a Korean National Health Survey (2008-2012). Patients had undergone a detailed ophthalmological examination, including fundus picture, two IOP measure-ments and a Frequency Doubling Technology (FDT), from which a Glaucoma diagnosis was retrieved. In addition to demographic parameters, systemic parameters such as blood pressure, diabetes mellitus and cholesterol levels as well as vascular-related symptoms such as migraine or Raynaud were registered. With over 14.000 subjects included, one interesting feature of the study was the stratification of glaucoma patients by IOP (between high teens and low teens). Their multivariate analysis suggested that unlike their higher IOP counterparts, glaucoma patients with IOP < 15mmHg were positively associated with arterial hypertension, hyperlipidemia, ischemic heart conditions and stroke. Interestingly, this study could not determine whether DM was in fact related to glaucoma or not, possibly as a number of confounding factors exist in understanding the complex relation between Diabetic induced vascular problems and this neurodegenerative disease. In spite of some limitations inherent to these type of cross sectional studies, this paper provides further support the concept of an underlying vascular phenotype in these patients who develop glaucoma despite an apparent low IOP status.

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