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Editors Selection IGR 8-1

Examination methods: CCT

Comment by Douglas Anderson on:

11740 Central corneal thickness and vascular risk factors in normal tension glaucoma, Doyle A; Bensaid A; Lachkar Y, Acta Ophthalmologica Scandinavica, 2005; 83: 191-195

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Doyle et al. (29) reviewed retrospectively the records of 54 patients with normal-tension glaucoma (NTG) and 54 patients with primary open angle glaucoma (POAG), that is, glaucoma associated with an abnormal intraocular pressure (IOP). They confirmed that on the average corneas were thinner in the group with NTG (528 &plm; 31 μm) than in those with POAG (549 &plm; 34 μm), as might be expected if some patients in the NTG group had abnormal IOPs and some in the POAG group had normal IOP, because of tonometer errors produced by deviations from the average central corneal thickness. The NTG group was further studied for presence (or absence) of vascular risk factors, yielding four cases with migraine, five with Raynaud's syndrome, two with both migraine and Raynaud's syndrome, and two with history of nocturnal hypotension (Total of 13 among 54 cases of NTG). (By way of comparison, among 54 cases in the POAG group, there were 3 cases with vascular disease, one each of Raynaud's syndrome, nocturnal hypotension, and a blood transfusion.) Those with such risk factors in the NTG group had thinner corneas (512 &plm; 31 μm, n = 13) than those without vascular risk factors (533 + 31 μm, n = 41), p = 0.034. In keeping with this, nine of 22 (40.9%) of NTG patients with corneas thinner than 520 μm had vascular risk factors, while 4 of the 32 with thicker corneas had vascular risk factors (12.5%, p < 0.05%). The association of thin corneas and vascular disease was unexpected and mystified the authors, who could only speculate that vasospastic disease might produce thinner corneas, or that thinner corneas indicate weaker connective tissue in the lamina cribrosa (and blood vessel adventitia?).

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