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Editors Selection IGR 9-4

Clinical forms of glaucoma: Exfoliation syndrome and cardiovascular dysfunction

Robert Ritch
Zaher Sbeity

Comment by Robert Ritch & Zaher Sbeity on:

20847 Decreased Cardiovagal Regulation in Exfoliation Syndrome, Visontai Z; Horváth T; Kollai M et al., Journal of Glaucoma, 2008; 17: 133-138


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Not only is exfoliation syndrome (XFS) the most common identifiable cause of open-angle glaucoma worldwide, but there is increasing evidence that it is much more than just a cause of glaucoma. Exfoliative glaucoma, prognostically more severe than POAG and proportionally more frequently a cause of blindness, is still just one ocular manifestation of a protean systemic disorder, the implications and ramifications of which have yet to be defined. Systemic vascular alterations are increasingly associated with XFS. These include reduced ocular, retrobulbar, and cerebral blood flow,1-3 alterations in carotid artery function and parasympathetic vascular control,4 reduced middle cerebral artery flow velocity,5 and coronary artery disease.6 Parasympathetic cardiovascular regulation, baroreflex sensitivity (BRS), and pulse wave velocity (PWV) are important clinical markers for assessing risks for cardiovascular events, which could have an important impact on mortality and quality of life. In an earlier study, Visontai et al.4 showed increased carotid artery stiffness, elevated homocysteine levels, and decreased BRS in XFS/XFG patients, suggesting large artery dysfunction and altered parasympathetic vascular control. In the current study, Visontai et al. (285) investigated the clinical significance of cardiovascular dysfunction by evaluating heart rate variability, BRS, and aortic PWV in 27 XFS/XFG patients and 20 controls with or without open angle glaucoma. Both groups were matched by age, sex, and systemic vascular diseases. The heart rate indices and the BRS were all significantly lower in the XFS group than for the controls. The PWV was significantly greater in the XFS group than in the control group, suggesting decreased cardiovascular regulation. This study, despite the relatively small number of subjects analyzed, provides for the first time information on the clinical severity of cardiovagal impairment and conduit vessel dysfunction in XFS. Further prospective studies are needed to explore whether or not decreased BRS and HRV can serve as predictors for poor cardiovascular prognosis in patients with XFS.

References

  1. Yüksel N, Anik Y, Kilic A, Karabas V, Demirci A, Caglar Y. Cerebrovascular blood flow velocities in pseudoexfoliation. Graefes Arch Clin Exp Ophthalmol 2006; 244: 316-321.
  2. Yüksel N, Karabas VL, Arslan A, et al. Ocular hemodynamics in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Ophthalmology 2001; 108: 1043-1049.
  3. Galassi F, Giambene B, Menchini U. Ocular perfusion pressure and retrobulbar haemodynamics in pseudoexfoliative glaucoma. Graefe's Arch Clin Exp Ophthalmol 2008; 246: 411-416.
  4. Visontai Z, Merisch BM, Kollai M, Hollo G. Increase of carotid artery stiffness and decrease of baroreflex sensitivity in exfoliation syndrome and glaucoma. Br J Ophthalmol 2006; 90: 360-367.
  5. Akarsu C, Unal B. Cerebral haemodynamics in patients with pseudoexfoliation glaucoma. Eye 2005.
  6. Citirik M, Acaroglu G, Batman C, Yildiran L, Zilelioglu O. A possible link between the pseudoexfoliation syndrome and coronary artery disease. Eye 2007; 21: 11-15.
     

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