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Editors Selection IGR 9-2

Risk Factors: Retinal vascular narrowing

Comment by Andreas Boehm on:

22324 Evidence of retinal vascular narrowing in glaucomatous eyes in an Asian population, Amerasinghe N; Aung T; Cheung N et al., Investigative Ophthalmology and Visual Science, 2008; 49: 5397-5402

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Amerasinghe et al. (1493) showed in a study examining more than 3000 fundus photos of Malayan patients that retinal vascular narrowing is more present in patients with glaucoma compared to patients without glaucoma. The difference was still present after correcting for other factors which might contribute to vascular narrowing, e.g., age, sex, smoking, IOP, and other vascular risk factors. The presence of vascular narrowing was not linked to IOP. The reported presence of retinal vascular narrowing is consistent with earlier studies examining Asian patients. However, in Caucasian patients this link is not well established with conflicting results. Interestingly, the authors observed the same pattern of association in all glaucoma subtypes, e.g., POAG, NTG, and ACG. Narrower vessels were correlated to a larger c/d-ratio. The authors conclude that their data support the concept that vascular factors contribute to the glaucomatous optic neuropathy. However, it is still not clear whether these differences are primary (as a sign of an impaired perfusion) or secondary (caused by the RNFL loss). As all different glaucoma types showed the same pattern and narrower vessels were correlated to larger c/d-ratios it seems more likely that the vascular narrowing is a secondary effect of retinal nerve fiber loss. Longitudinal studies need to clarify whether patients with narrower vessels are more likely to develop glaucomatous damage.

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