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Editors Selection IGR 9-4

Examination methods: Optic disc and bloodpressure

Comment by Felipe Medeiros on:

13973 Association of blood pressure status with the optic disk structure in non-glaucoma subjects: the Thessaloniki eye study, Topouzis F; Coleman AL; Harris A et al., American Journal of Ophthalmology, 2006; 142: 60-67

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Conflicting evidence exists with regards to the association between blood pressure and risk of developing glaucoma. Topouzis et al. (621) investigated the association between blood pressure status and optic disk structure in non-glaucomatous subjects as part of the Thessaloniki Eye Study, a cross-sectional population-based study conducted in Greece. A total of 232 non-glaucomatous subjects were imaged using the Heidelberg Retina Tomograph (HRT). The authors found that subjects with diastolic blood pressure (DBP) lower than 90 mmHg as a result of antihypertensive therapy had significantly thinner neuroretinal rim measurements and larger values of cup area compared to subjects with high DBP (≥90 mmHg) or to subjects with normal DBP levels that had not received antihypertensive treatment. They also found that a low perfusion pressure was significantly associated with increased cup area and thinner neuroretinal rim. Their findings are

Subjects with diastolic blood pressure (DBP) lower than 90 mmHg as a result of antihypertensive therapy had significantly thinner neuroretinal rim measurements and larger values of cup area compared to subjects with high DBP (?90 mmHg)

in agreement with previous studies that have reported an association between low blood pressure and increased prevalence and incidence of glaucoma. In the accompanying Editorial, Jost Jonas¹ speculates about the implications of the study by Topouzis et al. He argues that a low blood pressure could be related to a low cerebrospinal fluid (CSF) pressure which would result in an elevated translamina cribrosa pressure that could potentially be harmful to the optic nerve fibers. Although the study by Topouzis et al. may offer insight into the pathogenesis of glaucoma, several questions remain unanswered. Could different antihypertensive treatments produce different effects? Interestingly, a beneficial effect of angiotensin-converting enzyme (ACE) inhibitors in patients with normal tension glaucoma has been recently suggested by a small retrospective study.² It is also important to keep in mind the possible influence of antihypertensive medications on the optic nerve head vasculature and its effect on HRT measurements. As the HRT incorporates the area of blood vessels that lie above the reference plane as if they were part of the neuroretinal rim, changes in the caliber of blood vessels as a result of systemic antihypertensive treatment could potentially affect measurements of neuroretinal rim and cup areas. In conclusion, longitudinal studies are necessary to more clearly define the role of blood pressure in the pathogenesis of glaucoma.

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