Purpose: The aim of this study was to examine ocular blood flow parameters that may predict structural and functional disease progression in open-angle glaucoma (OAG) patients of different diabetic status, gender, ethnicity, and body mass index (BMI).
Methods: One hundred twelve patients with OAG were assessed for systemic blood pressure (BP), ocular perfusion pressure (OPP), retrobulbar blood flow, capillary blood flow, and optic nerve head morphology at baseline and every six months for a five-year period. Structural progression was monitored with optical coherence tomography and Heidelberg retinal tomography-III. Functional disease progression was monitored with automated perimetry using Humphrey visual fields. Factors associated with OAG structural and functional progression were analyzed using Cox proportional hazards models.
Results: The following were associated with shorter time to structural progression: In diabetic patients, larger area of avascular space; in males, lower central retinal artery peak systolic velocity and end diastolic velocity; in patients of African descent, higher systolic BP and OPP; in obese patients, lower ophthalmic artery end diastolic velocity. The following were associated with shorter time to functional progression: In diabetic patients, cup area, cup volume, cup/disc area ratio, linear cup/disc ratio, mean cup depth, cup shape; in males, systolic BP, diastolic BP, mean arterial pressure, systolic PP, diastolic PP, OPP, mean PP; in overweight patients, higher ophthalmic artery and central retinal artery resistive indices; in obese patients, lower central retinal artery resistive index.
Conclusions: Structural and functional OAG disease progression may be influenced differently in patients based on diabetic status, gender, ethnicity, and BMI. Mathematical modeling of risk variables that takes into account demographic characteristics may assist in better identifying OAG progression risk.
Cook C, Foster P. Epidemiology of glaucoma: What’s new? Can J Ophthalmol. 2012;47(3): 223-226.
Grewe R. The history of glaucoma. Klin Monbl Augenheilkd. 1986;188(2): 167-169.
Leske CM, Heijl A, Hyman L et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114(11): 1965-1972.
Suzuki Y, Shirato S, Adachi M, Hamada C. Risk factors for the progression of treated primary open-angle glaucoma: a multivariate life-table analysis. Graefes Arch Clin Exp Ophthalmol. 1999;237(6):463-467.
Drance S, Anderson DR, Schulzer M, Collaborative Normal-Tension Glaucoma Study G. Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol. 2001;131(6):699-708.
Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120(6):714-720.
Harris A, Siesky B, Wirostko B. Cerebral blood flow in glaucoma patients. J Glaucoma. 2013;22(5): S46-S48.
Friedman DS, Wolfs RC, O’Colmain BJ, et al. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol 2004;122:532-538.
Hyman L, Wu SY, Connell AM, et al. Prevalence and causes of visual impairment in the Barbados Eye Study. Ophthalmology 2001;108:1751-1756.
Mitchell P, Smith W, Chey T, Healey PR. Open angle glaucoma and diabetes: the Blue Mountains eye study, Australia. Ophthalmology. 1997;104:712-718.
Chopra V, Varma R, Francis BA, Wu J, Torres M, Azen SP. Type 2 diabetes mellitus and the risk of open-angle glaucoma: the Los Angeles Latino Eye Study. Ophthalmology. 2008;115: 227-232.
Tielsch JM, Katz J, Quigley HA, Javitt JC, Sommer A. Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey. Ophthalmology. 1995;102: 48-53.
De Voogd S, Ikram MK, Wolfs RC, Jansonius NM, Witteman JC, Hofman A, de Jong PT. Is diabetes mellitus a risk factor for open-angle glaucoma? The Rotterdam Study. Ophthalmology, 2006;113(10): 1827-1831.
Xu L, Xie XW, Wang YX, Jonas JB. Ocular and systemic factors associated with diabetes mellitus in the adult population in rural and urban China. The Beijing Eye Study. Eye (Lond), 2009;23(3): 676-682.
Tan GS, Wong TY, Fong CW, Aung T. Diabetes, metabolic abnormalities, and glaucoma. Singapore Malay Eye Study. Arch Ophthalmol, 2009;127(10): 1354-1361.
Lee H, Harris A, Siesky B, Schaab T, McIntyre N, Tobe LA, Ling J. The influence of retinal blood flow on open-angle glaucoma in patients with and without diabetes. Eur J Ophthalmol, 2014;24(4): 542-549.
Shoshani Y, Harris A, Shoja MM, Arieli Y, Ehrlich R, Primus S, Ciulla T, Cantor A, Wirostko B, Siesky BA. Impaired ocular blood flow regulation in patients with open-angle glaucoma and diabetes. Clin Experiment Ophthalmol, 2012;40(7): 697-705.
Yanagida K, Iwase T, Yamamoto K, Ra E, Kaneko H, Murotani K, Matsui S, Terasaki H. Sex-related differences in ocular blood flow of healthy subjects using laser speckle flowgraphy. Invest Ophthalmol Vis Sci. 2015;56(8):4880-4890.
Marianovic I, Marianovic M, Gvozdenovic R, Risovic D. Retrobulbar hemodynamic parameters in men and women with open angle glaucoma. Vojnosanit Pregl, 2014;71(12): 1128-1131.
Tobe LA, Harris A, Trinidad J, Chandrasekhar K, Cantor A, Abrams J, Amireskandari A, Siesky B. Should men and women be managed differently in glaucoma? Ophthalmol Ther, 2012;1(1):1.
Huck A, Harris A, Siesky B, Kim N, Muchnik M, Kanakamedala P, Amireskandari A, Tobe LA. Vascular considerations in glaucoma patients of African and European descent. Acta Ophthalmol, 2014;92(5): e336-e340.
Girkin CA, Sample PA, Liebmann JM, Jain S, Bowd C, Becerra LM, Medeiros FA, Racette L, Dirkes KA, Weinreb RN, Zangwill LM. African Descent and Glaucoma Evaluation Study (ADAGES): II. Ancestry differences in optic disc, retinal nerve fiber layer, and macular structure in healthy subjects. Arch Ophthalmol, 2010;128(5): 541-550.
Schroeder A, Harris A, Siesky BA, Tobe LA, Kim NJ, Amireskandari A, Marek MB, Racette L, Eckert GJ, Tyring A. Retinal nerve fiber layer thickness is correlated to retrobulbar blood flow in glaucoma patients of African descent. Annual Meeting of the Association for Research in Vision and Ophthalmology; 2013. Program 442, Abstract D0182.
Tobe LA, Harris A, Siesky BA, Racette L, WuDunn D, Amireskandari A, Kim NJ, Huck HA, Tyring A, Zalish M. Changes in retinal blood flow are strongly correlated to changes in optic nerve head morphology in patients of African descent. Annual Meeting of the Association for Research in Vision and Ophthalmology; 2013. Program 4443, Abstract D0183.
Ngo S, Harris A, Siesky BA, Schroeder A, Eckert G, Holland S. Blood pressure, ocular perfusion pressure, and body mass index in glaucoma patients. Eur J Ophthalmol, 2013;23(5): 664-669.
Geloneck MM, Crowell EL, Wilson EB, Synder BE, Chuang AZ, Baker LA, Bell NP, Feldman RM. Correlation between intraocular pressure and body mass index in the seated and supine positions. J Glaucoma, 2015;24(2): 130-134.
Wang YX, Xu L, Zhang XH, You QS, Zhao L, Jonas JB. Five-year change in intraocular pressure associated with changes in arterial blood pressure and body mass index. The Beijing eye study. PLoS One, 2013;8(10): e77180.
Karadag R, Arslanyilmaz Z, Aydin B, Hepsen IF. Effects of body mass index on intraocular pressure and ocular pulse amplitude. Int J Ophthalmol, 2012;5(5): 605-608.
Wygnanski-Jaffe T, Bieran I, Tekes-Manova D, Morad Y, Ashkenazi I, Mezer E. Metabolic syndrome: a risk factor for high intraocular pressure in the Israeli population. Int J Ophthalmol, 2015;8(2): 403-406.
Yoshida M, Ishikawa M, Karita K, Kokaze A, Harada M, Take S, Ohno H. Association of blood pressure and body mass index with intraocular pressure in middle-aged and older Japanese residents: a cross-sectional and longitudinal study. Acta Med Okayama, 2014;68(1): 27-34.
Berdahl JP, Fleischman D, Zaydlarova J, Stinnett S, Allingham RR, Fautsch MP. Body Mass Index Has a Linear Relationship with Cerebrospinal Fluid Pressure. Invest Ophthalmol Vis Sci. 2012;53(3):1422-1427.
Zheng Y, Cheung CY, Wong TY, Mitchell P, Aung T. Influence of height, weight, and body mass index on optic disc parameters. Invest Ophthalmol Vis Sci, 2010;51(6): 2998-3002.
Harris A, Guidoboni G, Arciero JC, Amireskandari A, Tobe LA, Siesky BA. Ocular hemodynamics and glaucoma: the role of mathematical modeling. Eur J Ophthalmol, 2013;23(2): 139-146.