Comparison of Primary Vascular Dysregulation in Normal Tension Glaucoma and Primary Open Angle Glaucoma

Wool Suh; Sung Chul Park; Chang Won Kee

doi:10.3341/jkos.2010.51.3.393

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Suh, Park, and Kee: Comparison of Primary Vascular Dysregulation in Normal Tension Glaucoma and Primary Open Angle Glaucoma

Original Article

J Korean Ophthalmol Soc 2010;51(3):393-400.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.393

Comparison of Primary Vascular Dysregulation in Normal Tension Glaucoma and Primary Open Angle Glaucoma

Wool Suh, MD, Sung Chul Park, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Chang Won Kee, MD, PhD Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center #50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3564, Fax: 82-2-3410-0074, E-mail: ckee@skku.edu

Received 27 July 2009 Accepted 2 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical symptoms or signs of primary vascular dysregulation (PVD) in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG).

Methods

From June 2008 to June 2009, we administered questionnaires to patients with glaucoma. The questionnaire was composed of 11 items, and the questionnaire results were compared between patients with NTG and POAG. NTG patients were subdivided by age(criterion: 55 years) and perimetric mean deviation (criterion: −6dB).

Results

We detected a significant increase in hypotension (p=0.036) in NTG patients (n=133), compared to POAG patients (n=68). Migraines and emotional stress were more frequent in younger patients (＜55 years) with NTG (46%, 71%, p=0.027) than in older patients (＞55 years) with NTG (27.5%, 42.9%, p=0001). The frequency of drug sensitivity and systemic vasospasm is higher in older patients with NTG (28.6%, 17.4%) than younger patients with NTG (12.9%, 4.9%) but the rate of systemic vasospasm is much higher in younger patients, compared to the prevalence in the general Korean population. In patients with moderate and advanced NTG, hypotension is highly prevalent (p=0.018).

Conclusions

Hypotension is a greater risk factor for NTG than for POAG. Indeed, vascular factors may be correlated with NTG, especially in younger patients with moderate, advanced visual field defects.

Keywords: Normal tension glaucoma, Primary open angle glaucoma, Primary vascular dysregulation

References

1. Flammer J, Orgül S, Costa VP, et al. The impact of ocular blood flow in glaucoma. Pro Retin Eye Res. 2002; 21:359–3.

2. Flammer J, Pache M, Resink T. Vasospasm, its role in the abdominal of disease with paticular reference to eye. Pro Retin Eye Res. 2001; 20:319–49.

3. Nicolela MT. Clinical clues of vascular dysregulation and its abdominal with glaucoma. Can J Ophthalmol. 2008; 43:337–41.

4. Levene RZ. Low tension glaucoma: a critical review and new material. Surv Ophthalmol. 1980; 24:621–4.

5. Leske MC, Wu SY, Hennis A, et al. Risk factors for incident open angle glaucoma: the Barbados Eye Studies. Ophthalmology. 2008; 115:85–93.

6. Graham SL, Drance SM, Wijsman K, et al. Ambulatory blood pressure monitoring in glaucoma. The nocturnal dip. Ophthalmology. 1995; 102:61–9.

7. Mayer JH, Brandi-Dohrn J, Funk J. Twenty four hour blood abdominal monitoring in normal tension glaucoma. Br J Ophthalmol. 1996; 80:864–7.

8. Bechetoille A, Bresson-Dumont H. Diurnal and nocturnal blood pressure drops in patients with focal ischemic glaucoma. Graefes Arch Clin Exp Ophthalmol. 1994; 232:675–9.

9. Drance SM. Some factors in the production of low tension glaucoma. Br J Ophthalmol. 1972; 56:229–42.

10. Drance SM, Sweeney VP, Morgan RW, Feldman F. Studies of abdominals involved in the production of low tension glaucoma. Arch Ophthalmol. 1973; 89:457–65.

11. Hayreh SS. The blood supply of the optic nerve head and the abdominal of it: myth and reality. Prog Retin Eye Res. 2001; 20:563–93.

12. Gherghel D, Orgul S, Gugleta K, et al. Relationship between abdominal perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage. Am J Ophthalmol. 2000; 130:597–605.

13. Sehi M, Flanagan JG, Zeng L, et al. Relative change in diurnal mean ocular perfusion pressure; a risk factor for the diagnosis of primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2005; 46:561–7.

14. Tielsch JM, Katz J, Sommer A, et al. Hypertension, perfusion pressure and primary open-angle glaucoma. A population-based assessment. Arch Ophthalmol. 1995; 113:216–21.

15. Bonomi L, Marchini G, Marraffa M, et al. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000; 107:1287–93.

16. Mitchell P, Lee AJ, Rochtchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: The Blue Mountain Eye Study. J Glaucoma. 2004; 13:319–26.

17. Orzalesi N, Rossetti L, Omboni S. OPTIME Study Group (Osservatorio sulla Patologia glaucomatosa, Indagine Medico Epidemiologica); CONPROSO (Collegio Nazionale dei Professori Ordinari di Scienze Oftalmologiche). Vascular risk factors in abdominal: the results of a national survey. Graefes Arch Clin Exp Ophthalmol. 2007; 245:795–802.

18. Usui T, Iwata K. Finger blood flow in patients with low tension glaucoma and primary open-angle glaucoma. Br J Ophthalmol. 1992; 76:2–4.

19. Drance SM, Douglas GR, Wijsman K, et al. Response of blood flow to warm and cold in normal and low-tension glaucoma patients. Am J Ophthalmol. 1988; 15(105):35–9.

20. Hafez AS, Bizzarro R, Descovich D, Lesk MR. Correlation abdominal finger blood flow and changes in optic nerve head blood flow following therapeutic intraocular pressure reduction. J Glaucoma. 2005; 14:448–54.

21. Fraenkel L. Raynaud's phenomenon: epidemiology and risk factors. Curr Rheumatol Rep. 2002; 4:123–8.

22. Orgül S, Flammer J. Headache in normal tension glaucoma patients. J Glaucoma. 1994; 3:292–5.

23. Lee TG, Chung KC, Choi JW. Prevalence of migraine in Korean adults: A nationwide survey. Korean Journal of Headache. 2000; 1:57–66.

24. Usui T, Iwata K, Shirakashi M, Abe H. Prevalence of migraine in low-tension glaucoma and primary open angle glaucoma in Japanese. Br J Ophthalmol. 1991; 75:224–6.

25. Kaiser HJ, Flammer J, Graf T, Stümpfig D. Systemic blood abdominal in glaucoma patients. Grafes Arch Clin Exp Ophthalnol. 1993; 231:677–80.

26. O'Brien E, Murphy J, Tyndall A, et al. Twenty four hour abdominal blood pressure in men and women aged 17 to 80 years; the Allied Irish Bank Study. J Hypertens. 1991; 9:355–60.

27. Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL. Nocturnal arterial hypotension and its role in optic nerve head abdominal disorders. Am J Ophthalmol. 1994; 117:603–24.

28. Kaiser HJ, Flammer J. Systemic hypotension; a risk factor for glaucomatous damage? Ophthalmologica. 1991; 203:105–8.

29. Zachariah PK, Krier J, Schwartz GL. Orthostatic hypotension and ambulatory blood pressure monitoring. J Hypertens. 1991; 9:S78–80.

30. Anderson DR. Normal Tension Glaucoma Study. Collaborative normal tension glaucoma study. Curr Opin Ophthalmol. 2003; 14:86–90.

31. Rojanapongpun P, Drance SM. The response of blood flow abdominal in the ophthalmic artery and blood flow of the finger to warm and cold stimuli in glaucomatous patients. Graefes Arch Clin Exp Ophthalmol. 1993; 231:375–7.

Figure 1.

Questionnaire about primary vascular dysregulation

Table 1.

Demographic comparisons between normal tension glaucoma (NTG) and primary open angle glaucoma (POAG)

	NTG	POAG	p-value
No of patients	133	68
Age (years)	54.8 ± 13.4	53.6 ± 15.3	>0.05
Gender (M:F)	69: 64	50: 18	<0.05
IOP^*	17.0 ± 2.73	27.1 ± 5.63	<0.05
Refraction (diopter)	–2.524 ± 2.703	–2.297 ± 2.564	>0.05
MD^† (dB)^‡	–8.138 ± 6.983	–9.854 ± 6.036	>0.05
PSD^§ (dB)	9.919 ± 4.835	10.776 ± 3.964	>0.05

^* IOP=intraocular pressure

^† MD=mean deviation

^‡ dB=decibel

^§ PSD=pattern standard deviation.

Table 2.

Comparsions of young g age and old age normal tension glaucoma

	Young age NTG (<55 yrs)	Old age NTG(≥55 yrs)	p-value
No of patients	63	70
Age(years)	43.4 ± 8.33	65.2 ± 7.31	<0.05
Gender (M:F)	36: 27	33: 37	>0.05
IOP^*	17.0 ± 3.0	17.0 ± 2.4	>0.05
Refraction (diopter)	–4.158 ± 2.458	–0.836 ± 1.742	<0.05
MD^† (dB)^‡	–6.413 ± 5.856	–9.712 ± 7.576	<0.05
PSD^§ (dB)	9.687 ± 5.201	10.135 ± 4.497	>0.05

^* IOP=intraocular pressure

^† MD=mean deviation

^‡ dB=decibel

^§ PSD=pattern standard deviation.

Table 3.

Comparisons of early and moderatae, advanced normal tension glaucoma

	Early NTG (MD<-6dB)	Moderate, advanced NTG (MD≥-6dB)	p-value
No of patients	68	65
Age (years)	50.6 ± 12.9	59.3 ± 12.4	>0.05
Gender (M:F)	35: 33	34: 31	>0.05
IOP^*	17.4 ± 2.6	16.5 ± 2.6	>0.05
Refraction (diopter)	–3.199 ± 2.763	–1.782 ± 2.448	<0.05
MD^† (dB)^‡	–2.800 ± 1.873	–13.640 ± 5.967	<0.05
PSD^§ (dB)	5.765 ± 2.728	13.367 ± 3.518	<0.05

^* IOP=intraocular pressure

^† MD=mean deviation

^‡ dB=decibel

^§ PSD=pattern standard deviation.

Table 4.

Comparisons of questionnaire between NTG and POAG (%)

	NTG^*	POAG^†	p-value
Cold hand	33.8	37.3	0.626
Thirst	46.6	47.8	0.878
Vertigo	21.8	24.2	0.699
Orthostatic hypotension	27.1	32.8	0.396
Sleep latency	40.2	39.4	0.918
Migraine	36.4	33.3	0.674
Hypertension	43.6	36.4	0.328
Hypotension	19.7	7.9	0.036^‡
Emotional stress	56.1	52.2	0.609
Drug sensitivity	21.2	17.6	0.550
Systemic vasospasm	14.6	7.5	0.146

^* NTG=normal tension glaucoma

^† POAG=primary open angle glaucoma

^‡ Chai square test p<0.05.

Table 5.

Comparisons of questionnaire between young and old age with NTG (%)

	Young age (＜55yrs)	Old age (≥55yrs)	p-value
Cold hand	33.3	34.3	0.908
Thirst	42.9	50.0	0.401
Vertigo	25.4	18.6	0.341
Orthostatic hypotension	30.2	24.3	0.447
Sleep latency	35.5	44.3	0.303
Migraine	46.0	27.5	0.027^*
Hypertension	44.4	42.9	0.854
Hypotension	14.3	24.6	0.135
Emotional stress	71.0	42.9	0.001^*
Drug sensitivity	12.9	28.6	0.028^*
Systemic vasospasm	4.9	17.4	0.030^*

^* Chai square test p<0.05.

Table 6.

Comparisons of questionnaire betw and moderate, advanced NTG (%)

	Early NTG a	Moderate, advanced NTG	G p-value
Cold hand	55.6	44.4	0.465
Thirst	43.5	56.5	0.102
Vertigo	41.4	58.6	0.235
Orthostatic hypotension	50.0	50.0	0.874
Sleep latency	45.3	54.7	0.303
Migraine	52.1	47.9	0.818
Hypertension	48.3	51.7	0.563
Hypotension	30.8	69.2	0.018^*
Emotional stress	55.4	44.6	0.228
Drug sensitivity	35.7	64.3	0.073
Systemic vasospasm	36.8	63.2	0.189

^* Chai square test p<0.05; NTG=normal tension glaucoma.

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