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CVD an important risk factor for rapid glaucoma disease progression

21 Jul 2017

Glaucoma patients with cardiovascular disease (CVD) are at an increased risk of rapid disease progression compared with those who do not have the said condition, with progression occurring irrespective of intraocular pressure (IOP) control, according to a study.

Aimed at identifying the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors vs nonrapid disease progressors, the retrospective case control study included 48 rapidly progressing eyes (progression ≥1 dB mean deviation (MD)/year) and 486 nonrapidly progressing eyes (progression <1 dB MD/year). All patients had ≥5 Humphrey visual fields, and none showed an improvement in MD or had >5 dB MD variation in between visits. The patients did not present with obvious neurological fields.

Researchers collected and analysed clinical and demographic data (age, gender, central corneal thickness [CCT], IOP, refraction, medications), as well as medical, surgical and ocular histories. The main outcome investigated was risk factor differences between the cohorts using the independent t-test, Wald chi-squared and binomial regression analysis.

Compared with nonrapid progressors, rapid progressors were older and had significantly lower CCT and baseline IOPs. Rapid progressors were also more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes and IOP lowering surgery.

Of note, the rates of CVD and hypotension were significantly higher in the rapid progression vs nonrapid progression group. Patients with CVD were 2.33 times as likely as those without CVD to develop rapidly glaucoma progression despite significantly lower mean and baseline IOPs.

A leading cause of blindness worldwide, glaucoma has been increasingly shown to be associated with CV risk factors, migraine, vasospastic syndrome, optic disc haemorrhage, silent myocardial ischaemia, carotid artery stenosis and altered ocular haemodynamics. Previous studies have also documented vascular dysregulation of the CV system in glaucoma patients. [Arch Ophthalmol 2009;127:888-893]

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Elvira Manzano, 6 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
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