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    Ocular perfusion pressure, cerebrospinal fluid pressure: New players in glaucoma


    CSF pressure

    Lower CSF pressure is another potential risk factor that should be considered regarding its effect on the eye. It was reported as a risk factor for normal tension glaucoma in a Chinese study.

    “In the eye, the IOP pushes against the laminar cribrosa and causes distortion,” Dr. Liebmann explained. “In the presence of low CSF pressure, there is counterbalancing force and the deformation is worsened, even at the same level of IOP. These factors could be potential targets of study in the future.”

    Lower BP and OPP are associated with a higher glaucoma prevalence, Dr. Liebmann said. Overtreatment of systemic BP should be avoided. Nocturnal hypotension can be deleterious to glaucoma. OPP should be a consideration during the evaluation of glaucoma patients.

    “Careful patient histories regarding the presence and treatment of hypotension are needed and it should be determined if patients take pressure-lowering medications at night and if the hypertensive treatment is appropriate,” Dr. Liebmann pointed out. “The use of certain glaucoma medications, such as topical beta-blockers, should be minimized at night for less impact on the cardiovascular system.”

    Jeffrey M. Liebmann, MD

    e. [email protected]

    This article was adapted from a presentation that Dr. Liebmann delivered at the Precision Ophthalmology 2016 meeting. He has no financial interest in any aspect of this report.

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