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    Unraveling the complex role of perfusion pressure in glaucoma progression

    Pressure rate under closer scrutiny since investigation began into the disease’s causes

    Bloomington, IN—The understanding of the etiology of glaucoma has come a long way since the time that IOP was considered the sole determinant of glaucomatous damage. 

    Investigators currently are on the threshold of uncovering the complex relationships in the eye that govern the development and progression of glaucoma.

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    Perfusion pressure is another factor that has recently began to come under closer scrutiny. In the eye, according to Alon Harris, MS, PhD, FARVO, ocular perfusion pressure can be calculated by the formula 2/3 of the mean arterial pressure minus the IOP.

    “The difference between IOP and blood pressure is critical when talking about the driving force of the perfusion pressure,” said Dr. Harris, director of clinical research, Lois Letzter professor of ophthalmology, professor of Ccellular and integrative physiology, within the department of ophthalmology, at Indiana University School of Medicine, Bloomington, IN.

    Dr. Harris discussed the relationship among different variables that affect the perfusion pressure, specifically the IOP, blood pressure, and the combination of the two, the weight of each variable, and whether it the same across the entire IOP spectrum.

    “These are important clinical questions,” he said.

    Evaluation

    Dr. Harris and his colleagues have embarked upon development and evaluation of mathematical models to answer questions about the relevance of these factors in the development and progression of glaucoma.

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    He pointed out that numerous studies have suggested that low diastolic perfusion pressure is an important risk factor for the prevalence of glaucoma, beginning with the Baltimore study up to the recent South India study. Some, such as the Barbados Eye study and the Rotterdam study, have suggested that perfusion pressure is a risk factor for the glaucoma incidence and progression. While other studies, such as the Early Manifest Glaucoma study, have suggested that the perfusion pressure is an important factor in glaucoma progression.

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