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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

     

    The Thessalonika study, in which Dr. Harris is an investigator, evaluated progression models for diastolic blood pressure as a continuous variable, and determined that low diastolic blood pressure and anti-hypertensive treatment are independently associated with the structure of the optic disc, he explained.

    However, they rethought their approach because of misinterpretations of the original data.

    More clinicaly relevant?

    “When we analyzed the data and stratified it by the level of blood pressure and treatment, we found that only in subjects with low diastolic blood pressure and treated with anti-hypertensive drugs that structure was associated with ocular perfusion pressure,” he said.

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    In the Thessalonika study, they hypothesized that the status of the perfusion pressure—that is, ocular perfusion pressure with or without anti-hypertensive treatment—may be more related to the pathogenesis of glaucoma than the ocular perfusion pressure by itself.

    “After subgroup analysis based on the status of the ocular perfusion pressure, we found that diastolic perfusion pressure was significantly associated with glaucoma in those treated with anti-hypertensive medications, and this was not the case in patients not treated with anti-hypertensive drugs,” Dr. Harris reported.

    This suggested that the perfusion pressure status may be more clinically relevant than just the level of the perfusion pressure. The findings were published in the American Journal of Ophthalmology (2013;155:843-51. doi: 10.1016/j.ajo.2012.12.007. Epub 2013 Feb 6).

    One explanation for this finding is related to the treated patients having more decreases in nocturnal blood pressure with consequent variations in the perfusion pressure. A second explanation is that the anti-hypertensive drugs may disrupt the ability of the blood vessels to autoregulate.

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    When conducting research in this area, he noted, it is difficult to isolate all factors that affect perfusion pressure and isolate their effect on the system. 

    “There are anatomic and physiologic variations among species and among individual patients,” Dr. Harris said.

    Next: Diving into the mathematical model

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