Systemic diseases and glaucoma

Abstract

Although intraocular pressure is the most important risk factor in the development of and progression of glaucoma, non-pressure-related factors have been shown to play a significant role in influencing disease progression. Over the past three decades, peripheral vascular dysregulation (PVD) has emerged as one of the most important and controversial risk factors. Specifically, low perfusion pressure has been shown in some clinical trials such as the Barbados Eye Study to be associated with increased likelihood of visual field progression. Nocturnal hypotension occurring as a result of overdipping blood pressure has also been shown to be associated with increased risk of developing optic nerve damage. The latter may be especially important in the wake of sleep studies which have shown that nocturnal IOP is higher in the habitual supine position. In addition to vascular dysregulation and nocturnal hypotension, hypothyroidism, sleep apnea, diabetes, use of statin drugs, and diet lifestyle changes could also potentially influence optic nerve health in the glaucoma patient. At the moment, however, data linking glaucoma and sleep apnea are equivocal. On the other hand, recently published data shows a protective effect of statins with longer duration of use and dietary intake of antioxidants (retinol and vitamin B1), and omega 3 fatty acids were associated with lower risk of development of open-angle glaucoma.