The Hettinger hand vibration test, vasospasm, and glaucoma

Ocular vasospasm in response to local and/or systemic stimuli may contribute to ischemia of the optic nerve. The Hettinger hand vibration test was applied to patients with and without glaucoma to identify subgroups with a high systemic vasospastic tendency. A total of 580 subjects were tested (113 controls, 86 glaucoma suspects, 270 with primary open-angle glaucoma, 71 with secondary open-angle glaucoma, 30 with normal-tension glaucoma, and 10 with angle-closure glaucoma). The frequency distribution curve of Hettinger scores (HS) was bimodal, suggesting two distinct groups. Within each diagnostic group, a subpopulation with a high HS could be identified. Multivariate analysis demonstrated a significant association between the nonselective topical beta-blocker timolol and higher mean HS (P = 0.04) and a significantly higher proportion of subjects with HS of 1.5 or more (P = 0.01). Although subjects taking systemic beta1-selective blockers had significantly lower mean HS (P = 0.04), the proportion of patients with HS of 1.5 or more was not affected significantly by topical and systemic beta1-selective blocker use. Whereas topical nonselective beta-blockers may have an adverse effect on vasospastic tendency, systemic beta1-selective blockers may be partially protective against this effect.