Blood pressure, perfusion pressure, and glaucoma

Area of Science:

• Ophthalmology
• Cardiovascular Physiology
• Vascular Biology

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Ocular blood flow and systemic blood pressure are implicated in glaucoma pathogenesis.
• Current understanding of ocular perfusion pressure's role in glaucoma is incomplete.

Purpose of the Study:

• To critically review the relationship between blood pressure, ocular blood flow, and glaucoma.
• To evaluate the potential for glaucoma treatment by modulating ocular perfusion.

Main Methods:

• Literature review of studies on blood pressure, ocular blood flow, and glaucoma.
• Expert opinion from glaucoma researchers and specialists.
• Group discussion on epidemiology, blood flow measurement, and cardiovascular physiology.

Main Results:

• Accurate measurement of optic nerve head blood flow remains challenging.
• Autoregulation of ocular blood flow occurs over a wide pressure range.
• Low ocular perfusion pressure and low blood pressure are associated with increased glaucoma risk.
• Vascular factors may be significant in normal-tension glaucoma and vasospasm.

Conclusions:

• Decreased perfusion pressure and blood pressure are linked to glaucoma.
• No current evidence supports increasing blood pressure as glaucoma therapy.
• Lack of knowledge on microvascular beds and measurement methods hinders treatment development.
• Cardiovascular safety concerns exist for therapies increasing ocular perfusion pressure.