Should Men and Women be Managed Differently in Glaucoma?

Area of Science:

• Ophthalmology
• Vascular Biology
• Glaucoma Research

Background:

• Primary open angle glaucoma (OAG) is a leading cause of irreversible blindness.
• Understanding the role of ocular hemodynamics in OAG pathogenesis is crucial for developing effective treatments.
• Previous studies have suggested potential sex-based differences in glaucoma, but specific associations with ocular perfusion pressure (OPP) and blood flow remain unclear.

Purpose of the Study:

• To investigate and compare the associations between ocular perfusion pressure (OPP) and retinal/retrobulbar blood flow in male and female patients diagnosed with primary open angle glaucoma (OAG).
• To explore potential sex-specific differences in vascular autoregulation mechanisms within the ocular system of OAG patients.

Main Methods:

• The study included 116 patients with OAG (mean age 66.9 years, 70% female) from the Indianapolis Glaucoma Progression Study.
• Ocular perfusion pressure (OPP), retinal microcirculation (peripapillary capillary blood flow), and retrobulbar blood flow (ophthalmic artery, central retinal artery, ciliary arteries) were assessed.
• Confocal scanning laser Doppler flowmetry and Color Doppler imaging were utilized, followed by bivariate Spearman correlation and multivariate linear regression analyses.

Main Results:

• A positive association was observed between retinal capillary blood flow and OPP in female OAG patients.
• In male OAG patients, a negative association was found between retinal blood flow and OPP.
• While retrobulbar blood flow showed no significant association with OPP in males, associations were found between ophthalmic artery and temporal posterior ciliary artery peak systolic velocities and OPP in females.

Conclusions:

• Significant sex-based differences exist in the relationship between retinal microcirculation and ocular perfusion pressure (OPP) among patients with primary open angle glaucoma (OAG).
• These findings indicate that male and female OAG patients may exhibit distinct vascular autoregulation strategies in response to changes in OPP.
• Further research is warranted to elucidate the clinical implications of these sex-specific hemodynamic differences in OAG management.