Vascular and autonomic dysregulation in primary open-angle glaucoma

Area of Science:

• Ophthalmology
• Cardiovascular Medicine
• Genetics

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• The role of intraocular pressure (IOP) in POAG pathogenesis is well-established, but other factors are increasingly recognized.
• Systemic vascular and autonomic dysfunction are potential contributors to POAG.

Purpose of the Study:

• To review the relationship between vascular dysfunction, autonomic dysfunction, and primary open-angle glaucoma (POAG).
• To determine if these dysfunctions are stratified by intraocular pressure (IOP) levels in POAG patients.

Main Methods:

• Literature review of studies investigating vascular and autonomic function in POAG.
• Analysis of genetic associations with POAG subtypes.
• Comparison of findings across different IOP levels (high-tension vs. normal-tension glaucoma).

Main Results:

• POAG patients exhibit ocular and nonocular vascular abnormalities.
• Genetic variations in NOS3 and CAV1/CAV2 are associated with POAG, potentially stratifying subtypes by sex or visual field loss pattern, not IOP.
• Cardiovascular autonomic dysfunction is present in both high-tension and normal-tension glaucoma, though its prevalence difference remains unclear.

Conclusions:

• POAG is a heterogeneous condition, and stratification by IOP may be less informative than other endophenotypic approaches.
• Recognizing systemic endothelial and autonomic dysfunction is crucial for a comprehensive understanding of POAG.
• Moving beyond an IOP-centric view may improve understanding of POAG pathogenesis and clinical management.