An evaluation of anticoagulation in glaucoma therapy

Area of Science:

• Ophthalmology
• Neurology

Background:

• Glaucomatous field loss may potentially progress due to optic nerve head ischemia even after intraocular pressure (IOP) control.
• Bishydroxycoumarin (Dicumarol) has been proposed as a treatment to mitigate this ischemia-driven progression.

Purpose of the Study:

• To investigate the theory that glaucomatous field loss can progress due to optic nerve head ischemia after IOP normalization.
• To evaluate the efficacy of bishydroxycoumarin in managing such cases.

Main Methods:

• Retrospective review of 551 consecutive glaucoma patient records.
• Analysis of apparent visual field progression at IOPs of 20 mm Hg or less.
• A pilot study assessing bishydroxycoumarin's benefit.

Main Results:

• The study did not support the theory of ischemia-driven glaucomatous field loss post-IOP control.
• Apparent progression was attributed to artifacts in visual field testing or inadequately controlled IOP.
• The pilot study indicated bishydroxycoumarin provided no significant benefit.

Conclusions:

• Optic nerve head ischemia is unlikely to be the sole cause of glaucomatous field loss progression when IOP is controlled.
• Careful assessment of visual field testing and IOP is crucial for managing glaucoma.
• Bishydroxycoumarin is not effective for glaucoma progression in these specific circumstances.