Association of Open-angle Glaucoma With Perfusion Pressure Status in the Thessaloniki Eye Study

doi:10.1016/j.ajo.2012.12.007

American Journal of Ophthalmology

Volume 155, Issue 5, May 2013, Pages 843-851.e1

https://doi.org/10.1016/j.ajo.2012.12.007 Get rights and content

Purpose

To investigate the association of open-angle glaucoma (OAG), primary open-angle glaucoma (POAG), and pseudoexfoliative glaucoma (PEXG) with ocular perfusion pressure status (ocular perfusion pressure with or without antihypertensive treatment).

Design

Cross-sectional, population-based study.

Methods

A total of 2554 randomly selected, ≥ 60-year old subjects participated in the Thessaloniki Eye Study. Only clinic-visit participants (n = 2261), who had uniformly collected data, were included in the analyses. A logistic regression model was run for OAG in all clinic-visit participants; covariates included age, sex, diastolic ocular perfusion pressure, antihypertensive treatment, intraocular pressure (IOP), IOP-lowering treatment, pseudoexfoliation, and vascular factors identified as risk factors for glaucoma in a previous analysis. Similar logistic regression models were run separately for POAG and PEXG. In addition, logistic regression models were run for OAG, POAG, and PEXG in subjects with and without antihypertensive treatment. Also, logistic regression models were run to assess the role of systolic ocular perfusion pressure in OAG, POAG, and PEXG.

Results

Among clinic-visits, 1212 subjects (53.7%) were using antihypertensive treatment. An association of borderline significance was found between low diastolic ocular perfusion pressure and POAG (OR = 0.84 per 10 mm Hg, 95% CI = 0.70-1.01, P = .059). The effect of antihypertensive treatment on POAG was not statistically significant (OR = 1.20, 95% CI = 0.75-1.91, P = .45). In subgroup analyses, diastolic ocular perfusion pressure was significantly associated with POAG in subjects using antihypertensive treatment (OR = 0.78 per 10 mm Hg, 95% CI = 0.62-0.97, P = .028). No association was found between diastolic ocular perfusion pressure and PEXG, regardless of the use of antihypertensive treatment. No associations were found between systolic ocular perfusion pressure and OAG, POAG, or PEXG, regardless of the use of antihypertensive treatment.

Conclusions

Low diastolic ocular perfusion pressure may be associated with increased risk for POAG. This association was confirmed in subjects treated for systemic hypertension in subgroup analysis. This may support the hypothesis that the concept of ocular perfusion pressure status may be more relevant to glaucoma pathogenesis than ocular perfusion pressure alone.

Section snippets

Methods

The Thessaloniki Eye Study is a cross-sectional population-based study of chronic eye diseases in the population of Thessaloniki, which is the major urban center in Northern Greece. Details of the recruitment process and random selection have been previously described.¹⁷ Briefly, the initial recruitment frame of the Thessaloniki Eye Study consisted of 5000 people, 60 years of age or older, who were randomly selected in February 1999 from approximately 321 000 persons registered in the

Results

Among clinic-visit participants, 135 OAG (94 POAG and 41 PEXG) subjects and 2126 non-OAG subjects were identified and included in the analyses. Characteristics of clinic-visit participants are presented in Table 1. Subjects with OAG were older (mean ± standard deviation [SD] 73.2 ± 6.0 years vs 70.7 ± 5.7 years, P < .001), had higher IOP (mean ± SD 18.8 ± 5.8 mm Hg vs 15.7 ± 3.7 mm Hg, P < .001), and presented more frequently with pseudoexfoliation (41/135; 30.4% vs 229/2126; 10.8%, P < .001),

Discussion

After adjusting for potential confounders (including, among others, IOP, IOP-lowering treatment, and antihypertensive treatment), there was some evidence for an association between low diastolic ocular perfusion pressure and increased POAG risk. In subgroup analyses, this association was confirmed in subjects treated for systemic hypertension. However, the interaction between diastolic ocular perfusion pressure and antihypertensive treatment in the overall analysis for POAG was not

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Fotis Topouzis, MD, PhD, is an Associate Professor of ophthalmology at the Aristotle University of Thessaloniki, Greece. He completed his Fellowship in glaucoma at the Jules Stein Eye Institute, Los Angeles, California in 1998, and received the Shaffer International Fellowship Award from the Glaucoma Research Foundation, San Fransisco, California. He is member of the Executive Committee of the European Glaucoma Society and Secretary of GlaucoGENE, a special interest group of the European Glaucoma Society. Dr Topouzis main research interest includes epidemiology and clinical and genetic research in glaucoma and age related macular degeneration. He is the principal investigator of two large population-based studies (Thessaloniki Eye Study and the Eureye Study) and co-ordinator for the GlaucoGENE project.

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Original articleAssociation of Open-angle Glaucoma With Perfusion Pressure Status in the Thessaloniki Eye Study

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Prog Retin Eye Res

Ophthalmology

Lancet

Lancet

Am J Hypertens

Blood pressure and glaucoma

Br J Ophthalmol

Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam study

Arch Ophthalmol

Risk factors for open-angle glaucoma. The Barbados Eye Study

Arch Ophthalmol

Hypertension, perfusion pressure, and primary open-angle glaucoma. A population-based assessment

Arch Ophthalmol

The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER

Arch Ophthalmol

Blood pressure, perfusion pressure, and open-angle glaucoma: the Los Angeles Latino Eye Study

Invest Ophthalmol Vis Sci

Distribution of ocular perfusion pressure and its relationship with open-angle glaucoma: the Singapore Malay Eye Study

Invest Ophthalmol Vis Sci

Original article
Association of Open-angle Glaucoma With Perfusion Pressure Status in the Thessaloniki Eye Study