Coexistence of macro- and micro-vascular abnormalities in newly diagnosed normal tension glaucoma patients

Acta Ophthalmol. 2012 Nov;90(7):e553-9. doi: 10.1111/j.1755-3768.2012.02494.x. Epub 2012 Sep 23.


Purpose: To investigate the coexistence of ocular microvascular and systemic macrovascular abnormalities in early stage, newly diagnosed and previously untreated normal tension glaucoma patients (NTG).

Methods: Retinal vascular reactivity to flickering light was assessed in 19 NTG and 28 age-matched controls by means of dynamic retinal vessel analysis (IMEDOS GmbH, Jena, Germany). Using a newly developed computational model, the entire dynamic vascular response profile to flicker light was imaged and used for analysis. In addition, assessments of carotid intima-media thickness (IMT) and pulse wave analysis (PWA) were conducted on all participants, along with blood pressure (BP) measurements and blood analyses for lipid metabolism markers.

Results: Patients with NTG demonstrated an increased right and left carotid IMT (p = 0.015, p = 0.045) and an elevated PWA augmentation index (p = 0.017) in comparison with healthy controls, along with an enhanced retinal arterial constriction response (p = 0.028), a steeper retinal arterial constriction slope (p = 0.031) and a reduced retinal venous dilation response (p = 0.026) following flicker light stimulation.

Conclusions: Early stage, newly diagnosed, NTG patients showed signs of subclinical vascular abnormalities at both macro- and micro-vascular levels, highlighting the need to consider multi-level circulation-related pathologies in the development and progression of this type of glaucoma.

MeSH terms

  • Blood Pressure / physiology
  • Carotid Artery, Internal / pathology
  • Female
  • Humans
  • Intraocular Pressure / physiology
  • Lipid Metabolism
  • Low Tension Glaucoma / complications*
  • Low Tension Glaucoma / diagnosis
  • Low Tension Glaucoma / physiopathology
  • Male
  • Middle Aged
  • Photic Stimulation
  • Retinal Diseases / complications*
  • Retinal Diseases / diagnosis
  • Retinal Diseases / physiopathology
  • Retinal Vessels / pathology*
  • Tunica Intima / pathology