Risk Factors for Primary Open Angle Glaucoma (POAG) Progression: A Study Ruled in Torino.

PURPOSE: Aim of this retrospective, observational study is to describe features of a population sample, affected by primary open angle glaucoma (POAG) in order to evaluate damage progression on the basis of the emerged individual risk factors. METHODS: We included 190 caucasian patients (377 eyes), evaluating relationship between individual risk factors (explicative variables) and MD (Mean Deviation) of standard automated perimetry. We also considered the dependent variable NFI (Neural Fiber Index) of GDx scanning laser polarimetry. Progression has been evaluated through a statistic General Linear Model on four follow up steps (mean follow up 79 months). RESULTS: Factors reaching statistical significance, determining a worsening of the MD variable, are: age (P<0.0001), intraocular pressure (IOP) at follow up (P < 0.0001), female gender (P<0.0001), hypertension (P< 0.0001) and familiarity (P = 0.0006). Factors reaching statistical significance, determining a worsening of the NFI variable, are only IOP at follow up (P = 0.0159) and depression (P = 0.0104). CONCLUSION: Results of this study confirm and enforce data coming from most recent studies: IOP remains the main risk factor for glaucoma assess and progression; age and familiarity are great risk factors as underlined in the last decades; female sex can be an important risk factors as emerged only in the last years; arterial hypertension should always be evaluated in timing of our clinic follow up.

An internal medicine perspective review of risk factors for assessing and progression of primary open angle glaucoma.

Aim of this review was to resume risk factors for the assess and progression of primary open-angle glaucoma (POAG), particularly considering systemic risk factors that can be associated with glaucomatous damage. If intraocular pressure is the main risk factor, we must consider carefully familiarity, age, gender and possible associations with diabetes, hypertension, vascular autoregulation disorders, hypo- and hyperthyroidism, hypo- and hyperadrenalism, sleep apnea syndrome, corticosteroids therapies and other suspected factors cited in literature. Glaucoma's etiology remains unknown, its physiopathology is poorly understood and its diagnosis is often difficult. It is the leading cause of irreversible blindness worldwide and it is the real "silent thief of sight" because the loss of vision often occurs gradually over a long period of time, and symptoms only occur when the disease is quite advanced. Cost-effectiveness analyses for POAG screening are weighted by the degree of uncertainty that glaucoma screening can be effective and reliable achieved. Addressing patients to an ophthalmologic investigation on the basis of the identified risk factors is a fundamental preventing measure.

The effects of dorzolamide 2% and dorzolamide/timolol fixed combination on retinal and optic nerve head blood flow in primary open-angle glaucoma patients.

PURPOSE: To compare the effect of dorzolamide hydrochloride 2%, timolol maleate 0.5%, and their fixed combination on intraocular pressure (IOP)and retinal and optic nerve head haemodynamics in primary open-angle glaucoma patients. METHODS: Twenty-eight patients with early moderate glaucomatous damage treated with ß-blockers (>6 months) with IOP values ranging from 18 to 22 mmHg at trough participated in this trial. After a 4-week washout period,patients were randomised in two groups: group I started with dorzolamide 2% monotherapy and group II with timolol 0.50% monotherapy for 4 weeks. After this period, both groups switched to dorzolamide/timolol fixed combination for 4 weeks. IOP, ocular diastolic perfusion pressure, heart rate, and Scanning Laser Doppler Flowmetry measurements at the peripapillary retina and neuroretinal rim were taken at T0 (enrolment), T1 (wash out), T2(monotherapy), and T3 (dorzolamide/timolol).Data were compared between different study times. Statistical analysis was conducted using a paired t-test. RESULTS: Between T1 and T3, IOP decreased significantly in group I (-21.40%) (P<0.001)and in group II (-21.25%) (P<0.001). At the same time intervals, blood flow increased significantly at rim level for group I (+30.03%)(P<0.05) and also when all patients were considered (rim +20.81%) (P<0.05). Between T1 and T3, we also observed a significant increase of ODPP in group I (+7.24%) (P<0.01)and in group II (+6.08%) (P<0.05) and when all patients were considered (+6.71%)(P<0.001) [corrected]. CONCLUSIONS: Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim showing a combination of hypotensive and haemodynamic effects.

Intraocular pressure and progression of visual field damage.

Contradicting results concerning IOP control and visual field deterioration are presented. Some of these inconsistencies may be due to the statistical method of analysis. Sixty POAG patients with a perimetric follow-up over 3 years were selected. Mean and maximum IOPs were considered during the same period. The patients were divided into two groups according to the IOP control (well controlled or poorly controlled). Visual field progression was defined as a reduction in sensitivity over the fifth percentile in more than four points. Mean IOPs were not significantly different in the group of patients with a visual field deterioration compared to the stable ones, but the percentage of patients with a visual field deterioration was significantly higher in patients with higher IOPs. This holds especially true if IOP below 16 mmHg (G) is considered the 'target pressure'. IOP reduction seems to play an essential role in visual field progression. In glaucomatous patients, a strict (<16 mmHg (G)) might be necessary.

Ultrabiomicroscopic study of the effects of brimonidine, apraclonidine, latanoprost and ibopamine on the chamber angle and ciliary body.

The authors used the Zeiss Humphrey (Mod840, 50 MHz) ultrabiomicroscope to evaluate the changes that Brimonidine, Apraclonidine, Latanoprost and Ibopamine cause in the anterior chamber and on the ciliary body of healthy subjects. The eyes of 60 volunteers, separated into 4 groups according to drug instilled, were studied and the parameters analyzed were: anterior chamber depth (ACD), pupillary diameter (PD), angle opening at 500 microns from the scleral spur (AOD500), trabecular iris angle (TIA) and iris thicknesses (ID1 and ID3). The study showed the miotic effect of Brimonidine (S) that was accompanied by an angle opening (S). Apraclonidine and Latanoprost caused no statistically significant changes in the angle or in the ciliary body. Ibopamine caused mydriasis (S). The UBM, therefore, showed itself to be useful also in the study of the mechanism of action of drugs on the angular structures and on the ciliary body.