Understanding pressure relationships may improve glaucoma treatment

This article provides a fantastic summary of glaucoma mechanisms and processes in need of further research and understanding, with particular focus on the interaction of various pressure measurements. The authors conclude that better understanding of the relationship between these measurements has great potential to improve the treatment of glaucoma.

They note that an increased trans-lamina cribrosa pressure gradient, or the difference between IOP and orbital cerebrospinal fluid pressure, has been associated with decreased neuroretinal rim area and increased visual field defects. This has been found to be consistent in both open-angle glaucoma and normal-tension glaucoma, which makes this finding interesting with respect to the potential pathogenesis of glaucoma.

This article also summarizes findings with respect to blood pressure and body mass index (BMI). The authors argue that with diabetes and hypertension increasing, the relationship between BMI and cerebrospinal fluid pressure should be further studied and considered, as should the effects of changes in arterial blood pressure on cerebrospinal fluid pressure.

They conclude that the regulation of pressures in the arterial system, the eye and the brain has profound influence on the development of glaucomatous change. Systemic arterial blood pressure, IOP and cerebrospinal fluid pressure are inextricably tied to one another, and altering one often alters another.

How many of your glaucoma patients receive regular blood pressure readings during their standard ophthalmologic visit? Should we be checking every patient every time?