Why retinal vasculature could aid glaucoma diagnosis
Congenital anomalies, angle closure, and juvenile open-angle glaucoma aside, it can be generally agreed upon that glaucoma tends to be a disease of relatively older persons. This rings especially true in the arena of normal-tension glaucoma in which intraocular pressure (IOP) may play less of a causative role compared to vascular and hemodynamic dysfunction.
Congenital anomalies, angle closure, and juvenile open-angle glaucoma aside, it can be generally agreed upon that glaucoma tends to be a disease of relatively older persons. This rings especially true in the arena of normal-tension glaucoma in which intraocular pressure (IOP) may play less of a causative role compared to vascular and hemodynamic dysfunction.
More glaucoma:
I subscribe to the notion that many cases of glaucoma are truly mixed-mechanism with several causes such as high IOP, low cerebrospinal fluid pressure, vascular compromise, and anatomic predisposition having varying degrees of causation. If there is any good fortune in all of the confusion surrounding such a multifactorial disease, it is that the number-one risk factor (ocular hypertension) also happens to be just about the only risk factor we can change in any significant fashion.
Retinal vessel diameter and glaucoma
With this said, I recently came across an interesting publication concerning retinal vessel diameter and a purported correlation with glaucoma.1 The paper, recently published in Investigative Ophthalmology and Visual Science, was retrospectively observational in nature and included a sample size of 205 patients (63 with “high-tension” glaucoma, 82 with “low-tension” glaucoma, and 60 controls). The overall conclusion pointed to retinal vessel narrowing as a good indicator for the development of glaucoma over time.
More glaucoma:
While not a novel concept in the field of glaucoma diagnosis (and certainly not pathognomonic), retinal vasculature appearance has the potential to be another tool in the glaucoma workbench, if you will. It has long been said that the eyes are like water from the well in the presence of systemic diseases such as hypertension and diabetes. By this it is meant that chronic vascular changes seen in the retinal vasculature are likely going on elsewhere in the body, and the same case could be made for the microvasculature of the optic nerve with its sometimes marked variability not only between two persons, but perhaps also between the eyes of the same person. In short, vascular compromise in the retina is likely indicative of compromise elsewhere. The retina is just the only place in which we can see it with our own eyes.
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