Ocular perfusion pressure and glaucoma: clinical trial and epidemiologic findings

Purpose of review A possible connection between ocular perfusion pressure and open-angle glaucoma (OAG) has been hypothesized. This review summarizes the scientific rationale for the proposed relationship, presents recent data, and outlines potential implications. Recent findings Population-based epidemiologic studies found strong relationships between low ocular perfusion pressure and OAG prevalence, as well as OAG incidence. Clinical studies report similar associations between low perfusion pressure and OAG progression. These consistent findings suggest that altered blood flow in the optic disc increases both the risk of OAG development and the progression of established OAG. An underlying factor would be impaired vascular autoregulation, which may lead to poor perfusion in OAG. In contrast, there is conflicting evidence on the possible link of glaucoma to blood pressure/hypertension. Summary Current evidence supports the role of vascular factors as part of the multifactorial cause of OAG. As ocular perfusion pressure reflects the vascular status at the optic disc, it may be more relevant than systemic blood pressure alone. Although the associations of OAG to perfusion pressure are strong, consistent, and biologically plausible, they require careful interpretation. The evidence implicating a vascular cause in OAG is mounting, but the clinical implications for patient management are still uncertain.