Ocular blood flow in patients with asymmetric glaucoma

Background. Hemodynamic factors are gaining increasing importance in the pathogenesis of glaucoma. This study was designed to investigate ocular blood flow in patients with asymmetric glaucoma. Methods. The more affected and the contralateral eyes of 15 glaucoma patients with asymmetric scotomas (difference in mean deviation greater than or equal to8 dB) despite equal IOP were compared with reference to IOP, optic nerve head excavation, mean deviation in scotomas and ocular blood flow (OBF). Exclusion criteria were defined as follows: operated eyes, secondary glaucomas, differences in IOP and in antiglaucoma therapy, differences in visual acuity >2 steps and other ophthalmological diseases. For statistical analysis the Wilcoxon test for paired samples was used. Results. A comparison of IOP's of the more affected eyes with the contralateral eyes showed no differences. Vertical and horizontal excavation differed significantly (p=0.027 and p=0.01, respectively) and also the mean deviation in scotomas showed a statistically significant difference (p=0.001). The pulse amplitude and the pulse volume showed only a slight tendency, but the pulsatile ocular blood flow was significantly lower in the more affected eyes (p=0.047). Conclusion. The lower pulsatile ocular blood flow in the more affected eye in patients with asymmetric glaucoma could be the lateralizing factor in these patients, and suggests an influence of hemodynamic factors in the pathogenesis of glaucoma.