Chat Highlights
Systemic Problems Associated With Glaucoma
November 15, 2000

On Wednesday, November 15, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Systemic Problems Associated With Glaucoma." 

P:  Dr. Wilson, what systemic problems are associated with glaucoma? 

Dr. Wilson:  Systemic problems include poor circulation, a cardiac irregularity, conditions that cause inflammation in the eye, autoimmune problems, etc.

P:  Isn't it likely that a high number of normal pressure glaucomas are actually systemic problems that are aggravated by "normal" pressure?

Dr. Wilson:   True.  That is what is suspected.  We just don't know all the contributing factors yet.

P:  How about blood pressure?

Dr. Wilson:  If blood pressure is too low, it increases the risk of glaucoma damage six times!

P:  What is considered low pressure?

Dr. Wilson:  Pressures of 90/55 or below.

P:  What is an ideal pressure for a person taking blood pressure medications? 

Dr. Wilson:  A pressure not below 100 over 60.  The problem is the two thirds of patients whose blood pressure drops ten percent or more during the night.  The night-time dippers are thought to be especially susceptible to progressive glaucoma damage.

P:  In what way does high blood pressure affect glaucoma?

Dr. Wilson:  Early on, high blood pressure helps blood flow into the eye.  Unfortunately, the walls of the blood vessels get hardened after being subjected to the high blood pressure for some time.  Then atherosclerosis sets in and blood flow finally decreases over time, adversely influencing the course of the glaucoma.

Moderator:  What is an antibody?

Dr. Wilson:   An antibody is a chemical made by the body's defense system that attacks a particular set of body-building blocks or invading proteins like a virus.  Some patients with normal-tension glaucoma have antibodies against their own retinal proteins.

P:  Is there a way to check for these antibodies?

Dr. Wilson:  Yes.   Dr. Marty Wax checks for these at Washington University in St. Louis, Missouri.

P:  Years ago I used a carbonic anhydrase inhibitor that had an additive diuretic effect to the diuretic I used to control my high blood pressure.  My ophthalmologist added Trusopt to reduce my IOP further and I've noticed an increased diuretic effect.  Is that much of  the Trusopt being absorbed systemically, and should I reduce my hypertension medicine?

Dr. Wilson:   There is not that much diuretic effect from the Trusopt, but there is some.  I doubt that you would need to reduce your systemic hypotensive agent, but you should ask your internist.

P:  If the optic nerve is being deprived of blood by some local circulation problem, is there a way to detect that and to treat it?

Dr. Wilson:  That can be done with a group of advanced and sensitive machines, each looking at a particular part of the blood supply to the optic nerve. 

P:  Are the machines available in most cities or only a few?

Dr. Wilson:  Only a few have the entire complement, with the trained technicians to do the tests.

P:  Isn't the eye considered an extremity and therefore it sort of gets robbed in terms of blood flow, say as compared to the kidney or some other places in the body?

Dr. Wilson:  The eye is really considered an extension of the brain and is subject to autoregulation to keep the blood flow constant in the face of decreased blood pressure or increased metabolic needs.  The rub is that if there is more than one problem to autoregulate for, the mechanism may not be effective enough.

P:  Can diseases such as RA (rheumatoid arthritis) or fibromyalgia affect or change my glaucoma or intraocular pressure?  

Dr. Wilson:   RA or fibromyalgia are not definite risk factors, that I know of.  However, if you look at patients with normal-tension glaucoma as a whole, they will have a higher prevalence of autoimmune disease than age-matched normals.  That prevalence will include both RA and fibromyalgia by definition.

P:  Besides glaucoma, I also have Raynaud's Syndrome and take a low-dose calcium blocker to help control it.  Can the eye be affected like my toes and fingers?

Dr. Wilson:  Yes, it seems that it can.  The Raynaud's may be a second problem needing autoregulation.

P:  Can dry eyes have a systemic cause or systemically related contributing factors?

Dr. Wilson:   Usually.  Autoimmune disease like Sjogren's and RA are classic examples of diseases that can result in dry eyes.

P:  If a person had an autoimmune disease such as lupus or juvenile rheumatoid arthritis for a long time, is he or she predisposed to certain eye diseases, such as glaucoma?

Dr. Wilson:  There is probably a slightly higher risk, but we have not been able to spell out the risk yet.

On November 22st, Dr. Rick Wilson discussed "Glaucoma and Pain" in the Chat room. Click here for highlights of that meeting.

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