RISK FACTORS OF GLAUCOMA

Dr Samarth Mishra

RISK FACTORS OF GLAUCOMA

General

Ocular

Systemic

GENERAL FACTORS OF OCULAR HTN

1) AGE- common >40 yrs

2) Gender- F>M

3) Race – African- American

OCULAR FACTORS OF OCULAR HTN

1) Significant diurnal variation- > 8mm of Hg

2)Significant positive water drinking provocative test

3)Splinter haemorrhage over/ near OD

4)IOP constantly >28 mm of Hg

5)Retinal nerve fibre layer defect

6)Parapapillary changes

7)CCT<555 micro mt

8)C/D ratio

9)Greater PSD on HFA

10)Significant asymmetry in cup size of two eyes (0.2 )

SYSTEMIC FACTORS OF OCULAR HTN

1) Myopia

2) Diabetes

3)Heart disease

GENERAL FACTORS OF POAG

1) AGE- common >40 yrs

- prevalance doubles for each decade over 40

- 10 fold rise over 80 yrs

2) RACE- higher in Blacks

- intermediate in Whites, Hispanics &

Southern Asia

- lowest in Northern Asia

3) Family/ H- 4times risk in siblings & 2times risk in

offsprings

OCULAR FACTORS OF POAG1) IOP- higher IOP greater risk

- 1 mm rise leads to 10% increase risk

2) Optic nerve head & peripapillary features-

a) C/ D ratio- > 0.7 leads to 8.6 fold incidence

b) Vertical disc dia

c) Disc area

d) O.D haemorrhage- increased risk of visual field loss

e) Parapapillary atrophy- zone beta has 3 times risk

3) Myopia- 2-3 fold risk

4) Others- Exfoliation Syndrome & CCT

RISK OF GLAUCOMA

ACCORDING TO IOP & CCTMean IOP >25.75

mm Hg

36% 13% 6%

Mean IOP > 23.75

to <25.75 mm Hg

12% 10% 7%

Mean IOP < 23.75

mm Hg

17% 9% 2%

CCT<555 microM CCT >555 to <588 CCT >588

RISK OF GLAUCOMA ACCORDING TO

VERTICAL C/D RATIO & CCTC/D ratio >0.5 22% 16% 8%

C/D ratio >0.3 to

<0.5

26% 16% 4%

C/D ratio <0.3 15% 1% 4%

CCT<555 microM CCT >555 to <588 CCT >588

SYSTEMIC FACTORS OF POAG1) DM- increased prev. & incid. of rise in IOP

2) BP- low dias. BP-> low ocular perfusion pressure

->risk of progr.

- Noturnal arte. Hypotension -> progr. Of POAG & NTG

3) Migraine –rise in prog.

4) CSF pressure – low -> risk of progr.

5) Others-

a) Hypothy. – common

b) Grave’s disease – increa. Prev. of ocular HTN & POAG

CONT.

c) Cushing’s Syn. – Rise in IOP

d) Rise in level of proges. & estr.- decrea. In

IOP

e) Rise in testo.- rise in IOP

f) Sleep apnoea – rise in IOP

g) Steroid response – intra- & peri ocular ,

periocular skin cream & nasal spray -. Rise

in IOP

RISK FACTORS FOR NTG/LTG

1) Age - > 50yrs

2) Gender – F>M

3) Race – Japan> Europe/ North America

4) Family/H – POAG is more in families of NPG

- mutation of OPTN gene

5) CCT – lower than POAG

6) Vasospasm in migraine & Raynaud’s phenomenon

7) syst. Hypotension – nocturnal dips on oral anti-HTN

8) Obs. Sleep apnoea syn.

9) Autoantibody levels – higher

GENERAL FACTORS OF PACG

1) Age – 6th – 7th decade

2) Race – common in South-east Asians,

Chinese & Eskimos

3) Gender – M:F is 1:3

4) Family/H – 20% in 1st relatives

OCULAR FACTORS OF PACG

1) Hypermetropic eyes

2) Anteriorly placed iris-lens diaphragm

3) Narrow angle - Small eyeball

- large size of lens

- smaller dia. Of cornea

- bigger size of cili. Body

- ant. Insertion of iris

4) Plateau iris cofiguration

SYSTEMIC FACTORS OF PACG

1) Diabetes- rise in prev.

2) Drugs – antipsychotics, antidepressents,

antiparkinsonism, mydritics, antibiotics

CONCLUSION

Useful to access the risk of glaucoma in

individual pts.

Importance & magnitude of clinical risk

factors

Useful to know the risk factors for

progression

THANK YOU