Study On The Relationship Between Primary Open-angle Glaucoma And Autonomic Nervous Dysfunction

1.The effect of low heart rate variability on the progression of primary open-angle glaucomaObjective:To study the effect of low heart rate variability(HRV)on glaucoma progression in patients with primary open-angle glaucoma(POAG).Methods:Retrospective study of 40 cases of POAG patients who underwent regular reexamination for more than 3 years in the Ophthalmology Clinic of Tongji Hospital was performed.According to SDNN,which is an index of HRV,they were divided equally into two groups,namely low HRV group and high HRV group.The lower the SDNN was,the lower the HRV was.Systematic ophthalmological examination was performed on all participants and the progression of glaucoma damage was assessed by the progression of visual field(VF)parameters and thinning rate of retinal nerve fiber layer(RNFL)thickness.Results:There were 20 cases in low HRV group and 20 cases in high HRV group.The two groups were comparable in age,gender and the degree of glaucoma damage.The thinning rate of RNFL in low HRV group was significantly faster than that in high HRV group(1.44±1.58 vs 0.29±0.56μm/year,P=0.00),accompanied by greater fluctuation of intraocular pressure(IOP)(P=0.04),lower diastolic blood pressure(P=0.01)and mean blood pressure(P=0.04),lower mean ocular perfusion pressure(P=0.04).Meanwhile,the incidence of central VF defects in low HRV group was significantly higher than that in high HRV group(65.0%vs 30%,P=0.03).Multiple regression analysis showed that there was a significant correlation between SDNN and the thickness loss rate of RNFL(P=0.001).Conclusions:The low the HRV is,the faster the glaucoma progression in POAG patients is.Low HRV(high sympathetic tone)may contribute to the rapid progression of POAG by promoting IOP and vascular risk factors associated with POAG.2.Autonomic,systemic and ocular response to Valsalva maneuver in primary open-angle glaucomaObjective:We aimed to assess systemic and ocular responses to the autonomic provocation test-Valsalva maneuver(VM)in primary open-angle glaucoma(POAG)and normal subjects.Methods:Forty POAG and forty control subjects were subjected to the VM.Heart rate variability(HRV)was used to assess the autonomic nervous activity during the VM,of which the high-frequency component(HF)and the low-frequency(LF)/HF ratio were used as an index of parasympathetic and sympathetic activation respectively.Systemic and ocular parameters were measured at baseline,phase 2 and phase 4 of the VM(VM2 and VM4).Results:POAG demonstrated a higher sympathetic activation(LF/HF ratio median:2.17 vs 1.53,P=0.000)than controls at baseline.POAG exhibited attenuated both sympathetic and parasympathetic responses(a smaller change in LF/HF and HF values)during the VM than controls.During the VM,the intraocular pressure(IOP),mean blood pressure(MAP),mean ocular perfusion pressure(MOPP),area of Schlemm’s canal(SCAR)increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups(all P<0.05).However,when we compared the changes above,the fluctuations of IOP,MAP,MOPP were more pronounced in POAG than in the normals(all P<0.05),while the change amplitudes of SCAR were smaller in POAG(P<0.05).Furthermore,from VM2 to VM4,the choroid thickness(ChT)in POAG group met a significant decrease,while it was unchanged in normal subjects(P=0.258).The regression analysis showed a significant correlation of baseline LF/HF with IOP change values(△IOP)from baseline to VM2 in POAG(R2=0.147,P=0.014).Conclusions:Patients with POAG showed more pronounced fluctuation in IOP,MAP,MOPP and ChT during VM compared to the controls.These reactions could be manifestations of the autonomic dysfunction in POAG.3.Autonomic,systemic and ocular responses to aerobic exercise in patients with primary open-angle glaucomaObjective:We aimed to compare autonomic,systemic and ocular responses to the autonomic nerve stimulation test-aerobic exercise in primary open-angle glaucoma(POAG)and normal subjects.Methods:40 patients with POAG and 40 healthy controls were enrolled in the study.The subjects were asked to run on a treadmill for 20 minutes.Heart rate variability(HRV)was used to assess autonomic nerve activity after aerobic exercise,and the high frequency component(HF)and low frequency component/high frequency component(LF/HF)of HRV were used as indicators of parasympathetic and sympathetic nerve activation,respectively.Compare systemic and ocular parameters which measured at baseline and immediately after exercise.Results:After exercise,the mean arterial pressure increased significantly in the control group(93.27±9.15 vs 98.92±10.99,P=0.000),but not in the POAG group(95.01±9.81 vs 94.10±11.90,P=0.654).After exercise,there was no significant change of the choroidal thickness in the control group(321.24±103.90vs317.5±108.32,P=0.065),but the choroidal thickness significantly decreased in the POAG group(337.36±106.48 vs 327.74±105.86,P=0.000).After exercise,LF/HF decreased and HF increased significantly in both groups,but the increase of LF/HF was smaller in the POAG group than in the control group(median 2.16 vs 1.28,P=0.006).After exercise,the intraocular pressure decreased significantly in both groups,but it decreased even more in the POAG group(-2.43±2.44 vs-3.85±2.91,P=0.021).The area of Schlemm’s canal and the pupil diameter were significantly enlarged in both groups.However,in POAG group,both the increase of the pupil diameter(0.39±0.39 vs 0.23±0.31,P=0.044)and the the area of Schlemm’s canal(2947.24±1809.25 vs 2086.86±1356.84,P=0.018)were smaller.Conclusions:After exercise,the mean arterial pressure increased significantly in the normal control group,but not in the POAG patients.At the same time,the intraocular pressure and choroid thickness of POAG group decreased significantly after exercise,and the amplitude of the decrease was significantly greater than that of the control group.The difference in response to aerobic exercise between POAG patients and healthy subjects may be caused by autonomic dysfunction of POAG.4.Autonomic symptoms in patients with primary open-angle glaucoma were investigated using the COMPASS-31Objective:To investigate autonomic symptoms in POAG patients with the composite autonomic symptom score-31(COMPASS-31).Methods:A cross-sectional case-control study was conducted in 62 patients with POAG under the control of medication and 40 healthy controls.The COMPASS-31 scores were compared between the POAG group and the control group.Results:The two groups matched in age and sex.Patients with POAG had significantly higher total COMPASS-31 scores than normal subjects(median 12.74 vs.8.29,P=0.01).Among them,when the scores of each subdomain included were analyzed separately,the score of orthostatic intolerance in POAG patients was significantly higher than that in the normal control group(P=0.01).Conclusions:Symptoms of autonomic dysfunction are more common in POAG patients,especially the symptoms of orthostatic intolerance.