Low pressure glaucoma: patients threatened of vision worsening and blindness

Purpose To study the presence of systemic diseases in low pressure glaucoma (LPG) and primary open-angle glaucoma (OAG) patients, and the specific characteristics of functional and structural damages in those two types of glaucoma. Methods all consecutive glaucoma patients diagnosed and treated for a period of 6 months (October 2010 – March 2011). They were evaluated by routine methods and stereoscopic examination of the optic nerve, computer perimetry (Humphrey) and Stratus OCT. The existence of systemic diseases has been studied in details in all patients, with emphasis on vascular risk factors. Additional specialized consultations and examinations were conducted. Results IOP was lower than the statistically defined normal IOP values in 44 (55%) out of 80 studied patients. Within this group of LPG patients we established the presence of specific topographic changes in the optic nerve and typical changes in the layer of ganglion cells and nerve fibers. In compliant patients with disease progress and IOP values between 19-20 mm, we established significantly higher prevalence of systemic diseases leading to general and local ischemia: uncontrolled blood pressure, diabetes mellitus, etc. We followed also the subsequent functional differences in the development of damage in optic nerve and visual field in the two groups. Conclusion Until recently, IOP has been considered the only factor for control and prevention of glaucomatous damage. Literature data and our observations explicitly demonstrate the existence of additional risk factors in the pathogenesis of glaucoma, indicating for the necessity of lower level of IOP. Preserving vision and quality of life of patients depends both on the timely decision for lower IOP target in patients with LPG and inju