Key result
Patients with normal tension glaucoma demonstrated a more pronounced sympathetic autonomic response to a cold provocation test compared to healthy controls, which correlated with reduced ocular perfusion pressure and retrobulbar blood flow.
Why the study?
Does autonomic dysfunction assessed by heart rate variability during a cold provocation test correlate with ocular blood flow and structural damage in normal tension glaucoma?
Case-Control (n=138)
No
Does autonomic dysfunction assessed by heart rate variability during a cold provocation test correlate with ocular blood flow and structural damage in normal tension glaucoma?
Patients with normal tension glaucoma exhibit autonomic nervous system disturbances that increase in response to stress and correlate with reduced ocular blood flow and structural damage.
Primary vascular dysregulation (PVD) is believed to be a main cause of local vasospasm and impaired autoregulation as a possible contributing factor in the pathogenesis of normal tension glaucoma (NTG). Subjects with PVD respond stronger to psychological stress. Autonomic dysfunction is another reason of instable ocular blood flow and may be studied by means of assessment of heart rate variability (HRV) especially during a hand-cold provocation test (CPT).To compare the shift of HRV parameters in NTG and healthy subjects after a cold provocation test and to assess the relation between structural damage, circulatory parameters and autonomic dysfunction in NTG.HRV was studied using CPT in 78 NTG patients and 60 health control matches. The ocular blood flow was measured using color Doppler imaging (CDI). The 24 hours blood pressure (BP) monitoring was carried out. The cardiovascular fitness assessment was made to all patients before and after CPT. Mean group difference of HRV parameters was compared between NTG and healthy subjects using the Euclidean metric. The mean ocular perfusion pressure (MOPP) was measured. Optic nerve head and retinal nerve fiber layer (RNFL) were evaluated using spectral-domain optic coherence tomography (SD-OCT). The relation between HRV, CDI, and SD-OCT-parameters was assessed.In contrast to healthy subjects, a predominance of the sympathetic activity after the CPT was revealed in the NTG group. The end diastolic velocity (EDV) in central retinal artery (CRA) and short posterior ciliary artery (SPCA) was significantly reduced in NTG compared to healthy eyes. In NTG, the main HRV parameter characterizing the total effect of autonomic blood circulation regulation (SDNN) correlated with MOPP (0.75, P = .035), SPCA EDV (0.93, P < .001), and CRA EDV (0.9, P < .001). The average daily diastolic BP correlated with RNFL (0.67, P = .009).The NTG patients have the disturbance of the autonomic nervous system, which increases in response to stress provocation and is related to ocular blood flow and structural damage.
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Курышева et al. (2018) conducted a case-control in Normal tension glaucoma (n=138). Normal tension glaucoma vs. Healthy subjects was evaluated on Standard deviation of NN-interval (SDNN) after cold provocation test (p=0.005). Patients with normal tension glaucoma demonstrated a more pronounced sympathetic autonomic response to a cold provocation test compared to healthy controls, which correlated with reduced ocular perfusion pressure and retrobulbar blood flow.
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