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Looking at Glaucoma as a Systemic Disease
Date:11/11/2007

related to elastic fibers along with pigment from the iris break off and block the drainage of fluid in the eye, thus elevating interocular pressure. Exfoliative glaucoma is the most common recognizable cause of open angle glaucoma in the world and in certain countries is the cause of the majority of glaucoma cases. But the degenerated or abnormal elastic fibers whose shedding leads to exfoliative glaucoma are found in other organs as well.

"You can find exfoliative material all over the body, mostly in connective tissue, such as the walls of blood vessels and cardiac muscle," says Dr. Ritch.

Studies have found that patients with exfoliative glaucoma have a higher incidence of several other diseases, including Alzheimer's and vascular diseases. "The same genetic variation that affects the eye is probably active in all these other tissues," says Dr. Ritch. "The gene is hopefully going to explain not just exfoliation in the eye. Perhaps it's also plays a role in stroke and myocardial infarction."

By contrast, normal-tension glaucoma occurs when there is damage to the optic nerve even when pressure within the eye seems to remain normal. However, Dr. Ritch notes, patients with the disease exhibit other risk factors, particularly reduced blood flow, or ischemia.

Patients often exhibit poor circulation throughout their extremities. They are also more prone to sleep apnea and an abnormal reduction in blood pressure while sleeping.

"Normal-tension glaucoma is really a nighttime disease," says Dr. Ritch.

Other risk factors associated with ischemia directly affect the retinal ganglian cells. Cells are programmed to die when they are no longer useful or have become damaged, a process known as apoptosis. But a genetic variation affecting individuals with normal-tension glaucoma causes their retinal ganglian cells to die at a more rapid rate.

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