Glaucoma risk factors

1. RISK FACTORS OF GLAUCOMA
Dr Samarth Mishra

2. RISK FACTORS OF GLAUCOMA
 General
 Ocular
 Systemic

3. GENERAL FACTORS OF OCULAR HTN
1) AGE- common >40 yrs
2) Gender- F>M
3) Race – African- American

4. 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 )

5. SYSTEMIC FACTORS OF OCULAR HTN
1) Myopia
2) Diabetes
3)Heart disease

6. 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

7. OCULAR FACTORS OF POAG
1) 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

8. RISK OF GLAUCOMA
ACCORDING TO IOP & CCT
Mean 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

9. RISK OF GLAUCOMA ACCORDING TO
VERTICAL C/D RATIO & CCT
C/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

10. SYSTEMIC FACTORS OF POAG
1) 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

11. 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

12. 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

13. 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

14. 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

15. SYSTEMIC FACTORS OF PACG
1) Diabetes- rise in prev.
2) Drugs – antipsychotics, antidepressents,
antiparkinsonism, mydritics, antibiotics

16. 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

17. THANK YOU