This document discusses the various risk factors for different types of glaucoma. General risk factors for glaucoma include increasing age over 40, female sex, and African ancestry. Ocular risk factors include high intraocular pressure, thin central corneal thickness, large cup-to-disc ratio, myopia, and exfoliation syndrome. Systemic factors include diabetes, low blood pressure, migraine, and thyroid disorders. Narrow-angle glaucoma has additional risk factors such as hyperopia, anteriorly positioned iris, and smaller eye anatomy. Understanding an individual's risk factors can help assess their risk of glaucoma and progression.

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