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The Role of Blood Flow in Optic Nerve Damage

Over the past 20 years, a variety of investigators have performed extensive studies, some of which have indicated that spasm of the blood vessels that provide blood to the optic nerve may be responsible for glaucoma in some patients. Some individuals, such as those with migraine, are predisposed to this type of spasm. It has been known for quite a few years that patients with migraine are predisposed to "normal pressure" glaucoma. Studies have also shown that blood flow disturbance generally seems to be more pronounced in normal tension compared to high tension glaucoma. Furthermore, blood flow reduction is more pronounced in patients that show progressive damage from glaucoma compared to patients who are stable.
More recently, collaborative work between the University of Indiana and Wills Eye Hospital in Philadelphia, have used a new technology that permits visualization of the blood vessels of the eye. Based on this technology, they have described different patterns of blood-flow abnormality in different types of glaucoma. It has also been shown that lowering the pressure inside the eye improved the blood flow in patients with glaucoma. In another study, they related the amount of damage to the optic nerve in patients with glaucoma to the amount of abnormality of blood flow.

The Future

While we now know a fair amount about the relationship between blood flow in the eye and glaucoma, investigators have a long way to go. A comprehensive understanding of the various mechanisms by which the optic nerve becomes damaged in glaucoma still remains to be established. Once these are known, physicians will be in a far better position to help each individual patient. As this new knowledge unfolds, we will see very exciting changes resulting in significant improvements in patient care.

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