Beyond IOP in Glaucoma : Role of Ocular Blood Flow in Diagnosis and Management

Chairperson : Dr. Harsh Kumar

Moderator : Dr. Murali Ariga

Panellists : Dr. Alon Harris, Dr. Krishnadas, Dr. Ganesh Raman, Dr. Sagarika Patyal

The current management goals for glaucoma aims at maintaining a target Intraocular Pressure (IOP). However, in many cases, glaucoma progression occurs despite maintaining target IOP. For instance, in the Collaborative Normal-Tension Glaucoma (CNTG) study, 12 to 18% of glaucoma patients progressed despite a 30% IOP reduction over a period of 4 years; in the Early Manifest Glaucoma Trial (EMGT), 45% progressed despite an average IOP reduction of 25% at 6-year follow up. Leske et al. further reported that 67% of patients progressed over 11 years of follow up despite IOP reduction. Non-IOP factors have also been identified as contributing to Open-Angle Glaucoma (OAG) progression, including lower Ocular Perfusion Pressure (OPP), reduced Ocular Blood Flow, are being considered as a potential causative factor in the development of glaucomatous optic neuropathy. What Conclusions Can We Begin to Draw? Vascular abnormalities appear to be important risk factors for the development of glaucoma and prognostic factors for progression. Despite the evidence supporting the role of ocular blood flow in glaucoma progression,this concept is still at
a nascent stage in India. It is mainly due to lack of robust, cost-effective techniques to measure Ocular Blood Flow in India, it is also difficult to measure Ocular Blood Flow in tiny blood vessels of eye (SPCA, LPCA). It is still not known whether manipulation of perfusion pressure, blood pressure, and ocular dlood flow will prevent glaucoma progression. Therefore the clinician always has this question : Why, then, measure blood flow in the firstplace? Recent workshops done across India over the past few month has proved that sophisticated technologies are not necessary for assessing perfusion pressure in patients with glaucoma. This symposium has been designed to elucidate the simple ways by which ocular blood flow can be measured, the relevance of ocular blood flow in glaucoma. How can it impact your decision making while treating your patients with glaucoma?

1 Clinical Significance of Ocular Blood Flow in Diagnosis and
Management of Glaucoma ( 20 mins )
 Dr. Alon Harris
2 Role of Color Doppler Imaging– A Radiologist’s View ( 5 mins ) Dr. Venkata Sai
3 Ocular Blood Flow by CDI in Indian Glaucomatous Eyes :
6 months of Clinical Experience ( 5 mins )
Dr. Ganesh Raman
( Panel Discussion 25 mins )

session video

Presbyopia Concord – Using Phakic Lens & Panfocal Lens
Current Concepts in the Diagnosis, Pathogenesis and Management of NAION

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