Ophthalmology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania.
Rom J Ophthalmol. 2021 Jan-Mar;65(1):15-19. doi: 10.22336/rjo.2021.4.
Primary open angle glaucoma (POAG) is a multifactorial optic neuropathy, which progresses in a chronic manner. Several etiological factors are involved, including genetic factors, race, age, IOP or vascular, systemic factors. IOP has an established role in the initiation and evolution of glaucoma, but its interactions with additional risk factors are complex. We propose the notion of the Glaucoma Etiological Area (GEA), as a representation of all the elements acting in collaboration in the physiopathology of each glaucoma case. When combined in different proportions, these elements may trigger the typical glaucomatous optic neuropathy (GON). We know that the statistical values of IOP are valid for normal eyes, but the glaucoma eye is not a normal eye. The notion of GEA can open a new perspective to interpret IOP values and to assess the true value of IOP control as a treatment for glaucoma. Applying the GEA theory allows us to tune the role of IOP. Additional factors, such as ocular properties (RGCL status, CCT, IOP fluctuation curve), ocular comorbidities (PEX, PDS), systemic comorbidities (arterial hypertension, vasospastic diseases such as migraines or Reynaud's syndrome) or patient's attitude towards glaucoma management (treatment compliance, access to follow-up and treatment) may greatly influence the evolution of GON and should be viewed holistically when developing a management plan for each patient. Applying the notion of GEA in clinical practice allows a more realistic approach of the pathophysiology of the disease and for a glaucoma treatment that is tailored to each patient. AG = advanced glaucoma, BP = blood pressure, CCT = central corneal thickness, CIGTS = Collaborative Initial Glaucoma Treatment Study, CNTGS = Collaborative Normal-Tension Glaucoma Study, EMGT = Early Manifest Glaucoma Trial, GEA = glaucoma etiological area, GON = glaucomatous optic neuropathy, IOP = intraocular pressure, NTG = Normal Tension Glaucoma, OHTS = Ocular Hypertension Study, PDS = Pigmentary dispersion syndrome, PEX = Pseudoexfoliation syndrome, POAG - primary open-angle glaucoma, RGCL = retinal ganglion cell layer, VFL = visual field loss.
原发性开角型青光眼（POAG）是一种多因素的视神经病变，呈慢性进展。涉及多种病因因素，包括遗传因素、种族、年龄、眼压或血管、全身因素。眼压在青光眼的发生和进展中起重要作用，但它与其他危险因素的相互作用非常复杂。我们提出青光眼病因区域（GEA）的概念，作为代表每个青光眼病例的病理生理中协同作用的所有因素的表示。当这些因素以不同的比例组合时，可能会引发典型的青光眼视神经病变（GON）。我们知道眼压的统计值对正常眼有效，但青光眼眼不是正常眼。GEA 的概念可以为我们提供一个新的视角来解释眼压值，并评估眼压控制作为青光眼治疗的真正价值。应用 GEA 理论可以调整眼压的作用。其他因素，如眼部特征（RGCL 状态、CCT、眼压波动曲线）、眼部合并症（PEX、PDS）、全身合并症（高血压、偏头痛或雷诺氏综合征等血管痉挛性疾病）或患者对青光眼管理的态度（治疗依从性、获得随访和治疗），可能会极大地影响 GON 的进展，在为每位患者制定管理计划时应全面考虑这些因素。在临床实践中应用 GEA 的概念可以更现实地了解疾病的病理生理学，并为每位患者量身定制青光眼治疗方案。AG=晚期青光眼，BP=血压，CCT=中央角膜厚度，CIGTS=合作性初始青光眼治疗研究，CNTGS=合作性正常眼压青光眼研究，EMGT=早期显性青光眼试验，GEA=青光眼病因区域，GON=青光眼视神经病变，IOP=眼压，NTG=正常眼压青光眼，OHTS=眼压升高研究，PDS=色素播散综合征，PEX=假性剥脱综合征，POAG-原发性开角型青光眼，RGCL=视网膜神经节细胞层，VFL=视野丧失。
