open access


Purpose: The aim of this study was to examine ocular blood flow parameters that may predict structural and functional disease progression in open-angle glaucoma (OAG) patients of different diabetic status, gender, ethnicity, and body mass index (BMI).

Methods: One hundred twelve patients with OAG were assessed for systemic blood pressure (BP), ocular perfusion pressure (OPP), retrobulbar blood flow, capillary blood flow, and optic nerve head morphology at baseline and every six months for a five-year period. Structural progression was monitored with optical coherence tomography and Heidelberg retinal tomography-III. Functional disease progression was monitored with automated perimetry using Humphrey visual fields. Factors associated with OAG structural and functional progression were analyzed using Cox proportional hazards models.

Results: The following were associated with shorter time to structural progression: In diabetic patients, larger area of avascular space; in males, lower central retinal artery peak systolic velocity and end diastolic velocity; in patients of African descent, higher systolic BP and OPP; in obese patients, lower ophthalmic artery end diastolic velocity. The following were associated with shorter time to functional progression: In diabetic patients, cup area, cup volume, cup/disc area ratio, linear cup/disc ratio, mean cup depth, cup shape; in males, systolic BP, diastolic BP, mean arterial pressure, systolic PP, diastolic PP, OPP, mean PP; in overweight patients, higher ophthalmic artery and central retinal artery resistive indices; in obese patients, lower central retinal artery resistive index.

Conclusions: Structural and functional OAG disease progression may be influenced differently in patients based on diabetic status, gender, ethnicity, and BMI. Mathematical modeling of risk variables that takes into account demographic characteristics may assist in better identifying OAG progression risk.