Patients with normal tension glaucoma who develop a branch retinal vein occlusion should be monitored with greater care

The Science behind the Tip

If a branch retinal vein occlusion (BRVO) occurs in a patient with normal tension glaucoma, it tends to occur in the eye that has more advanced glaucoma (1). In a retrospective case - controlled comparative study it has recently been reported that flame-shaped disc haemorrhages are more likely to be found and the rate of progressive visual loss is more rapid than expected in the contralateral eye of patients with normal tension glaucoma who develop a BRVO (1).

The commonest cause of a BRVO is arteriosclerosis secondary to systemic hypertension and vascular risk factors are known to increase the risk of glaucoma progression (2). Reduced retrobulbar blood flow has been reported to be associated with simultaneous functional and structural glaucomatous progression (3).

Contributor: J F Salmon MD Consultant Ophthalmologist - Oxford Eye Hospital (UK)

References:

1) Park HL, Jeon S, Lee MY, Park CK. Glaucoma progression in the unaffected fellow eye of glaucoma patients who developed unilateral branch retinal vein occlusion. AmJ Ophthalmol 2017; 175: 194-200.

2) Blumberg D, Skaat A, Leibmann JM. Emerging risk factors for glaucoma onset and progression. Prog Brain Res 2015; 221: 81-101.

3) Moore NA, Harris A, Wentz S et al. Baseline retrobulbar blood flow is associated with both functional and structural glaucomatous progression over 4 years. Br J Ophthalmol 2016; (bj ophthalmol - 2016 - 308460 (Epub ahead of print).

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand