SAN DIEGO – A presenter here at Optometry’s Meeting said that because sleep apnea is a recognized risk factor for cardiovascular and neurovascular disease, “it probably fits into the realm of glaucoma.”
Eric Schmidt, OD, who was part of a panel discussion on glaucoma, told attendees: “It creates changes in oxygenation and circulatory, hemodynamic and inflammatory factors. It sets up repeated bouts of apoxia throughout the night. Hypo-oxygenation of blood and sympathetic vasoconstriction may lead to optic nerve hypoxia.”
In a 2003 study by Bendel, 33% of patients with severe sleep apnea were diagnosed with glaucoma, Schmidt said.
“The conclusion was that occlusive sleep apnea may be a modifiable risk factor for glaucoma,” he said. “It was recommended that all patients with sleep apnea be screened for glaucoma.”
Another study looked at healthy patients with no prior history of glaucoma. The patients were divided into four groups: no sleep apnea, mild sleep apnea, moderate or severe.
No one with sleep apnea developed hypertension, Schmidt said, and 7.9% of those with severe sleep apnea developed normal tension glaucoma.
“Sleep apnea had no effect on IOP; this is clearly a vasoocclusive problem,” he said. “Not one patient developed open-angle glaucoma.”
This begs the question: Does sleep apnea cause glaucoma, or do people with normal-tension glaucoma develop sleep apnea because of vasoocclusive disorder?
“To me, sleep apnea severe enough to have CPAP use is a strong risk factor for glaucoma,” Schmidt concluded.
Panel member Joseph Sowka, OD, said, “For those patients with glaucoma who are failing and should be doing well, look at the possibility of sleep apnea.”
Richard Madonna, OD, another panel member, added: “Individualize your care for glaucoma patients. You’re not just talking about IOP.”
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