Migraine and Elevated IOP Increase the Risk of Low Ocular Perfusion Pressure, May Associate with Increased Risk of Glaucoma

Table of Content

Introduction

Glaucoma is a multifactorial disease characterized by progressive optic neuropathy and associated visual field loss. The main risk factor for development and progression of glaucoma is increased intraocular pressure (IOP) however, it does not explain the full picture as some patients conditions progress despite a significantly lowered IOP.

Aim

To investigate the associations between mean ocular perfusion pressure (MOPP) and several variables including body mass index (BMI), comorbid medical conditions and various ocular parameters in a population-based sample.

Patient Profile

  • Adults ≥40 years of age who were screened for glaucoma
Table 1: Baseline and clinical characteristics

Female gender

74.1% (n = 1549)

Hypertension

33.0% (n = 691)

Diabetes

12.4% (n = 260)

Coronary heart disease

9.1% (n = 190)

Migraine

3.3% (n = 69)

Obesity

35.2% (n = 737)

History of smoking

22.4% (n = 469)

Elevated IOP (≥21 mmHg)

4.6% (n = 96)

Methods

  • Data of 2091 healthy participants from a previous population based cross-sectional study were reviewed
  • Participants were initially interviewed face-to-face using a standard questionnaire which aimed to collect data on their self-reported medical history including presence of hypertension, diabetes, coronary heart disease, migraine, family history of glaucoma and smoking status
  • Height, weight, systolic and diastolic blood pressures (SBP, DBP) were measured at the time of the interview by a proficient research technician after a 10-minute resting period
  • A basic ocular examination was performed which included IOP and central corneal thickness measurement, slit-lamp examination and non-mydriatic optic disc photography.
  • MOPP was calculated using the formula -IOP
  • Low MOPP was defined as MOPP ≤45 mmHg

Results

  • The analysis included patients with a mean age of 63.04 ± 9.7 years and the majority were women (74.1%)
  • Mean MOPP values (p < 0.001, in all pairwise comparisons)
    • normal weight (BMI < 25): 46.9 ± 9.0 mmHg
    • overweight (BMI = 25-29.9) :48.6 ± 9.2 mmHg
    • obese individuals: 50.7 ± 10.0 mmHg  
  • Mean MOPP was significantly different across the age groups (p < 0.001, in all pairwise comparisons)
    • the highest MOPP noted in subjects aged >70 years (52.0 ± 9.5 mmHg) followed by the age range 56-59 years (49.2 ± 9.4 mmHg) and ≤55 years (45.2 ± 8.8 mmHg)
  • Men (48.1 ± 8.3 mmHg) had slightly lower MOPP values in comparison to women (49.2 ± 10.0 mmHg, p < 0.05)
  • Migraine and IOP elevation (per 1 mmHg increment) were significantly associated with a low MOPP (OR: 2.10 and 1.22, p = 0.008 and < 0.001, respectively)
  • Risk of low MOPP was reduced in subjects with hypertension, and with increasing age and BMI
Table 2: Univariable and Multivariable Logistic Regression Showing Determinants of low MOPP

Variable

Univariable*

Multivariable

 

OR (95% CI)

p value

OR (95% CI)

p value

Age (per 1-year increment)

0.95 (0.94-0.96)

<0.001

0.97 (0.96–0.98)

<0.001

Gender

 

 

 

 

Female (reference)

 

 

 

 

Male

1.03 (0.84–1.27)

0.78

 

 

BMI (per 1-unit increment)

0.95 (0.93–0.97)

<0.001

0.95 (0.93–0.97)

<0.001

Hypertension

0.16 (0.12–0.21)

<0.001

0.15 (0.11–0.20)

<0.001

Diabetes

1.00 (0.74–1.34)

0.97

 

 

Coronary heart disease

0.74 (0.52–1.06)

0.10

 

 

Migraine

1.80 (1.10–3.00)

0.02

2.10 (1.22–3.63)

0.008

Family history of glaucoma

1.14 (0.87–1.51)

0.35

 

 

History of smoking

1.18 (0.94–1.50)

0.16

 

 

CCT ≤540 μm

0.86 (0.70–1.05)

0.14

 

 

IOP (per 1 mmHg increment)

1.16 (1.12–1.20)

<0.001†

1.22 (1.17–1.26)

<0.001†

DA (per 0.1 mm2 increment)

 

 

 

 

Presence of α zone

1.06 (0.85–1.32)

0.62

 

 

Presence of β zone

1.08 (0.76–1.56)

0.66

 

 

Body mass index (BMI), Central corneal thickness (CCT), Intraocular pressure (IOP), Disc area (DA), *Univariable analyses were adjusted for age and gender, † adjusted for CCT

Conclusion

  • The study demonstrated that the risk of low MOPP was reduced in subjects with hypertension and with increasing age and BMI
  • Moreover, migraine and IOP elevation (per 1 mmHg increment) were significantly associated with a low MOPP which would be associated with defective autoregulation and increased risk of glaucoma

Reference

Japanese Journal of Ophthalmology 2020. https://doi.org/10.1007/s10384-020-00728-1