COMMENTARY

Intraocular Pressure and Hemodialysis

Shuchi B. Patel, MD

Disclosures

March 17, 2014

Viewpoint

Given the significant number of patients on hemodialysis, it is important to analyze its effect on the progression of glaucoma, another entity that is common in a similar population.

This study addressed not only how dialysis affects IOP but also ocular perfusion pressure, which has been shown to be important in the progression of glaucoma. This is a unique aspect of this study, as opposed to the myriad previous studies correlating hemodialysis and IOP in which no definitive conclusion was reached. Some studies have suggested that IOP increases with hemodialysis,[1,2,3] whereas others have demonstrated no significant change in IOP, or even a reduction in IOP, with hemodialysis.[4,5,6,7,8,9]

One reason for the contradictory findings from different studies may be whether the hemodialysis patient has coexisting glaucoma and the mechanism of glaucoma. Patients without glaucoma may experience a reduction in IOP with hemodialysis, whereas those with glaucoma (particularly narrow angles) may experience an increase in IOP. This study seems to support the findings that those with glaucoma may be at higher risk for progressing because of an increase in IOP during and after hemodialysis.

The other important finding is the reduction in OPP with dialysis. This reduction, as well as the temporary increase in IOP, may explain why some patients with otherwise well-controlled IOP when measured in the clinic seem to still progress in terms of glaucomatous damage.

These findings and the difficulty in slowing progression in certain populations, especially patients on hemodialysis, suggest that further studies should be pursued. Studies examining specific subsets of patients should be the next step. Comparing the IOP and OPP in patients without glaucoma with those who have primary open-angle glaucoma, secondary open-angle glaucoma, low-tension glaucoma, or narrow angles/closed angles would provide useful information on the pathophysiology of why progression occurs with hemodialysis. Also, comparing patients with filtering surgery or laser surgery with those who have not had any intervention would provide important information for future treatment of patients with glaucoma who are on dialysis.

Abstract

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....