EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/194331
October 2013 If further studies support these new findings, Dr. Aref said "this relationship would have a profound clinical impact, as it would give ophthalmologists an objective sign to determine risk of glaucoma in association with OSA." Take-home messages An example of floppy eyelid syndrome Source: Francis S. Mah, MD "It could be possible that the elastic fiber depletion described in FES and OSA could indicate some of the characteristics present in other ocular structures, such as lamina cribrosa or/and trabecular meshwork," said MªJesús Muniesa Royo, MD, Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Lleida, Spain. "These changes could increase the risk of glaucoma in OSA patients affected by FES. The hypothesis is that a subtle form of underlying generalized connective tissue alteration could be responsible for the relationship between OSA, glaucoma and FES." In Dr. Royo's study,2 the results suggested OSA could be a subset of lax eyelid conditions and once that laxity reaches a certain threshold, patients would be at risk for developing FES with inflammatory sequelae of the conjunctiva, cornea, and tear film. "These changes could explain how OSA, eyelid hyperlaxity, and FES could be different manifestations of the same disease," Dr. Royo said. In fact, the study found among patients with FES, the prevalence of OSA was 85%, and most of the OSA was considered serious. "FES may be a predictive factor for the presence of glaucoma in patients with OSA." Clinicians should consider "routine screening of newly diagnosed FES patients for symptoms of sleep apnea and consider referral to a sleep specialist," Dr. Royo said. For patients who have glaucoma progression at pressure levels previously deemed to be adequate, "the clinician should seriously consider an underlying diagnosis of OSA potentially contributing to nocturnal optic nerve perfusion abnormalities and causing non-pressure, dependent disease progression," Dr. Aref said. At a minimum, he suggested clinicians question nighttime sleeping habits (snoring, apneic episodes). "There should be an extremely low threshold for OSA work-up in these circumstances as this disorder may not only impact glaucomatous progression, but may have serious general health consequences such as increased risk of cardiovascular and cerebrovascular events," he said. EW References 1. Aref AA. What happens to glaucoma patients during sleep? Curr Opin Ophthalmol. 2013;24(2):162-6. 2. Muniesa MJ, Huerva V, Sanchez-de-la-Torre M, Martinez M, Jurjo C, Barbe F. The relationship between floppy eyelid syndrome and obstructive sleep apnoea. Br J Ophthalmol doi:10.1136/bjophthalmol-2012-303051 [online ahead of print]. 3. Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: A population-based matched-cohort study. Ophthalmology. 2013 Apr 16. pii: S0161-6420(13)00008-0. doi: 10.1016/ j.ophtha.2013.01.006 [Epub ahead of print]. Editors' note: The physicians have no financial interests related to this article. Contact information Aref: aaref@uic.edu Royo: +34 649 297 040, mariajesus.muniesa@gmail.com