Simultaneous management of blood flow and IOP in glaucoma

Factors other than intraocular pressure (IOP) elevation must be involved in initiation and progression of glaucoma. An additional element in disease c ausation may be ischemia in the retina and optic nerve head. Ischemic damag e to neurons in the CNS is similar mechanistically and histopathologically to changes seen in glaucoma. Further, glaucoma patients with normal IOP sho w clear evidence for cerebral and ocular ischemia. Aging and atherosclerosi s reduce the ability of the eye to autoregulate blood flow when ocular perf usion pressure changes: the dependence of blood flow on perfusion pressure links ischemia to IOP. Consequently, neuroprotective treatments for glaucom a should be designed to both reduce IOP and improve ocular nutrient deliver y.