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1 (ET-1) opposes NO, leading to a state of 2004. 2011. http://www.nei.nih.gov/news/ 14. Kannel WB, McGee DL. Diabetes and cardiovascular
vasoconstriction, and increased aqueous pressreleases/041204.asp (accessed 18 Jul 2011). risk factors: the Framingham study. Circulation
2. Klein BE, Klein R, Jensen SC. Open-angle glaucoma 1979;59:8e13.
humour levels of ET-1 have also been and older-onset diabetes. The Beaver Dam Eye Study. 15. Stroman GA, Stewart WC, Golnik KC, et al.
found in patients with glaucoma.25 The Ophthalmology 1994;101:1173e7. Magnetic resonance imaging in patients with low-
roles of NO and ET-1 in glaucoma and 3. Dielemans I, de Jong PT, Stolk R, et al. Primary tension glaucoma. Arch Ophthalmol
diabetes provide a potential mechanism open-angle glaucoma, intraocular pressure, and 1995;113:168e72.
diabetes mellitus in the general elderly population. 16. Zhang L, Krzentowski G, Albert A, et al. Risk of
for vascular dysfunction in both diseases.
The Rotterdam Study. Ophthalmology developing retinopathy in diabetes control and
The relationship between glaucoma and 1996;103:1271e5. complications trial type 1 diabetic patients with good
diabetes is not well established, and 4. Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. or poor metabolic control. Diabetes Care
several important questions remain. While Predictive factors for glaucomatous visual field 2001;24:1275e9.
multiple studies currently seem contro- progression in Advanced Glaucoma Intervention 17. Balluz LS, Okoro CA, Mokdad A. Association
Study. Ophthalmology 2004;111:1627e35. between selected unhealthy lifestyle factors, body
versial, could this discrepancy be due to 5. Tielsch JM, Katz J, Sommer A, et al. Hypertension, mass index, and chronic health conditions among
differing levels of diabetes that are evalu- perfusion pressure, and primary open-angle individuals 50 years or age or older, by race/ethnicity.
ated? For example, the Beaver Dam Eye glaucoma. A population based assessment. Arch Ethn Dis 2008;18:450e7.
Study used treatment of diabetes as an Ophthalmol 1995;113:216e21. 18. McGill JB. Improving microvascular outcomes
6. Quigley HA, West SK, Rodriguez J, et al. The in patients with diabetes through management
inclusion factor,2 while the Rotterdam Eye
prevalence of glaucoma in a population-based study of hypertension. Postgrad Med
Study excluded such patients.3 Second, of Hispanic subjects: Proyecto VER. Arch Ophthalmol 2009;121:89e101.
should patients with diabetes be evaluated 2001;119:1819e26. 19. Berisha F, Feke GT, Hirose T, et al. Retinal blood flow
for vascular dysfunction and for the pres- 7. Sommer A, Tielsch JM, Katz J, et al. Relationship and nerve fiber layer measurements in early-stage
ence of other vascular diseases, such as between intraocular pressure and primary open angle open-angle glaucoma. Am J Ophthalmol
glaucoma among white and black Americans. The 2008;146:466e72.
hypertension? Finally, do patients with Baltimore Eye Survey. Arch Ophthalmol 20. Krentz AJ, Clough G, Byrne CD. Interactions
diabetes warrant more aggressive preven- 1991;109:1090e5. between microvascular and macrovascular disease in
tion and therapy of glaucoma? Better 8. Bonomi L, Marchini G, Marraffa M, et al. Vascular diabetes: pathophysiology and therapeutic
treatment of both diseases lies in the risk factors for primary open angle glaucoma: the implications. Diabetes Obes Metab 2007;9:
EgnaeNeumarkt Study. Ophthalmology 781e91.
answers to these questions.
2000;107:1287e93. 21. van Hecke MV, Dekker JM, Nijpels G, et al. Are
Competing interests None. 9. Orzalesi N, Rossetti L, Omboni S, et al; OPTIME retinal microvascular abnormalities associated with
Study Group (Osservatorio sulla Patologia large artery endothelial dysfunction and intima-media
Contributors Conception and design: SP, AH, BS, GG&
glaucomatosa, Indagine Medico Epidemiologica); thickness? The Hoorn Study. Clin Sci (Lond)
Drafting the manuscript: Critical revision: SP, AH, BS,
CONPROSO (Collegio Nazionale dei Professori Ordinari 2006;110:597e604.
GG. AH proposed project idea. SP carried out the
di Scienze Oftalmologiche). Vascular risk factors in 22. Creager MA, Lüscher TF, Cosentino F, et al.
relevant literature searches and drafting of manuscript
glaucoma: the results of a national survey. Diabetes and vascular disease: pathophysiology,
with the aid of BS and GG, both of whom continually
Graefes Arch Clin Exp Ophthalmol clinical consequences, and medical therapy: Part I.
aided in the reshaping of the project. SP, AH, BS and GG
2007;245:795e802. Circulation 2003;108:1527e32.
were involved in the critical revision and approval prior to
10. Akarsu C, Bilgili MY. Color Doppler imaging in ocular 23. Liu B, Neufeld AH. Activation of epidermal growth
publication.
hypertension and open-angle glaucoma. Graefes Arch factor receptor signals induction of nitric oxide
Provenance and peer review Not commissioned; Clin Exp Ophthalmol 2004;242:125e9. synthase-2 in human optic nerve head astrocytes in
internally peer reviewed. 11. Logan JF, Rankin SJ, Jackson AJ. Retinal blood flow glaucomatous optic neuropathy. Neurobiol Dis
measurements and neuroretinal rim damage in 2003;13:109e23.
Accepted 20 August 2011 glaucoma. Br J Ophthalmol 2004;88:1049e54. 24. Liao Q, Wang DH, Sun HJ. Association of genetic
Published Online First 6 October 2011 12. Ludovico J, Bernardes R, Pires I, et al. Alterations of polymorphisms of eNOS with glaucoma. Mol Vis
Br J Ophthalmol 2011;95:1621e1622. retinal capillary blood flow in preclinical retinopathy in 2011;17:153e8.
doi:10.1136/bjophthalmol-2011-300788 subjects with type 2 diabetes. Graefes Arch Clin Exp 25. Iwabe S, Lamas M, Vasquez Pelaez CG, et al.
Ophthalmol 2003;241:181e6. Aqueous humor endothelin-1 (ET-1), vascular
13. Dimitroya G, Kato S, Yamashita H, et al. Relation endothelial growth factor (VEGF) and cyclooxygenase-
REFERENCES between retrobulbar circulation and progression of 2 (COX-2) levels in Mexican glaucomatous patients.
1. NIH National Eye Institute. ‘Vision Loss from Eye diabetic retinopathy. Br J Ophthalmol Curr Eye Res 2010;35:287e94.
Diseases Will Increase as Americans Age’ April 12, 2003;87:622e5.
These include:
References This article cites 24 articles, 5 of which you can access for free at:
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Notes