Treatment of Intraocular Pressure in Elderly Patients

  • Monika Schveoller
  • Iliana Iliu
  • Nicola Pescosolido
  • Angelica Cerulli
Part of the Aging Medicine book series (AGME)


The aim of this paper is to study the effect of many systemic antihypertension drugs on intraocular pressure and on the visual field.

Six hundred patients were enrolled in this experiment with the approval of the Ethical Committee of our hospital. All patients were divided into four groups: the first group of 200 patients was treated with local or systemic administration of a calcium channel blocker; the second group of 200 patients was treated with oral or systemic administration of β-blockers; the third group of 100 patients was treated with systemic administration of ACE inhibitors; and the fourth group of 100 patients was treated with a diuretic drug (acetazolamide). All patients were subjected monthly to measurements of their systemic blood pressure, intraocular pressure, and visual field.

Our results confirm that the oral administration of a calcium channel blocker (nitrendipina) in subjects with moderate essential hypertension and without ocular hypertonia causes systemic effects with a moderate decrease of ocular pressure, while the ocular instillation of the same drug causes a remarkable general hypotensive effect. The scotoma in glaucomatous subjects with normal pressure gets better after the administration of local calcium channel blockers, showing that the peripheral vascular reaction enhances the optical nerve blood flow. The oral administration of β-blockers is also correlated with a reduction of the intraocular pressure, especially if the β-blocker also reduces the systemic blood pressure.

Nadolol, a long half-life, nonselective β-blocker, in a single oral dose of 20 or 40 mg, may result in a remarkable decrease of the intraocular pressure during the whole day. It has been demonstrated that the systemic administration of ACE inhibitors is also effective in reducing intraocular pressure by some mechanisms which, although not known yet, seem to act on the posterior ciliary arteries, shunting the blood to the ciliary body. Finally, acetazolamide, a diuretic usually used to reduce systemic blood pressure, is also able to reduce intraocular pressure. On the other hand, if perfusion pressure is reduced as a consequence of antihypertensive treatment, damage to the visual field could be accelerated.


Low-tension glaucoma open-angle glaucoma antihypertension drug calcium channel blockers β-blockers ACE inhibitors diuretics 


  1. 1.
    Tielsch JM, Katz J, Sommers A, et al. (1995) Hypertension, perfusion pressure, and primary open-angle glaucoma. Arch. Ophthalmol.,113:216–221PubMedGoogle Scholar
  2. 2.
    Patel R and Abreau R (1970) Topica corticosteroid testing of myopic patients. Orient. Arch. Ophthalmol. 8:208–211Google Scholar
  3. 3.
    Becker B and Podos SM (1966) Krukemberg's spindles and primary open angle glaucoma. Arch. Ophthalmol., 76:635–639PubMedGoogle Scholar
  4. 4.
    Goldeberg L, Hollowos FC, Lass MA, et al. (1981) Systemic factors in patients with low-tension glaucoma. Br. J. Ophthalmol. 65:56–62CrossRefGoogle Scholar
  5. 5.
    Riva CE, Sinclair SH and Grunwald JE (1981) Autoregulation of retinal circulation in response to decrease of perfusion pressure. Invest. Ophthalmol. Vis. Sci. 21:34–38PubMedGoogle Scholar
  6. 6.
    Drance SM (1995) Update to glaucoma, ocular blood flow and drug treatment. Kugler (ed)Google Scholar
  7. 7.
    Leighton DA and Phillips CL (1972) Systemic blood pressure in open-angle glaucoma, low tension glaucoma, and the normal eye. Br. J. Ophthalmol. 56:447–453PubMedCrossRefGoogle Scholar
  8. 8.
    Rouhiainen HJ and Terasvirta ME (1990) Hemodynamic variables in progressive and non progressive low tension glaucoma. Acta Opthalmol. 68:34–36CrossRefGoogle Scholar
  9. 9.
    Dielemans I, Vingerling JR, Algra D, et al. (1995) Primary open-angle glaucoma, intraocular pressure, and systemic blood pressure in the general elderly population. The Rotterdam Study. Ophthalmology 102:54–60PubMedGoogle Scholar
  10. 10.
    Bulpitt CJ, Hodes C and Everitt MG (1975) Intraocular pressure and systemic blood pressure in the elderly. Br. J. Ophthalmol. 59:717–729PubMedCrossRefGoogle Scholar
  11. 11.
    Jonas J and Grundler A (1998) Prevalence of diabetes mellitus and arterial hypertension in primary and secondary open-angle glaucomas. Graefe's Arch. Clin. Exp. Ophthalmol. 236:202–206CrossRefGoogle Scholar
  12. 12.
    Kalm HA and Milton RC (1980) Alternative definitions of open-angle glaucoma effect on prevalence and associations in the Framingham Eye Study. Arch. Ophthalmol. 98:2172–2179Google Scholar
  13. 13.
    Klein BE and Klein R (1981) Intraocular pressure and cardiovascular risk factors. Arch. Ophthalmol. 99:837–839PubMedGoogle Scholar
  14. 14.
    Leske MC and Podgot MJ (1983) Intraocular pressure, cardiovascolar risk variables and visual field defects. Am. J. Ophthalmol. 118:280–287Google Scholar
  15. 15.
    Klein BEK, Klein R, Sponsel W, et al. (1992) Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 99:1499–1504PubMedGoogle Scholar
  16. 16.
    Morgan RW and Drance SM (1975) Chronic open-angle glaucoma and ocular hypertension an epidemiology study. Br. J. Ophthalmol. 59:211–215PubMedCrossRefGoogle Scholar
  17. 17.
    Katz J and Sommer A (1988) Risk factors for primary open angle glaucoma. Am. J. Prev. Med. 4:110–114PubMedGoogle Scholar
  18. 18.
    Carter CJ, Brooks DE, Doyle DL and Drance SM (1990) Investigation into a vascular etiology for low-tension glaucoma. Ophthalmology 97:49–55PubMedGoogle Scholar
  19. 19.
    Drance SM (1977) Is ischemia the villain in glaucomatous cupping and atrophy? In: Brockhurst RJ, Bonchoff SA, Hutchinson BJ and Lessel S (eds) Controversy in Ophthalmology. Kluger Philadelphia, 292–300Google Scholar
  20. 20.
    Spaeth GL (1975) Fluorescein angiography its contributions towards understanding the mecchanisms of visual loss in glaucoma. Trans. Am. Ophthalmol. Soc. 73:491–553PubMedGoogle Scholar
  21. 21.
    Chumbley LC and Brubaker RF (1976) Low-tension glaucoma. Am. J. Ophthalmol. 81:764–767Google Scholar
  22. 22.
    Phelps CD and Corbett JJ (1985) Migraine and low-tension glaucoma a case control study. Invest. Ophthalmol. Vis. Sci. 26:1105–1108PubMedGoogle Scholar
  23. 23.
    Sisler HA (1972) Comparative ophtalmodinamometry using scleral pressure, suction and corneal pressure units. Am. J. Ophthalmol. 74:964–966PubMedGoogle Scholar
  24. 24.
    Demmailly P, Aubuer G and Abadie P (1987) Timolol and functional perimetric prognosis of primary open angle glaucoma. J. Fr. Ophtalmol. 71:766–771CrossRefGoogle Scholar
  25. 25.
    Kaiser HJ, Flammer J, Stumplig D and Hendrickson P (1994) Long-term visual field follow-up of glaucoma patients treated with beta blockers. Surv. Ophthalmol. 38 (Suppl. May):156–160CrossRefGoogle Scholar
  26. 26.
    Monica LM, Hesse RJ and Messerli FM (1983) The effect of a calcium channel blocking agent on intraocular pressure. Am. J. Ophthalmol. 96:814PubMedGoogle Scholar
  27. 27.
    Ventura HO, Messerli FH, Oighman W, et al. (1983) Immediate hemodynamic effects of new calcium channel bloking agent (nitrendipine) in essential hypertension. Am. J. Cardiol. 51:783–791PubMedCrossRefGoogle Scholar
  28. 28.
    Kelly SP and Valley TJ (1988) Effects of calcium antagonist nifedipine on intraocular pressure in normal subjects. Br. J. Ophthalmol. 72:216–223PubMedCrossRefGoogle Scholar
  29. 29.
    Abelson MB, Gilbert CM and Smith LM (1998) Sub-stained reduction of intraocular pressure in humans with the calcium channel blocker verapamil. Am. J. Ophthalmol. 105:155–159Google Scholar
  30. 30.
    Beatty JF, Krupin T, Nichols PF and Becker B (1984) Elevation of intraocular pressure by calcium channel blocker. Arch. Ophthalmol. 102:172Google Scholar
  31. 31.
    Bill A (1985) Some aspects of the ocular circulation. Invest. Ophthalmol. Vis. Sci. 26:410–424PubMedGoogle Scholar
  32. 32.
    Johansson B (1978) Process involved in vascular smooth muscle contraction and relaxation. Circ. Res. 34 (Suppl. 1):1–14Google Scholar
  33. 33.
    Vanhoutte PM (1987) Expert committee of the world health organization on classification of calcium antagonist. The viewpoint of the rapport. Am. J. Cardiol. 59:3–9CrossRefGoogle Scholar
  34. 34.
    Netland PA, Chatuervedi N and Dreyer EB (1993) Calcium channel blockers in the menagement of low-tension and open-angle glaucoma. Am. J. Ophthalmol. 115:608–613PubMedGoogle Scholar
  35. 35.
    Glasser P and Flammer J (1987) Influence of vasospasm on visual function. Doc. Ophthalmol. 66:3–18CrossRefGoogle Scholar
  36. 36.
    Suzuki R, Hanada M, Fujii H and Kuimoto S (1992) Effects of orally administered β-adrenergic blockers and calcium channel blockers on the intraocular pressure of patients with treated hypertension. Ann. Ophthalmol. 24:220–223PubMedGoogle Scholar
  37. 37.
    Rennie DG and Smerdon DL (1985) The effect of a once daily oral dose of nadolol on intraocular pressure in normal volunteers. Am. J. Ophthalmol. 100:445–447PubMedGoogle Scholar
  38. 38.
    Duff GR (1987) The effect of twice daily nadolol on intraocular pressure. Am. J. Ophthalmol. 104:343–345PubMedGoogle Scholar
  39. 39.
    Williamson J, Atta HR, Kennedy PA and Moir JG (1985) Effect of orally administered nadolol on the intraocular pressure in normal voluntaries. Br. J. Ophthalmol. 69:38–40PubMedCrossRefGoogle Scholar
  40. 40.
    Williamson J, Young JDH, Atta H, et al. (1985) Comparative efficacy of orally and topically administered β-blockers for chronic simple glaucoma. Br. J. Ophthalmol. 69:41–45PubMedCrossRefGoogle Scholar
  41. 41.
    Ikemoto F and Yamamoto K (1978) Renin angiotensin system in the acqueous humor of rabbits, dogs and monkeys. Exp. Eye Res. 27:723–725PubMedCrossRefGoogle Scholar
  42. 42.
    Weinreb RN, Dandman R, Ryder ML and Friberg TR (1985) Angiotensin converting enzyme activity in Human acqueous humor. Arch. Ophthalmol. 103:34–36PubMedGoogle Scholar
  43. 43.
    Stamek SJ, Wallow HH, Tewksbury DA, et al. (1992) An ocular renin-angiotensin system. Invest. Ophtahlmol. Vis. Sci. 33:1627–1632Google Scholar
  44. 44.
    Kaufman PL and Barany EH (1981) Adrenergic drug effects on acqueous outflow facility following muscle retrodisplacement in the cynomolgus monkey. Invest. Ophthalmol. Vis. Sci. 20:644–51PubMedGoogle Scholar
  45. 45.
    Costagliola C, Di Benedetto R, De Caprio L, et al. (1995) Effect of oral captopril (SO14225) on intraocular pressure in man. Eur. J. Ophthalmol. 5:19–25PubMedGoogle Scholar
  46. 46.
    Sossi N and Anderson DR (1982) Blockage of axonal transport in optic nerve induced by elevation of intraocular pressure. Arch. Ophthalmol. 101:94–98Google Scholar
  47. 47.
    Regoli D and Batabe M (1980) Pharmacology of bradikinin and related kinins. Pharmacol. Rev. 22:1–45Google Scholar
  48. 48.
    Erdos G and Skidgel RA (1987) The angiotensin I converting enzyme. Lab. Invest. 56:345–348PubMedGoogle Scholar
  49. 49.
    McCannel CA, Heinrich SR and Brubaker RF (1992) Acetazolamide but not timolo lowers aqueous humor flow in sleeping humans. Graefe's Arch. Clin. Exp. Ophthalmol. 230:518–520CrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Monika Schveoller
    • 1
  • Iliana Iliu
    • 2
    • 3
  • Nicola Pescosolido
    • 4
  • Angelica Cerulli
    • 5
  1. 1.Department of Ophthalmology, European Ophthalmic Neuroscience ProgramUniversity of PécsPécsHungary
  2. 2.Geriatric Centre University of SalonicaSalonicaGreece
  3. 3.Ophthalmology,Department of Aging SciencesUniversity of Rome “La Sapienza,”RomeItaly
  4. 4.Senior Researcher Section of Ophthalmology, Department of OphthalmologyUniversity of Rome “Tor Vergata,”RomeItaly
  5. 5.Department of OphthalmologyUniversity of Rome “Tor Vergata,”RomeItaly

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