Abstract
PURPOSE: We tested the hypothesis that a questionnaire-based risk score predicts the prevalence of patients with primary open-angle glaucoma (POAG) with vascular predisposition. METHODS: The Flammer Syndrome Questionnaire (FSQ) was used to determine vascular risk scores in 823 healthy subjects and 512 patients with POAG. Next, we characterized blood flow pulsatility changes within the optic nerve head (ONH) in Flammer syndrome (FS) using laser speckle flowgraphy (LSFG) in 358 eyes of 206 patients with normal-tension glaucoma (NTG). Last, we examined the association between changes in Mean blur rate (MBRAve), an LSFG-derived ONH blood flow measurement, during cold provocation and the FSQ risk score in 56 eyes of 56 patients with NTG. RESULTS: Five FSQ-related symptoms were significantly associated in patients with POAG patients; cold hands/feet (odds ratio [OR] = 1.82), low blood pressure (BP; OR = 3.29), increased response to drugs (OR = 2.27), underweight (OR = 1.99), and tendency toward perfectionism (OR = 1.88). The vascular risk score showed the best discriminative accuracy in differentiating healthy subjects from patients with NTG (area under the curve [AUC] = 0.73). In the NTG eyes, ONH pulsatile blood flow in the FS group was characterized by greater pulsatility. Moreover, the negative correlation between the high FSQ risk score and the cold-induced ONH blood flow reduction was pronounced in eyes with NTG (correlation coefficient = -0.41). CONCLUSIONS: The FSQ risk score can be a screening tool to identify patients with POAG with increased vascular stiffness and further reduced ONH blood flow during cold stress. TRANSLATIONAL RELEVANCE: The vascular risk score may help tailor individual glaucoma care.