Hemodynamic instability and retinal vein occlusion in glaucoma: Comparative analysis of heart rate variability and choroidal perfusion

TL;DR

This study found that reduced heart rate variability may be linked to retinal vein occlusion in glaucoma patients, suggesting a potential marker for risk.

Contribution

The study introduces heart rate variability as a potential vulnerability marker for retinal vein occlusion in glaucoma patients.

Findings

HRV parameters SDNN and rMSSD were significantly lower in glaucoma patients with RVO.

Choroidal vascularity index differed significantly between RVO and non-RVO groups.

Multivariable analysis did not retain statistical significance for any variable.

Abstract

To assess the hemodynamic and structural differences between glaucoma patients who developed retinal vein occlusion (RVO) and those who did not.

Retrospective, single-center, case-control study

This study included glaucoma patients who underwent a heart rate variability (HRV) test between January 2018 and July 2024. Patients were subdivided into RVO and non-RVO groups. Baseline mean deviation (MD) and pattern deviation (PSD) of the visual field and optical coherence tomography parameters were analyzed.

Twenty-nine glaucoma patients with RVO and 34 glaucoma patients without RVO were included. Baseline MD and PSD had no difference (MD: −5.98 ± 9.05 vs. −3.70 ± 4.70, p = 0.114; PSD: 3.88 ± 3.78 vs. 3.98 ± 3.96, p = 0.883). HRV parameters, specifically Standard Deviation of NN interval (SDNN) and root-mean-square of successive differences (rMSSD), were significantly lower in the RVO group (SDNN: 22.12 ± 8.27 vs. 36.71 ± 24.74, p = 0.002; rMSSD: 16.34 ± 9.55 vs. 29.87 ± 31.58, p = 0.022). A significant difference in choroidal vascularity index was also observed between groups (64.62 ± 7.38 vs. 67.49 ± 5.90, p = 0.045). In a parsimonious multivariable logistic regression model, no variable retained statistical significance.

This study suggests that reduced heart rate variability, reflecting autonomic dysfunction, is associated with the development of RVO in glaucoma patients. Although these associations did not remain statistically significant in multivariable analysis, the consistent univariate findings indicate that HRV may serve as a potential vulnerability marker rather than an independent predictor. Further prospective studies are warranted to clarify the clinical utility of HRV in risk stratification for RVO in glaucoma patients.

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