Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 581 - 585

Correlation of Intraocular Pressure and Blood Pressure in Different Age Groups

Ravikiran Kisan, Swapnali Ravikiran Kisan, Anitha OR, Chandrakala SP, Rajendra S Koujalagi

1. Assistant Professor, Department of Physiology, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India. 2. Assistant Professor, Department of Biochemistry, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India. 3. Assistant Professor, Department of Physiology SIMS and RC Bangalore, India. 4. Assistant Professor, Department of Anatomy Sri Siddarth Medical College, Agalkote, B.H. Road Tumkur, Karnataka, India. 5. Professor, Department of Physiology, JJM Medical College, Davangere, Karnataka, India.

Correspondence Address :
Ravikiran Kisan,
Assistant Professor,Department of Physiology,
SS Institute of Medical Sciences and Research Centre,
Davangere, Karnataka, India.
Phone: 9945447207
E-mail: drravikirankisan@gmail.com

Abstract

Introduction and Aim: Elevated Intra-ocular Pressure (IOP) is one of the major risk factors for developing glaucoma or glaucomatous optic neuropathy and its progression. Glaucoma is a common ophthalmic disease in India and worldwide and it is a significant cause of visual impairment and blindness. Blindness leads not only to a reduced economical and social status, but it may also result in premature death. Hence, this work was undertaken to study the relationship between IOP and Blood Pressure (BP), so that the prediction of ocular hypertension and its consequences could be forecasted by using more common systemic parameters, i.e., BP.

Methods and Material: 300 apparently healthy subjects who were aged between 25 - 64 years were examined to find out the relationship between IOP and BP. The BP was recorded with the subjects in the supine position. The IOP was recorded by using Schiotz’s tonometer.

Results: The IOP was found to increase with age in both men and women and it was statistically significant. The systolic BP and the diastolic BP were positively and significantly correlated with the IOP.

Conclusion: As a person’s IOP increases along with his/her BP; the subjects with hypertension should be monitored for ocular hypertension. Advancing age was positively associated with the IOP. Hence, in older people, screening needs to be done for high IOP. By symmetry, persons with an elevated IOP suggest that periodic BP monitoring may be indicated for these patients. Hence, a population based screening for elevated IOP and its control could reduce the number of people who are at the greatest risk of glaucoma, which is the second commonest cause for blindness and visual impairment in India and also worldwide.

Keywords

Intra-ocular Pressure, Blood Pressure, Age

Introduction
Human aging is characterized by the progressive constriction of the homeostatic reserve of every organ system. This decline, which is often defined as homeostenosis, is evident by the third decade of life and is gradual and progressive (1). This decreased physiologic reserve in the eye and the cardiovascular system can be manifested by the changes in the intraocular pressure (IOP) and the blood pressure (BP) with increasing age respectively. The intra-ocular pressure (IOP) is maintained by an equilibrium between the aqueous production from the ciliary body and its drainage via the trabecular complex. The mean IOP varies between 10 and 21 mm Hg (mean 16 ± 2.5) (2). Any abnormalities in the IOP may result in the dysfunction of the eye, which in turn may affect the vision. The IOP is affected by various systemic parameters like age, gender and BP. The IOP tends to increase with the age of a person and a change in BP is directly associated with a change in the IOP [3,4]. A medical intervention can bring the BP back to normal, hence preventing the consequences of hypertension. An elevated IOP is one of the major risk factors for developing glaucoma or glaucomatous neuropathy and its progression [5,6]. Glaucoma is a common ophthalmic disease worldwide and a significant cause of visual impairment and blindness. It is the secondleading cause of blindness which is responsible for 23% of all the blindness cases (6). Blindness leads not only to a reduced economical and social status, but it may also result in premature death (7). The World Health Organization has estimated that India has a 1% prevalence of blindness. Of the estimated 8.9 million blind persons in India, 12.8% of the blind cases are caused by glaucoma. The problem is expected to reach alarming proportions by the turn of the century (8). The World Population Projection for 2010 and 2020 derived that by 2020, India would become second in having the maximum number of glaucoma cases, surpassing Europe. From 2010 to 2020, the most detectable change in glaucoma worldwide will be its increase in India. As the proportion of those above 40 years of age increases, the proportional increase in glaucoma will challenge our resources and ingenuity (9). If ocular hypertension or glaucoma are detected early and treated appropriately, their progression and blindness can be prevented. Yet, in the physiologic arena, the detailed variation of the IOP and the BP with reference to different age groups affecting the visual functioning is still not available completely. Hence, this work was undertaken to study the relationship between the IOP and the BP in different age groups, so that the prediction of ocular hypertension and its consequences could be forecasted by using more common systemic parameters, i.e., BP and age.

Material and Methods

The present study was conducted at Davangere, Karnataka, India, after getting the approval of the institutional ethical committee. Three hundred individuals of Davangere city are randomly selected, who were of the age group of 25 to 65 years. Normotensive and newly diagnosed hypertensive (systolic BP upto 160 mmHg and diastolic BP upto 100 mmHg) subjects who were not on any medication and who were asymptomatic were recruited for the study. These were the asymptomatic patients who were found to have hypertension when their BP was checked for screening purposes. After the examination of the IOP, these patients were referred to the Medicine OPD for the management of their BP. Persons with known hypertension who were on treatment were not included in the study. A gonioscopic examination (by using a Goldmann three mirror gonioscope) was done to rule out angle closure glaucoma. Persons with diabetes and any other medical or surgical illness, who were on medication, were not recruited for the study. Also, those who were blind and those with any history of eye surgery were excluded from the study. The written informed consent of the subjects was obtained. After taking a brief history and after a clinical examination, the anthropometric and blood pressure recording was done in with the subjects in the supine position after a 5 min rest, with a mercury sphygmomanometer, in the right upper limb by both the palpatory and the auscultatory methods. The IOP was recorded by using a Schiotz’s indentation tonometer. The instrument was calibrated before each use by placing it on a polished metal sphere and checking it to be sure that the scale reading was ‘zero’. If the reading was not zero, it was readjusted to zero. The patient was laid in the supine position and he/she was asked to look straight upwards on an over head target or on a mark on the ceiling with a fixed gaze. The cornea was anaesthetized with 2–3 drops of 4% topical lignocaine. The tonometer tip and the footplate were wiped carefully with an alcohol swab and they were allowed to air dry. The subject’s eye lids were retracted gently with the left hand without placing tension on the globe. The footplate of the tonometer was placed directly over the cornea by holding its handle with the right hand. The handle of the tonometer was lowered to a position midway between the top and the footplate of the cylinder. Thus, the instrument would act independently by its own weight. The reading on the scale was recorded as soon as the needle became steady. The scale of the Schiotz’s Indentation tonometer is calibrated in such a fashion that each scale unit represents a 0.05 mm protrusion of the plunger. The recording of the IOP was started with a 5.5 gram weight; however, if the scale reading was less than three, an additional weight was added to the plunger to make it 7.5 gram or 10 gram as indicated. The IOP measurement was repeated until three consecutive readings agreed within the 0.5 scale units. The average scale reading and the plunger weight were then converted into the IOP in mmHg by using a conversion chart, the Friedenwald Nomogram. After each use, the tonometer plunger and the footplate were rinsed with water, followed by alcohol and then they were wiped dry by using a lint–free material. After the procedure, a prophylactic antibiotic, Ciprofloxacin eye drops was instilled in both the eyes to prevent infections.

Statistics: The results were presented as mean ± standard deviation (SD). The Student’s t test was used for comparing means of the two groups. Correlation and regression analyses were performed to assess the relationship between the different variables. A ‘p’ – value of 0.05 or less was considered for a statistical significance.

Results

The ages of the subjects ranged between 25 to 64 years. The distributions of the subjects in the different age groups are shown in [Table/Fig-1]. The mean IOP in men and women in the different age groups is shown in [Table/Fig-2]. The IOP increased with the age in both men and women. After controlling the systolic BP and the diastolic BP, the age was found to be positively related to the IOP. As the age increased, the IOP of the subject also increased [Table/Fig-3], [Table/Fig-4].

A correlation analysis was performed to assess the relationship between the age, systolic BP, diastolic BP, the pulse pressure, the mean arterial pressure and the IOP and this relationship were statistically significant (P < 0.001) [Table/Fig-5]. By the correlation analysis study, the IOP of the subjects could be predicted from their age and Blood pressure by using the following formulae: In males: IOP in mmHg = 12.0 + 0.08 (Age in years) In females: IOP in mmHg = 14.2 + 0.04 (Age in years) IOP = 7.53 + 0.05 (Age) + 0.07 (MAP) – 0.01 (PP)

Discussion

Glaucoma is the commonest cause of irreversible blindness worldwide and the second most common cause of blindness overall, after cataract. It affects approximately 70 million people and among them, 7 million are blind (10). Glaucoma or glaucomatous optic neuropathy is characterized by a chronic, slowly progressive loss of the retinal ganglion cells and their neurons. An elevated IOP is one of the major risk factors for developing glaucomatous optic neuropathy (11). Open angle glaucoma is a leading cause of visual impairment and blindness [12,13]. Ocular hypertension is a predisposing factor for open angle glaucoma or glaucomatous optic neuropathy. The knowledge of their cause, their natural history and the risk factors of thesedisorders is incomplete. The IOP is widely regarded as the most important modifiable risk factor which is associated with the development of glaucomatous optic neuropathy [14-18]. Therefore, the factors that influence the IOP and its measurement are of great relevance in understanding the pathogenesis of the disease and in reducing the burden of blindness. The correlates of this measurement include other physiologic parameters that may be needed to be considered in investigating the determinants of the IOP. We briefly investigated and described the relationship between age, BP, gender and IOP. In the present study, the IOP correlated positively with age in both men and women. The increase in the IOP with age was statistically significant. Old age has been reported as a risk factor for the development of glaucoma in patients with ocular hypertension, in multiple progression studies [16,18]. Several population based studies have found that the incidence of open angle glaucoma increased with the older age groups (18) In a study, there was a strong evidence that old age was an independent risk factor for the progression of ocular hypertension and glaucoma (18).

In elderly individuals, the onset of the structural changes in the trabecular meshwork results in a reduction in the trabecular outflow facility and the uveoscleral outflow and hence an elevated IOP in the older age group [19-21]. Aging is associated with a modest elevation of the IOP and it is also linked to a progressive decline in the cerebral and the ocular perfusion (22). Older patients with glaucoma may have dysfunction of the ocular blood flow auto regulation (22). Other possible risk factors for the development of ocular hypertension or glaucoma in old age are : local vasospasm, sleep apnoea, abnormalities of the connective tissue of the lamina cribrosa, primary ganglion cell degeneration, systemic hypertension and atherosclerosis [22,23]. An increased age may reflect the cumulative effects of some other factors that cause the aging optic nerve head to be more vulnerable to the elevated IOP and even sometimes to the normal range of the IOP (15). The findings from our study indicated that systolic BP, diastolic BP, PP and MAP were positively independently correlated to the IOP and that the correlations were statistically significant. Some studies have found that a change in the IOP was directly and significantly associated with a change in the BP [14,15,24-28]. A positive association between the systolic BP and a raised IOP has constantly been shown in both cross sectional and longitudinal studies [24,29-32]. Some studies have shown that the diastolic BP was positively associated with a raised IOP [4,33,34].

The IOP may have been increased in patients with an increased BP due to an increased retinal blood volume after a rise in the central retinal vein pressure because of an increased pressure in the adjacent central retinal artery (34); an increased blood volume in the ciliary body and a decreased facility of the aqueous outflow, owing to an increase in the resistance in the episcleral and the anterior ciliary veins (34); an increased ultrafiltration of the aqueous fluid in the ciliary body, owing to the increased perfusion pressure in the ciliary arteries; [4,19,33-36] obstruction to the aqueous drainage at the anterior chamber angle due to the increasing episcleral venous pressure [3,4,34]. The IOP rises and falls by 1 mmHg with every heart beat; during systole, the centralretinal artery compress the accompanying vein to increase the vascular resistance in this vessel (34). Follow-up studies which were done for five years have shown that the cumulative probability of untreated patients developing glaucoma was calculated to be greater than twice the rate of that in the treated patients (16). The findings from this study indicate that the IOP increased with age in both men and women and that it was statistically significant. The systolic BP and the diastolic BP were positively and significantly correlated with the IOP.

Conclusion

It can be concluded that persons with hypertension and advancing age need to be monitored for high IOP. By symmetry, in persons with an elevated IOP, periodic BP monitoring may be indicated. Hence, a population based screening for an elevated IOP and its control could reduce the number of people who are at the greatest risk of glaucoma, which is the second commonest cause for blindness and visual impairment in India and also worldwide.

References

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Kasper DL, Braundwald E, Fauci AS, Hauser SL, Longo DL, Jame son JL. Harrison’s Principles of Internal Medicine. 16th ed. United States of America: The McGraw Hill Companies; 2005; 44. (vol.II).
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Khurana AK, Khurana I. Anatomy and Physiology of the Eye. 2nd ed. New Delhi: CBS Publishers and Distributors; 2006; 44-81.
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Kaufman PL, Alm A. Alder’s Physiology of the Eye: clinical application. 10th ed. Missouri: Mosby (inc); 2003; 235-71.
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Klein BEK, Klein R, Knudtson MD. Intra-ocular pressure and systemic blood pressure: a longitudinal perspective: the Beaver Dam eye study. Br J Ophthalmol 2005; 89: 284-7.
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Pache M, Flammer J. A sick eye in a sick body? Systemic findings in patients with primary open-angle glaucoma. Surv Ophthalmol 2006; 51(3): 179-212.
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Mansbeger SL, Demirel S. Early detection of glaucomatous visual field loss: why, what, where and how? Ophthalmol Clin N Am 2005; 18: 365-73.
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Park K. Park’s Textbook of Preventive and Social Medicine. 18th ed. Jabalpur: Banarsidas Bhanot Publishers; 2005; 319-23.
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Jacob A, Thomas R, Koshi SP, Braganza A, Muliyil J. Prevalence of primary glaucoma in an urban south – Indian population. Indian J Ophthalmol 1998; 46: 81-6.
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