Eye microcirculation in glaucoma. Part 3. Hypotensive therapy effect

Glaucoma is the main cause of irreversible vision loss in developed countries. Currently, glaucoma is defined as a group of multifactorial diseases with similar clinical, morphological, and functional manifestations. The main cause of blindness is progressive death of retinal ganglion cells, leading to optic neuropathy. Currently, mechanical and vascular mechanisms are suggested to play a key role in the development of primary glaucoma. The mechanical process includes compression of the axons caused by increased intraocular pressure. The vascular component suggests reduced blood flow and ocular perfusion pressure. Examination methods of the eye vasculature in glaucoma are constantly being improved and range from invasive, including angiography with fluorescein and indocyanine intravenous administration, to high-tech non-contact types such as color flow Doppler and pulsed wave Doppler, optical coherence tomography angiography, and laser speckle flowgraphy. This review provides the assessment of retrobulbar and ocular blood flow in patients with glaucoma and ocular hypertension receiving different therapies. Rapidly advancing technologies allow developing and studying highly informative methods for assessing ocular blood flow, thus contributing to better understanding of eye microcirculation and the development of new effective glaucoma therapies.