Ocular autonomic dysfunction in glaucoma

The retina relies primarily upon autoregulation of the retinal vasculature in cases of increased metabolic demand or reduced ocular perfusion pressure. The choroidal blood vessels are highly innervated by the autonomic nervous system, but are separated too far from the retina to respond to the local accumulation of vaso-active metabolites. It could therefore be hypothesized that conditions interfering with either the autoregulation or the autonomic nervous regulation could render the retina at a higher risk of ischemic damage. Glaucoma has been associated with disturbances in both types of regulation. Retinal oximetry is capable of providing reproducible in vivo, non-invasive measurements of the retinal vessel oxygen saturation and with the advent of enhanced depth imaging optical coherence tomography (EDI-OCT), allowing a detailed non-invasive evaluation of the choroid in-vivo, renewed interest in the role of the choroid in the pathogenesis of glaucoma has grown.