Hemodialysis & Glaucoma

Do you know the dynamics?...

The effects of hemodialysis on our glaucoma patients can be significant and should be part of our thought process as we continue to manage them.

By understanding vascular dynamics which occur during hemodialysis sessions, individuals with glaucoma are more likely to experience fluctuations in intraocular pressure (IOP) with increased variability compared to non-glaucomatous individuals. These IOP changes can also go unnoticed, as many patients are asymptomatic even if pressure spikes dramatically - sometimes exceeding 25 mmHg! Additionally, ocular perfusion pressure (OPP) tends to drop more significantly during dialysis, only exacerbating the risk of glaucomatous progression. Finally, the interplay between hemodialysis and certain glaucoma medications such carbonic anhydrase inhibitors (CAI's) requires careful consideration as well, with rapid shifts in fluid and solute levels potentially altering the effectiveness of treatment.

This is a reminder that outcomes for our glaucoma patients undergoing hemodialysis can very well be subject to change. By understanding these dynamics and potential cumulative effects, we can more effectively adjust and personalize our management in terms of treatment approach, follow-up, with more frequent OCT imaging and VF's justifiable over the long-term.

- JRM

Go to the article in Clinical Ophthalmology HERE.