FLAMMER SYNDROME-EYE BEYOND INTRAOCULAR PRESSURE Original Article ARIJITA BANERJEE * , INDU KHURANA * Dr. B. C. Roy Multi-Speciality Medical Research Centre, IIT Kharagpur, West Bengal 721302, India, Ex-Head Department of Physiology, PGIMS Rohtak, India Email: b.arijita@gmail.com Received: 07 Feb 2022, Revised and Accepted ABSTRACT : 29 Mar 2022 Objective: Flammer syndrome or Vascular dysregulation has nowadays become an important topic of debate since it is said to pose a risk in development of glaucomatous optic neuropathy, besides raised intraocular pressure. Our study was implemented to determine the role of flammer syndrome, far less known and often neglected in pathogenesis of glaucomatous optic neuropathy. Methods: The study group consisted of forty age and sex-matched diagnosed normal-tension glaucoma subjects and forty healthy controls. Each of them completed the Flammer syndrome questionnaire. T test was used for data analysis. Results: Statistically significant differences in symptoms like increased sensitivity (cold, drugs, smell, pain), long sleep onset time and a reduced feeling of thirst were existed between cases and control groups (p<0.001). They also demonstrated increased sensation to a few signs and symptoms like cold hands/feet, dizziness, migraines, headaches, and pain compared to controls but not significantly. Conclusion: The study could explain the possible relationship between normal-tension glaucoma and Flammer syndrome. Further research to be done to confirm this link in order to prevent the onset of glaucomatous optic neuropathy. Keywords: Normal-tension glaucoma, Optic neuropathy, Primary vascular degeneration, Autoregulation © 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/) DOI: https://dx.doi.org/10.22159/ijpps.2022v14i5.44348. Journal homepage: https://innovareacademics.in/journals/index.php/ijpps. INTRODUCTION The classical triad of Glaucomatous optic neuropathy (GON) constitutes retinal ganglion cell loss, optic disc cupping and visual field defects. In normal-tension glaucoma (NTG) patients, where intraocular pressure is under normal range (10-21 mmHg), decreased blood flow at the ocular level may be due to a primary component or secondary to GON is the sole reason behind it. However, vascular dysregulation is not confined to the eye but can be seen in the capillaries of the nail bed, which indirectly supports the presence of the primary component [1, 2]. The patients with Flammer syndrome react to multiple stimuli, for example, cold, and stress which, when gets provocated could predispose to serious diseases. Studies of potential links between different health conditions and glaucoma led to much controversy in the literature because that authors used the term glaucoma sometimes for an IOP increase (a risk factor for GON). Rather all the risk factors for arteriosclerosis were also risk factors for an IOP increase. With growing knowledge, the terminology changed from vasospasm over vasospastic syndrome to primary vascular dysregulation and finally to Flammer syndrome. Although this syndrome is harmless, the present research has been conducted to emphasize the contribution of the same to the occurrence of glaucoma [3, 4]. MATERIALS AND METHODS Methods The study group consisted of forty age and sex-matched normal tension glaucoma patients and forty healthy controls. Informed written consent was taken from each subject prior to the test. Glaucoma patients were diagnosed by the ophthalmology department. The patients whoever on antihypertensive drugs or having any cardiovascular disease were excluded from the study. The study was conducted after the approval of PGIMS Rohtak Institutional Ethical committee under the ‘exempt category’ due to the noninvasive nature of the study. Each individual was asked to fill the questionnaire following which blood pressure recording was taken using aneroid sphygmomanometer and basal heart rate variability (HRV) using ECG lead ІІ in Powerlab 26T Polyrite d system was taken for 5 min and different variables of time and frequency domain were analysed. The Flammer Syndrome Questionnaire (FSQ), prepared originally by the research team ocular blood flow of the department of ophthalmology at University Hospital Basel was used after taking approval from the above- mentioned concerned authority [5]. The 15-item scale consisted of 15 different signs and symptoms of Flammer syndrome. Responses to items along with HRV analysis were measured on a 4-point Likert scale ranging from 0(I do not know) to 3 (often). The mean scores of all the cases and controls were analysed in the form of mean±SD, the higher the score, more is the vascular dysregualtion. The mean score of each item between glaucoma cases and controls was compared by using a simple independent unpaired t test and regression analysis comparing the effect of questionnaire items on NTG patients to control subjects. P<0.05 was considered statistically significant. SPSS 20.0 was used to analyse the data. The FSQ is depicted in fig. 1. Fig. 1: Flammer syndrome-questionnaire Q1. Do you suffer from cold hands or feet (possibly also in the summer) or have other people ever told you that your hands are cold? International Journal of Pharmacy and Pharmaceutical Sciences Print ISSN: 2656-0097 | Online ISSN: 0975-1491 Vol 14, Issue 5, 2022