Paying attention to the cerebrovascular system in glaucoma.

In glaucoma, damage to vision pathways in the brain may contribute to vision dysfunction and loss. A large part of the central visual system is located within a watershed area of increased susceptibility to ischemic injury. In addition to glaucomatous central visual neuron injury, glaucoma patients may suffer silent vascular insults from cerebral small blood vessel disease. We hypothesize that "double-hit" mechanisms of injury, such as glaucoma and comorbid cerebrovascular conditions, play a role in glaucomatous susceptibility and disease manifestations in young and aging populations at risk.