Cold Sensitivity and Glaucoma: Flammer Syndrome

Many eye diseases have no symptoms, so knowing your “constitution” may help in finding them.
About glaucoma care

According to resident screenings and epidemiological surveys in Gifu Prefecture,
5% of Japanese people aged 40 and over, and 10.8% of those aged 70 and over, have glaucoma,
and about 90% were unaware that they had glaucoma and were not receiving treatment¹.
This is commonly known as the “Tajimi Study”, a glaucoma epidemiological study known worldwide.

It has become clear that people with “cold sensitivity” (cold hands and feet) are prone to glaucoma and other eye diseases.
Here is an introduction to Flammer syndrome².

Slim, with somewhat low blood pressure, fond of exercise and active, with hands and feet that get a little cold easily:
It is the opposite of metabolic syndrome, and these people are usually very healthy.

It is known that blood vessels “regulate” their diameter according to the condition of the body,
and in people with Flammer syndrome the shape of the blood vessels is normal.
What is abnormal is the regulation:
Primary vascular dysregulation (PVD)
– Vasospasm: temporary narrowing of blood vessels
is said to be the characteristic.

Because regulation of small blood vessels is disturbed, the eye, which has the finest blood flow, is thought to be affected.
In many cases, the eye ends up with normal-tension glaucoma.

The oxygen supply that should reach the optic nerve becomes unstable
Oxidative stress damages nerve cells and becomes a cause of glaucomatous optic neuropathy

For glaucoma and enlargement of the optic disc cup, analysis of the optic disc blood vessels³ and the usefulness of OCT angiography⁴ have also been shown.
OCT angiography (optical coherence tomography angiography)

Conditions potentially associated with Flammer syndrome:
Others include
Retinitis pigmentosa
Retinal artery occlusion
Retinal vein occlusion
Central serous chorioretinopathy, which can cause distorted vision
Leber hereditary optic neuropathy

Outside the eye,
Multiple sclerosis
Breast cancer
Altitude sickness
Tinnitus
Sudden sensorineural hearing loss
Anorexia nervosa
Thyroid dysfunction
Angina and ischemic heart disease
Slow recovery from whiplash
and others are listed⁵.

Please check whether any of the following apply to you.

Features of Flammer syndrome:

□ Cold hands and/or feet (cold sensitivity)
□ Low blood pressure (blood pressure drops especially at night)
□ Slim build (low body mass index)
□ Agile
□ Sporty, athletic
□ Long time to fall asleep
□ Reduced feeling of thirst
□ Increased response to certain drugs (some drugs do not agree with you)
□ Increased sensitivity to smells
□ Increased sensitivity to pain
□ Increased sensitivity to high altitude
□ Increased sensitivity to weather changes
□ Increased sensitivity to vibration (difficulty using vibrating devices)
□ Remarkable assiduousness, up to a tendency toward perfectionism
□ Headache
□ Dizziness
□ Tinnitus
□ Muscle cramps

(References)

1. Report of the Tajimi Epidemiological Survey (in Japanese), 2012, Japan Glaucoma Society
2. Konieczka, K., Ritch, R., Traverso, C.E., Kim, D.M., Kook, M.S., Gallino, A., Golubnitschaja, O., Erb, C., Reitsamer, H.A., Kida, T., Kurysheva, N., Yao, K., 2014. Flammer syndrome. EPMA J 5, 11. https://doi.org/10.1186/1878-5085-5-11
3. Flammer, J., Orgül, S., Costa, V.P., Orzalesi, N., Krieglstein, G.K., Serra, L.M., Renard, J.-P., Stefánsson, E., 2002. The impact of ocular blood flow in glaucoma. Progress in Retinal and Eye Research 21, 359–393. https://doi.org/10.1016/S1350-9462(02)00008-3
4. Lévêque, P.-M., Zéboulon, P., Brasnu, E., Baudouin, C., Labbé, A., 2016. Optic Disc Vascularization in Glaucoma: Value of Spectral-Domain Optical Coherence Tomography Angiography. Journal of Ophthalmology 2016,　1-9. https://doi.org/10.1155/2016/6956717
5. Konieczka, K., Erb, C., 2017. Diseases potentially related to Flammer syndrome. EPMA Journal 8, 327–332. https://doi.org/10.1007/s13167-017-0116-4

Note:

This is different from Raynaud’s phenomenon and Raynaud’s disease.