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The Ties That Blind

Tight neckwear boosts glaucoma risk, study claims

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, July 29, 2003 (HealthDayNews) -- Wear a tie that's too tight and you run the risk of the eye disease glaucoma.

That's the controversial contention of a new study that says snug neckwear can increase intraocular pressure (IOP) in the eyes, possibly leading to glaucoma.

"If men wear tight neckties when their IOP is measured, it can raise their IOP," says Dr. Robert Ritch, lead author of the study and a professor of clinical ophthalmology at The New York Eye and Ear Infirmary.

The results are twofold, Ritch says. First, if the patient has moderate or severe glaucoma damage, it's possible the increase in IOP caused by a tight tie can heighten the damage. Second, patients without glaucoma whose tight tie falsely increases IOP might end up being treated for glaucoma when they don't need to be, he says.

Ritch became aware of the phenomenon during his regular practice. "I just noticed that some patients had tight neckties, and I just loosened their neckties and their IOP would go down several points," he says.

To quantify his observation, Ritch and his colleagues studied 20 healthy men and 20 men with open angle glaucoma, the most common form of the disease.

The researchers measured IOP while the men weren't wearing neckties, three minutes after they put on a tight necktie, and three minutes after the tie was loosened.

Ritch's team found that in 70 percent of the healthy men, a tight necktie increased mean IOP, as it did in 60 percent of those with glaucoma. Increases in IOP while wearing a tight necktie ranged from more than 2 mmHg to more than 4 mmHg, compared to IOP readings when no ties were worn and after ties were loosened.

Ritch speculates that when a necktie exerts too much pressure on the jugular vein in the neck, pressure is increased in the entire venous system, including in the eye.

Ritch's team reports its results in the August issue of the British Journal of Ophthalmology.

Although there are no reported cases of glaucoma caused by a tight necktie, Ritch says it's theoretically possible.

"If you have glaucoma, don't wear your necktie so tight that it can constrict your neck," Ritch advises. "And if you are going to have your IOP measured during an eye exam, whether you do or don't have glaucoma, loosen your tie," he adds.

According to the Glaucoma Research Foundation, open angle glaucoma is the most common type of glaucoma and affects about 3 million Americans. Open angle glaucoma develops over time as the eyes' drainage canals become clogged.

"Most people have no symptoms and no early warning signs," the foundation says. "If open angle glaucoma is not diagnosed and treated, it can cause a gradual loss of vision. This type of glaucoma develops slowly and sometimes without noticeable sight loss for many years. It usually responds well to medication, especially if caught early and treated."

George Shafranov, an assistant professor and director of the glaucoma section at Yale University, says tight neckties "certainly don't cause glaucoma. Ties do increase IOP if the tie is really pressing on the neck and may make some ophthalmologists believe that glaucoma is present."

Neckties can affect the measurements of IOP, Shafranov says. And a tight necktie is something physicians should be aware of when measuring IOP, in addition to other factors that can increase the pressure during an examination.

More information

To learn more about glaucoma, visit the National Eye Institute or the Glaucoma Research Foundation.

SOURCES: Robert Ritch, M.D., professor of clinical ophthalmology, Chief Glaucoma Service, The New York Eye and Ear Infirmary, New York City; George Shafranov, M.D., assistant professor and director of the glaucoma section, Yale University, New Haven, Conn.; August 2003 British Journal of Ophthalmology
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