Intraocular pressure fluctuation in healthy and glaucomatous eyes: a comparative analysis between diurnal curves in supine and sitting positions and the water drinking test

Abstract

Approved by the Research Ethics Committee on human beings with the process number 106/06. RESUMO Objetivo: Comparar a flutuação da pressão intraocular (PIO) nas posições sentada e supina, através da curva tensional diária simplificada (CTDS), durante o horário de consultório em pacientes saudáveis e com glaucoma primário de ângulo aberto (GPAA Descritores: Glaucoma de ângulo aberto/fisiopatologia; Pressão intraocular/fi sio logia; Ritmo circadiano ABSTRACTPurpose: To compare intraocular pressure (IOP) using the simplified daily tensional curve (SDTC) between supine and sitting positions in terms of peak levels and amount of fluctuation in both, glaucomatous and healthy subjects. The secondary endpoint was the comparison of these measures with those derived from the water drinking test (WDT). Methods: Thirty patients with primary open-angle glaucoma (POAG) that were undergoing medical therapy and 30 healthy subjects were enrolled in this study. Each patient underwent a diurnal curve between 8 am and 4 pm. After lying down for 5 minutes, the IOP was measured with the Perkins tonometer. Patients were instructed to sit in the upright position for 5 minutes and the tonometry was repeated. At 4:15 pm, the WDT test was performed. Fluctuation was defined as the difference between the highest and the lowest IOP readings (range). The Student's t test was used to assess differences and a P value <0.05 was considered to be statistically significant. Results: The diurnal curve in the supine position demonstrated higher IOP average values (on average 3-4 mmHg higher) compared to the sitting position (p<0.0001) for both groups. IOP peaks were higher in the supine position; however, the IOP range was essentially the same between the three methods. Treated glaucomatous patients had higher IOP levels in all measurements, but the fluctuation for all tests performed appeared to be similar to that of healthy patients. Conclusion:The data suggested that WDT can be used to estimate the diurnal IOP peak and fluctuation observed in the SDTC of the supine position for treated glaucomatous patients. Further studies can compare the possible correlation between the WDT results and those obtained from nocturnal supine measurements.

Effects of three months treatment with sertraline on intraocular pressure and cup-to-disc ratio in patients with anxiety disorders/mixed anxiety and depressive disorder/major depressive disorder and without underlying eye disease

“…Although change in the IOP levels, in our study, was equal the daily change in the IOP level in persons without glaucoma or patients with normal-tension glaucoma(5), but the slight and continuous increase in the IOP level associated with changes in pupil size and CDR , especially in patients at risk of glaucoma in the long term, can cause a disruption in hydrodynamic homeostasis (27). More studies need to confirm our results We recommend that various studies be designed with different doses of sertraline and other types of SSRIs, participants' anxiety and depression severity levels and personality characteristics assessments, and longer periods of treatment with more patients, especially patients with risk factors of glaucoma, such as old age, female, positive family history of glaucoma, mid to high hyperopia and cataract, and the ones who receive other drugs or have underlying diseases, which affect the process of metabolism of SSRIs or disrupt the elimination of SSRIs.…”

“…In the present study, the mean sertraline dose was 95±2.5 mg daily. Previous studies have revealed (2,17,27,29,31)that the occurrence of this effect depends on the drug plasma level and its metabolites,occurring at a mean daily dose of SSRIs exceeding 20 mg(31) or ≥1 defined daily dose (17). In this study, we evaluated the effect of sertraline on the level of IOP and CDR in patients with anxiety disorders, mixed anxiety and depressive disorder, major depressive disorder.…”

“…It seems that during chronic treatment with SSRIs, the incidence of several temporary spam in the optic nerve head vessels causes hemodynamic changes and, eventually, ischemic optic neuropathy (28).A major populationbased survey based on theInternational Society Geographical and Epidemiological Ophthalmology(ISGEO), which studied the prevalence and types of glaucoma in Yazd province in central of Iran, showed that the overall prevalence of glaucoma was 4.4% and the prevalence of open-angle glaucoma and angle-closure glaucoma were 1.7% and 0.4% respectively (5).Also, the prevalence of normal-tension glaucoma was relatively high (1.5%). According to these results, some factors except IOP-such as cup-todisc ratio (27)and serum sodium levels(29, 30)-play a role in glaucomatous optic neuropathy in the Iranian race. This study has some limitations, which should be pointed out.…”

“…There was a meaningful difference between two groups in the cup-to-disc ratio change at the end of the first month and the third month. Although a change in the IOP level can equal the daily change in the IOP level in persons without glaucoma or patients with normaltension glaucoma(5),the change in the IOP level associated with changes in pupil size and cup-to-disc ratio, especially in patients at risk of glaucoma, can cause a disruption in hydrodynamic homeostasis (27). Also, Hayer et al showed that the increase in plasma serotonin levels can disturb blood supply in the optic nerve head, leading to ischemic optic neuropathy,independent of IOP levels (27).…”

“…Although a change in the IOP level can equal the daily change in the IOP level in persons without glaucoma or patients with normaltension glaucoma(5),the change in the IOP level associated with changes in pupil size and cup-to-disc ratio, especially in patients at risk of glaucoma, can cause a disruption in hydrodynamic homeostasis (27). Also, Hayer et al showed that the increase in plasma serotonin levels can disturb blood supply in the optic nerve head, leading to ischemic optic neuropathy,independent of IOP levels (27). It seems that during chronic treatment with SSRIs, the incidence of several temporary spam in the optic nerve head vessels causes hemodynamic changes and, eventually, ischemic optic neuropathy (28).A major populationbased survey based on theInternational Society Geographical and Epidemiological Ophthalmology(ISGEO), which studied the prevalence and types of glaucoma in Yazd province in central of Iran, showed that the overall prevalence of glaucoma was 4.4% and the prevalence of open-angle glaucoma and angle-closure glaucoma were 1.7% and 0.4% respectively (5).Also, the prevalence of normal-tension glaucoma was relatively high (1.5%).…”