Assessment of diurnal tensional curve in early glaucoma damage

Gonzalez, I.; Pablo, L.; Pueyo, M.; Ferrer, E; Melcón, B; Abecia, E.; Fm, Honrubia

doi:10.1007/bf00212956

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…Gonzales et al [10] found that IOP fluctuations were a significant risk factor for glaucomatous visual field defects in patients with ocular hypertension. They compared de- velopment of field loss in two groups of patients: one with IOP fluctuations >5 mmHg and another with such fluctuations ≤5 mmHg at a baseline tension curve.…”

Section: Discussionmentioning

confidence: 98%

“…Smith [25] found that diurnal fluctuations were as large in patients with elevated IOP without field loss as in glaucoma patients with field defects, while Bergeå et al [4] reported that glaucoma in patients with smaller IOP variations progressed less often than in those with larger variations. In a longitudinal study of patients with ocular hypertension Gonzales et al [10] reported that increased IOP variation at one baseline diurnal tension curve was a risk factor for development of glaucomatous field defects using manual perimetry.…”

Section: Introductionmentioning

confidence: 98%

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Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Bengtsson

Heijl

2005

Graefe's Arch Clin Exp Ophthalmol

126

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Bengtsson

Heijl

2005

Graefe's Arch Clin Exp Ophthalmol

126

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“…Previous studies have evaluated the role of diurnal IOP fluctuations as a risk factor for glaucoma progression. 6,8,9 Most of these studies were limited by their retrospective analysis and lack of control for potentially confounding factors. Asrani et al 6 found that diurnal IOP fluctuation, as measured by home self-tonometry, was a significant risk factor for progression.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] Results from the Advanced Glaucoma Intervention Study (AGIS) indicated that larger long-term IOP fluctuations were associated with progressive visual field (VF) deterioration. 7 In contrast, a recent report from the Early Manifest Glaucoma Trial (EMGT) did not find any relationship between long-term IOP fluctuations and risk of glaucoma progression.…”

mentioning

confidence: 99%

Long-term Intraocular Pressure Fluctuations and Risk of Conversion from Ocular Hypertension to Glaucoma

Medeiros¹,

Weinreb²,

Zangwill³

et al. 2008

Ophthalmology

157

108

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Purpose-To investigate whether long-term intraocular pressure (IOP) fluctuations are a risk factor for conversion from ocular hypertension to glaucoma. Design-Observational cohort study.Participants-The study included 252 eyes of 126 patients with ocular hypertension observed untreated as part of the Diagnostic Innovations in Glaucoma Study. At baseline, ocular hypertensive eyes had elevated IOP, normal visual fields (VFs) on standard automated perimetry, and normal optic discs as evaluated by stereophotograph assessment.Methods-Glaucoma conversion was defined as development of reproducible VF loss or optic disc damage. Analyses included all IOP measurements from the baseline visit to time of progression (for converters) and last follow-up (for nonconverters). Mean IOP and IOP fluctuation were calculated as the arithmetic mean and standard deviation (SD), respectively, of all available IOP measurements per eye.Main Outcome Measures-Univariable and multivariable Cox regression analyses were used to evaluate the association between IOP fluctuation and time to progression. Multivariable models adjusted for age, mean IOP, central corneal thickness, vertical cup-to-disc ratio, and pattern SD.Results-Forty eyes of 31 subjects developed glaucoma during follow-up. Mean IOPs during follow-up were 25.4±4.2 mmHg for the eyes that converted to glaucoma and 24.1±3.5 mmHg for the eyes that did not. Corresponding values for IOP fluctuation were 3.16±1.35 mmHg and 2.77±1.11 mmHg, respectively. Intraocular pressure fluctuation was not a risk factor for conversion to glaucoma both in univariable analysis (hazard ratio [HR], 1.30 per 1 mmHg higher; 95% confidence interval [CI], 0.76-1.96; P = 0.092) and in multivariable analysis (adjusted HR, 1.08 per 1 mmHg higher; 95% CI, 0.79-1.48; P = 0.620). Mean IOP during follow-up was a significant risk factor for progression both in univariable analysis (HR = 1.16 per 1 mmHg higher; 95% CI, 1.04-1.31; P = 0.010) and in multivariable analysis (adjusted HR, 1.20 per 1 mmHg higher; 95% CI, 1.06-1.36; P = 0.005).Conclusion-Long-term IOP fluctuations do not appear to be significantly associated with the risk of developing glaucoma in untreated ocular hypertensive subjects.Although elevated intraocular pressure (IOP) has been unquestionably demonstrated to be a risk factor for development and progression of glaucoma, 1-5 there has been controversy with regard to the IOP features that are the most relevant. Long-term (i.e., visit Both the AGIS and EMGT included only patients with definite glaucoma diagnosis at baseline. It is possible that the role of long-term IOP fluctuation as a risk factor for glaucoma development could be different than that for glaucoma progression. Two recent multicenter prospective randomized clinical trials reported on the predictive factors for conversion from ocular hypertension to glaucoma. In both the Ocular Hypertension Treatment Study 11 and the European Glaucoma Prevention Study, 12 higher IOP levels at the baseline visits were associated with a higher ...

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“…4, As is well-known, IOP fluctuation is proportional to IOP levels. 5,6 Diurnal IOP fluctuation has been reported to be a risk factor, independent of IOP level, for development of glaucoma 7 or glaucoma progression, 8,9 but these studies compared IOP measurements at different times, e.g., baseline IOP fluctuation vs. follow-up IOP levels, or before vs. after a glaucoma intervention. Other reports studying various IOP parameters, measured during the same period and the same conditions, have been unable to show that large IOP fluctuation is an independent risk for glaucoma, 10 or glaucoma progression.…”

mentioning

confidence: 99%

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

et al. 2007

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Purpose: To investigate whether increased fluctuation of intraocular pressure (IOP) is an independent factor for glaucoma progression.Design: Cohort of patients followed in a randomized clinical trial.Participants: Two hundred and fifty-five glaucoma participants of the Early Manifest Glaucoma Trial (EMGT; 129 treated and 126 control patients.)Methods: Study visits, conducted every three months, included ophthalmologic examinations, IOP measurements and standard automated perimetry, with fundus photography every six months. IOP values were included only until the time of progression, in those eyes that showed such progression. Individual mean follow-up IOP and IOP fluctuation, calculated as the standard deviation of IOP at applicable visits, were the variables of main interest. Cox regression with time-dependent variables was used to evaluate the association between IOP fluctuation and time to progression, both with and without IOP mean in the models. These analyses also controlled for other significant variables.Main Outcome Measures: Glaucoma progression, as defined by a predetermined visual field criterion, and/or worsening of the disk, assessed by an independent disk reading center.Results: Median follow-up time was 8 years (ranging from 0.1 to 11.1 years). Sixty-eight percent of the patients progressed. When considering mean follow-up IOP and IOP fluctuation in the same time-dependent model, mean IOP was a significant risk factor for progression. The hazard ratio (HR) was 1.11 (95% confidence interval: 1.06, 1.17; p<0.0001). IOP fluctuation was not related to progression, with a HR=1.00 (0.81, 1.24; p=0.999).Conclusion: These results confirm our earlier finding that elevated IOP is a strong factor for glaucoma progression, with the HR increasing by 11% for every mmHg of higher IOP. IOP fluctuation was not an independent factor in our analyses, a finding that conflicts with some earlier reports. One explanation for the discrepancy is that our analyses did not include postprogression IOP values, which would be biased towards larger fluctuations because of more intensive treatment. In contrast, in this EMGT report, no changes in patient management occurred during the period analyzed.

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Assessment of diurnal tensional curve in early glaucoma damage

Cited by 22 publications

References 13 publications

Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Long-term Intraocular Pressure Fluctuations and Risk of Conversion from Ocular Hypertension to Glaucoma

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

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