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

Bengtsson, Bo; Heijl, Anders

doi:10.1007/s00417-004-1103-8

Cited by 126 publications

(88 citation statements)

References 23 publications

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“…The results of our study also agree with those reported by Bengtsson and Heijl 16 as part of the Malmö Ocular Hypertension Study. In their investigation, high-risk ocular hypertensive patients were observed for 10 years as part of a prospective investigation to compare the rates of development of glaucomatous VF loss in patients treated with timolol versus a placebo.…”

Section: Discussionsupporting

confidence: 93%

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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Section: Discussionsupporting

confidence: 93%

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

Medeiros¹,

Weinreb²,

Zangwill³

et al. 2008

Ophthalmology

157

108

View full text Add to dashboard Cite

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“…12 In the latter, 90 patients were examined every 3 months with office-hours diurnal tension curves and computerised perimetry. After a maximum follow-up to 17 years, 37 patients had developed glaucomatous visual field defects.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The purpose of the present study was to evaluate whether the amplitude of day-andnight IOP measurements [4][5][6][7][8][9][10][11][12] is an additional factor associated with the progression of glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Diurnal intraocular pressure profiles and progression of chronic open-angle glaucoma

Jonas

Budde

Stroux

et al. 2006

Eye

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Purpose To evaluate whether the amplitude of day-and-night intraocular pressure (IOP) profiles influences the rate of progression of chronic open-angle glaucoma. Methods The hospital-based clinical observational study included day-and-night profiles of IOP measurements performed on 458 patients (855 eyes) with chronic open-angle glaucoma or ocular hypertension. The 24-h pressure profiles obtained by Goldmann applanation tonometry contained measurements at 0700, noon, 1700, 2100, and midnight. Results In the whole study population, IOP amplitude was significantly (Po0.001) and positively associated with the mean (r ¼ 0.26), minimal (r ¼ À0.23) and maximal (r ¼ 0.59) IOP values. Taking the whole study population, glaucoma progression was not associated with the IOP amplitude (P ¼ 0.09). After adjustment for age, neuroretinal rim area and the other IOP measurements, age (Po0.001) and neuroretinal rim area (P ¼ 0.05) remained as significant predictive factors in the selected Cox model. In the normal-pressure glaucoma group (n ¼ 174 eyes), progression was significantly positive associated with the minimal IOP value (Po0.001), the mean of the IOP values (P ¼ 0.024), and, less significantly (P ¼ 0.037) and negatively, with the pressure profile amplitudes. In the high-pressure glaucoma group (n ¼ 681 eyes), rate of glaucoma progression was not associated with the IOP amplitude (P ¼ 0.734) or the other IOP parameters. Conclusions Taking into account the highly significant associations between the IOP amplitude and the mean, minimal and maximal IOP values suggests that it is the IOP itself, and less the pressure amplitude, which has the main influence on the rate of the glaucoma progression.

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“…38,39 One long-term study that looked at diurnal IOP swings as an independent variable found that these fluctuations were not an independent risk factor for conversion to POAG. 40 Sleep laboratory experiments show that in all subjects supine and nocturnal IOPs rise, although the swing was lower in eyes with a higher baseline IOP. 41 However nocturnal (24 h) fluctuations may well contribute to the development of visual field progression in eyes with glaucoma damage, and measures to dampen such changes may offer additional protection.…”

Section: Commentmentioning

confidence: 93%

Glaucoma: an area of darkness

Hitchings

2008

Eye

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This review of Primary Open Angle Glaucoma looks at the management of the condition today. It does this by looking at the following areas: (a) the size of the problem; (b) the position of IOP, with respect to its elevation and fluctuation; (c) optic nerve head changes; and (d) visual function changes. In doing so, it contrasts what is known now with ideas and concepts that were prevalent at the time of the two previous Bowman lecturers, Duke Elder and Drance, as well as noting concepts about the disease that were current at the time of William Bowman. The review concludes by suggesting challenges in this area that lie ahead.

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

Abstract: IOP fluctuations were not an independent risk factor for the incidence of glaucomatous visual field loss in subjects with ocular hypertension.

Cited by 126 publications

References 23 publications

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

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

Diurnal intraocular pressure profiles and progression of chronic open-angle glaucoma

Glaucoma: an area of darkness

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