Effect of Different Head Positions in Lateral Decubitus Posture on Intraocular Pressure in Treated Patients With Open-Angle Glaucoma

Interaction of intraocular pressure and ganglion cell function in open angle glaucoma

“…This is in accordance with previous studies, that demonstrated LDP induced IOP increase of the lower eye in comparison to either sitting and/or supine postures in either healthy subjects 10,11,40 or untreated glaucoma patients 14,41 . The GLAIMP-group showed higher IOP fluctuations and rise than healthy subjects during postural change from sitting to LDP, which is in line with other studies that reported that higher LDP-or supineinduced IOP changes were associated with more progression or asymmetrical visual field defects of untreated and treated glaucoma patients 13,14,[42][43][44][45] ; however, others did not report a relationship of LDP-induced changes and glaucoma progression or laterality 15,46 . Our GLALE-group showed no significant IOP change during LDP vs sitting.…”

“…For example, supine posture with -10° head down tilt in a subpopulation of glaucoma suspects was found to be associated with an increase in IOP and a decrease of PERG amplitude 8,9 . An increase in IOP was also reported during lateral decubitus posture (LDP) for both participants with healthy vision [10][11][12] and for glaucoma patients [13][14][15] . Such approaches would greatly benefit from simultaneous IOP and PERG measurements, which was up-to-date technically not feasible.…”

Lateral Sleep Position and Asymmetry in Glaucoma

“…I recommend that the authors replay the videos of the participants and also assess the time spent for different head positions: (1) the side faced by the patient's head (right, left, up, or down) and (2) on versus off the pillow. Previously, my research team studied the effect of head position on IOP in lateral sleep position, 2,3 and also the effect on IOP of head rotation in prone position. 4 We found that low-head position supported by no or low pillow further elevates the IOP of the lower-sided eye in the lateral decubitus posture, 2,3 and that head rotation in the prone posture raises IOP in the lower-sided eye compared with the IOP measured in the lateral or supine body position.…”

“…Previously, my research team studied the effect of head position on IOP in lateral sleep position, 2,3 and also the effect on IOP of head rotation in prone position. 4 We found that low-head position supported by no or low pillow further elevates the IOP of the lower-sided eye in the lateral decubitus posture, 2,3 and that head rotation in the prone posture raises IOP in the lower-sided eye compared with the IOP measured in the lateral or supine body position. 4 I also suggest that the habit (or duration) of burying one's eye into the pillow should also be sought.…”

“…Second, monitoring only the body position may have missed the potential effect of head position and/or neck flexion on IOP during sleep as already mentioned above. 2,3 Third, although VFI is a well-established indicator of functional damage of glaucoma, it is subject to fluctuation or learning effect. Furthermore, the structural damage of glaucoma may precede functional loss at earlier stage, and there may also be mismatches between structural and functional losses.…”