Individual Variability in the Diurnal Intraocular Pressure Curve

Wilensky, Jacob T.; Gieser, David K.; Dietsche, Mary Lynn; Mori, Marek; Zeimer, Ran

doi:10.1016/s0161-6420(93)31551-4

Cited by 145 publications

(118 citation statements)

References 16 publications

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“…Differences between maximum and minimum values may amount to 8 mmHg. 36 in the present study, we found the difference between the maximum and minimum values amounting to 3mm Hg. The present study did not find any association between age, sex and the IOP parameters examined time of peak, trough and diurnal fluctuation).…”

Section: Resultssupporting

confidence: 58%

Physiological Variable Affectin G Intra Ocu Lar Pressure: Diurnal Variations

H¹

2015

jemds

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BACKGROUND:The existence of a diurnal variation in the Intra ocular Pressure (IOP) of both normal and glaucomatous eyes is well documented. However, the magnitude and pattern of that variation remains in conjecture. AIM: To study the diurnal fluctuation of the IOP in the normal subjects. MATERIALS AND METHODS: The study group consisted of 92 volunteers, visually normal as subjects, 50 boys and 42 girls in the age group of 18 to 20 years. Independent measurements of the IOP of each eye were obtained during the day with the subject in the upright position. The first measurement was undertaken between 8-9AM, the second between 12 Noon-1PM and the final reading between 5-6PM. The subjects carried normal routine activity during the period of measurement. Keelar Pulsair air impulse tonometer was used in all the subjects for IOP measurement. IOP was measured in the department of Ophthalmology, Teaching Hospital. STATISTICAL ANALYSIS: were done using Paired 't' test. RESULTS: The mean IOP of all the subjects decreased by 2.304 mmHg during the day. The change was statistically significant (<0.001). Mean IOP decreased by 2.977mmHg during the day in 83.69% of the subjects, all showing peak pressures in the morning. In a small proportion of subjects (10.86%) the mean increased by 1.75mm Hg which was not statistically significant. In 5.43% of the subjects the IOP remained the same during the day. The present study did not find any association between age, sex and the IOP parameters examined (Time of peak, trough and diurnal fluctuation). CONCLUSION: IOP decreased during the in a large number of subjects (83.69%). The peak IOP was before noon. The diurnal IOP variation is quite minimal averaging 3-4 mm Hg but a single measurement taken during the late afternoon or evening may miss IOP peak. There is no method to continually measure IOP. Even a large number of pressure measurements dispersed through a 24-hour period may miss the peak pressure for that day. Thus, it is obvious that any choice of measurement is arbitrary. Many factors are responsible for daily fluctuations in IOP. Some of these factors operate at the level of the eye.

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Section: Resultssupporting

confidence: 58%

Physiological Variable Affectin G Intra Ocu Lar Pressure: Diurnal Variations

H¹

2015

jemds

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“…Treatment should include the reduction of IOP as well as the reduction of the risks of pressure peaks and elevated IOP fluctuation (1,(6)(7)(8)(9)(10)(11) . To estimate this fluctuation, it is possible to use methods such as the daily tensional curve (DTC), the simplified daily tensional curve (SDTC), and the water drinking test (WDT).…”

Section: Introductionmentioning

confidence: 99%

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

Caiado¹,

Badaró²,

Kasahara³

2014

Arquivos Brasileiros De Oftalmologia

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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.

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“…Intra-individual variation of IOP can be several mm Hg, 26,27 often substantially larger than calibration errors, possibly leading to an assumption that small systematic errors are not important. Systematic errors are approximately constant and create a bias at every IOP reading in every individual.…”

Section: Discussionmentioning

confidence: 99%

Potential effects of systematic errors in intraocular pressure measurements on screening for ocular hypertension

Turner

Graham

Avolio

et al. 2013

Eye

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Aim Raised intraocular pressure (IOP) increases the risk of glaucoma. Eye-care professionals measure IOP to screen for ocular hypertension (OHT) (IOP421 mm Hg) and to monitor glaucoma treatment. Tonometers commonly develop significant systematic measurement errors within months of calibration, and may not be verified often enough. There is no published evidence indicating how accurate tonometers should be. We analysed IOP measurements from a population study to estimate the sensitivity of detection of OHT to systematic errors in IOP measurements. Methods We analysed IOP data from 3654 participants in the Blue Mountains Eye Study, Australia. An inverse cumulative distribution indicating the proportion of individuals with highest IOP421 mm Hg was calculated. A second-order polynomial was fitted to the distribution and used to calculate over-and under-detection of OHT that would be caused by systematic measurement errors between À 4 and þ 4 mm Hg. We calculated changes in the apparent prevalence of OHT caused by systematic errors in IOP. Results A tonometer that consistently under-or over-reads by 1 mm Hg will miss 34% of individuals with OHT, or yield 58% more positive screening tests, respectively. Tonometers with systematic errors of À 4 and þ 4 mm Hg would miss 76% of individuals with OHT and would over-detect OHT by a factor of seven. Over-and under-detection of OHT are not strongly affected by cutoff IOP. Conclusion We conclude that tonometers should be maintained and verified at intervals short enough to control systematic errors in IOP measurements to substantially less than 1 mm Hg.

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Individual Variability in the Diurnal Intraocular Pressure Curve

Cited by 145 publications

References 16 publications

Physiological Variable Affectin G Intra Ocu Lar Pressure: Diurnal Variations

Physiological Variable Affectin G Intra Ocu Lar Pressure: Diurnal Variations

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

Potential effects of systematic errors in intraocular pressure measurements on screening for ocular hypertension

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