The Effect of Diurnal Fluctuation in Intraocular Pressure on the Evaluation of Risk Factors of Progression in Normal Tension Glaucoma

Abstract

PurposeTo investigate whether diurnal fluctuation in intraocular pressure (IOP) can influence the result of the correlations between IOP-related factors and progression of normal tension glaucoma (NTG).MethodsGlaucoma progression was defined as visual field (VF) progression and changes in the optic disc and/or retinal nerve fiber layer (RNFL). Two different methods were used to evaluate the impact of the diurnal fluctuation in IOP. ‘Conventional method’ used in previous studies included all IOP measurements during the follow up time. ‘Time adjusted method’ was used to adjust diurnal fluctuation in IOP with the preferred time. Mean IOP, long term IOP fluctuation and the difference between the lowest and highest IOP were calculated using both methods. Cox regression analyses were performed to evaluate the association between IOP-related factors and NTG progression.ResultsOne hundred and forty eyes of 140 patients with NTG were included in this study. 41% (58 of 140 eyes) of eyes underwent NTG progression. Long term IOP variation calculated by conventional method was not a significant risk factor for NTG progression (hazard ratio[HR], 0.311; 95% confidence interval[CI], 0.056–1.717; P = 0.180). Long term IOP variation calculated by time adjusted method, however, was related to progression, with an HR of 5.260 (95% CI,1.191–23.232; P = 0.029).ConclusionAlthough having the same IOP-related factors, if diurnal fluctuation is included, different results may be found on the relationship between IOP-related factors and NTG progression. Based on our results, diurnal fluctuation in IOP should be considered when IOP-related factors are studied in the future.

Intraocular Pressure Spikes within First Postoperative Hours following Standard Trabeculectomy: Incidence and Associated Factors

“…The long-term efficiency of this procedure is known, not only because of the amount on IOP reduction, but also because it reduces the levels of IOP variation that occurs more commonly in patients with glaucoma than in normal eyes [14]. Rates of long-term success of TRAB reach high levels, such as more than 80% in 5 years of follow-up after primary TRAB as shown by the AGIS study [15].…”

The role of self-dependent tonometry in improving diagnostics and treatment of patients with open angle glaucoma

“…Однако, несмотря на то, что ВГД остаётся единственным модифицируемым фактором и все методы лечения направлены на его снижение, контроль ВГД производится однократно, в рабочие часы специалиста и только раз в месяц [7,10]. Многие офтальмологи, изме-ряя ВГД при плановом осмотре, обнаруживают цифры «давления цели», при отрицательной динамике по данным периметрии и ОКТ дисков зрительных нервов [9]. Недостаточная приверженность лечению и поздняя диагностика являются способствующими факторами, однако основной причиной нестабилизации глаукомного процесса может быть незнание пикового ВГД и размах колебаний в течение суток [4,8,9,14].…”

“…Многие офтальмологи, изме-ряя ВГД при плановом осмотре, обнаруживают цифры «давления цели», при отрицательной динамике по данным периметрии и ОКТ дисков зрительных нервов [9]. Недостаточная приверженность лечению и поздняя диагностика являются способствующими факторами, однако основной причиной нестабилизации глаукомного процесса может быть незнание пикового ВГД и размах колебаний в течение суток [4,8,9,14]. В течение последних десятилетий особое внимание уделяется роли суточных колебаний как независимому фактору риска прогрессирования глаукомного процесса [5,11,13] Самостоятельное участие пациента в процессе диагностики увеличивает осознание важности выполнения указаний врача, что значительно повышает эффективность лечения.…”

IOP, IOP Transient Impulse, Ocular Perfusion Pressure, and Mean Arterial Pressure Relationships in Nonhuman Primates Instrumented With Telemetry

“… 2 , 3 Lowering IOP is the only clinically proven method to prevent glaucoma and slow disease progression, although some patients develop glaucoma at statistically normal IOP levels, 4 , 5 and others continue to progress even after IOP is lowered. 6 Diurnal IOP fluctuations, measured hourly, have been reported as higher in glaucoma patients in some studies 7 and may be predictive of disease progression.…”

“…IOP is known to fluctuate at multiple timescales, 7 , 17 – 21 ranging from days to milliseconds, and current clinical approaches generally rely on single time point IOP measurements taken periodically during clinic office hours, which does not capture short-term IOP fluctuations. Hence, little is known about IOP fluctuations and how they relate to ocular physiology and disease.…”