Twenty-Four–Hour Pattern of Intraocular Pressure in Untreated Patients with Ocular Hypertension

Abstract

PURPOSE.To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated ocular hypertensive (OHTN) patients.METHODS. IOP measurements were taken every 2 hours during a 24-hour period from 15 untreated OHTN patients (ages 41-77 years). Measurements were both sitting and supine (diurnal) and supine only (nocturnal). Mean diurnal and nocturnal IOPs in the OHTN group were compared to previously reported values in age-matched healthy and glaucomatous eyes. Post hoc analysis compared the 24-hour IOP pattern of the OHTN patients who converted to glaucoma and those who did not with that in the same healthy and glaucomatous eyes.RESULTS. Mean sitting and supine IOPs were significantly higher in the OHTN group than in the healthy control but not the glaucoma group. Similar to the glaucoma group, the OHTN group demonstrated significant differences from healthy controls in diurnal IOP variation and IOP changes upon awakening in habitual and supine positions. The 24-hour IOP curve acrophases and amplitudes for OHTNs were closer to those of the glaucoma than the healthy control group in the habitual position. Thirty-three percent of OHTNs developed glaucoma during a mean follow-up period of 4.3 6 3.8 years. Similar to findings in the glaucoma group, habitual IOP curve phase delay, habitual IOP variation, diurnal-to-nocturnal IOP changes, and IOP changes upon awakening of the converters were significantly different from those in healthy controls. There were no differences between nonconverters and other groups.CONCLUSIONS. Baseline 24-hour IOP pattern in OHTN patients is similar to that in glaucomatous patients. In contrast to nonconverters, OHTN patients who converted to glaucoma are significantly different from healthy controls. (Invest Ophthalmol Vis Sci. 2013;54:512-517)

Postural and diurnal fluctuations in intraocular pressure across the spectrum of glaucoma

“…The mean sitting IOP in these patients was 22.9±1.5 and 22.3±0.7 mm Hg, respectively. In a study on patients with untreated OHT, Grippo et al 17 reported that baseline 24 h IOP pattern in patients with OHT was similar to that in glaucomatous patients. In contrast to non-converters, patients with OHT who converted to glaucoma were found to be significantly different from healthy controls.…”

“…Some papers on DV of IOP have taken IOP measurements in the sitting position during the day and supine position at night 17. This may confound their findings and what was attributed to DV alone may also have a postural variation component to it, which may have gone unrecognised.…”

Intraocular pressure fluctuation and glaucoma progression: what do we know?

“…A more recent study also showed that IOP fluctuation is significantly higher in eyes with primary chronic ACG (7.69±3.03 mm Hg) or POAG (8.31±2.58 mm Hg) compared to normal eyes (4.83±2.46 mm Hg) 38. Similarly, Grippo et al 39 followed the protocol of prior works and combined results to determine that daytime IOP variation—though not nighttime variation—was significantly greater in subjects with OHT and glaucoma than healthy individuals.…”

24-Hour Contact Lens Sensor Monitoring of Intraocular Pressure-Related Profiles in Normal-Tension Glaucoma and Rates of Disease Progression

“…There was no association between peak IOP or IOP fluctuation (defined as the difference between peak and minimum IOP during a 24-h period) and cross-sectional measurements of glaucoma severity including SAP MD. A small study examining 24-h IOP in patients with ocular hypertension also found no evidence of IOP fluctuation as a risk factor for developing glaucoma [22] . In contrast, De Moraes et al [17] recently reported that certain characteristics of the 24-h IOP profile, measured using the CLS, may be useful markers of faster rates of disease progression.…”