Water-Drinking Test in Patients with Primary Open-Angle Glaucoma While Treated with Different Topical Medications

Abstract

This study suggests that topical medications that enhance outflow (e.g., bimatoprost, latanoprost, travoprost, and brimonidine) may provide, under stressful conditions such as the WDT, better IOP stabilization than medications that decrease aqueous humor inflow, such as timolol and topical carbonic anhydrase inhibitors.

Author Response: Choroidal Thickness Change after Water Drinking Is Greater in Angle Closure than in Open Angle Eyes

“…Our group [3][4][5][6] and others [7][8][9][10][11] have been studying this stress test for the past decade and we are pleased to read that another group not only confirmed findings from our recent publication, 12 but also added innovative information to the field, despite some minor methodological differences. As their main result, Arora et al reported that the WDT resulted in a significant increase of the mean choroidal thickness (CT) in the eyes with angle-closure glaucoma (ACG) and among subjects whose intraocular pressure (IOP) rose >2 mm Hg (defined as ''responders''), but not in eyes with open-angle glaucoma (OAG) or in the entire sample pooled together.…”

“…15,16 We had many concerns with regard to how the WDT was performed in the study by Arora et al, as it appears to differ meaningfully from what our group and others have been doing. [3][4][5][6][7][8][9][10][11] For instance, we ask patients to refrain from ingestion of fluids at least 4 hours prior to the test (which was not clarified in their study methodology); we ask patients to drink the water in a short period of time (less than 5 minutes)-instead of 15 minutes; and we perform IOP measurements at baseline, 15, 30, and 45 minutes after water ingestion, while Arora et al measured the IOP only twice: before water ingestion and 30 minutes afterwards. 1 Their IOP measurements (which they called ''peaks'') were technically measurements taken 15 minutes after water ingestion only.…”

Reprodutibilidade do testes de sobrecarga hídrica

“…A utilização do TSH para avaliar controle pressórico em olhos sob terapia clínica também passou a ser estudada por centros de pesquisa em outras partes do mundo como Estados Unidos e Europa (12)(13)(14)(15)(16)(17)(18) . Particularmente em relação ao estudo apresentado pelos autores para avaliar a reprodutibilidade do TSH, gostaríamos de fazer algumas considerações.…”

“…Em resumo, o número expressivo de trabalhos e editoriais publicados recentemente em vários centros internacionais e com centenas de pacientes estudados sugerem a potencialidade deste teste em fornecer informações complementares importantes na avaliação do controle pressórico de pacientes glaucomatosos (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(21)(22) . …”

Reprodutibilidade do teste de sobrecarga hídrica em portadores de glaucoma de ângulo aberto sob tratamento clínico

“…Por essa razão, podem ter um benefício adicional no tratamento do glaucoma (6,8,43) . Embora timolol 0,5% mostrou redução da PIO similar à brimonidina 2,0%, a PIO permaneceu mais estável com brimonidina do que com timolol.…”