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Abstract #5708 Published in IGR 2-1
Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma
Asrani S; Zeimer R; Wilensky J; Gieser D; Vitale S; Lindenmuth KJournal of Glaucoma 2000; 9: 134-142
PURPOSE: To study the risk associated with diurnal intraocular pressure (IOP) variations in patients with open-angle glaucoma. PATIENTS AND METHODS: Sixty-four patients (105 eyes) from the practices of two glaucoma specialists successfully performed home tonometry with a self-tonometer five times a day for five days. All patients had open-angle glaucoma and documented IOP below 25 mmHg over a mean follow-up period of five years. Baseline status and time to progression of visual field loss were identified from the clinical charts. The level and variability of diurnal IOP obtained using home tonometry were characterized. Risk of progression was analyzed using a nonparametric time-to-event model, incorporating methods for correlated outcomes. RESULTS: Although mean home IOP and baseline office IOP were similar (16.4±3.6 mmHg and 17.6±3.2 mmHg, respectively), the average IOP range over the five days of home tonometry was 10.0±2.9 mmHg. Baseline office IOP had no predictive value (relative hazard, 0.98). The diurnal IOP range and the IOP range over multiple days were significant risk factors for progression, even after adjusting for office IOP, age, race, gender, and visual field damage at baseline (relative hazards (95% confidence intervals), 5.69 (1.86, 17.35) and 5.76 (2.2), 14.98)). Eighty-eight percent of patients in the upper 25th percentile of IOP and 57% of patients in the lower 25th percentile progressed within eight years. CONCLUSIONS: In patients with glaucoma with office IOP in the normal range, large fluctuations in diurnal IOP are a significant risk factor, independent of parameters obtained in the office. Fluctuations in IOP may be important in managing patients with glaucoma. Development of methods to control fluctuations in IOP may be warranted.
Dr. R. Zeimer, Johns Hopkins University School of Medicine, Wilmer Ophthalmological Institute, Ophthalmic Physics Laboratory, 6000 N Wolfe Street, Wilmer/Woods Building 355, Baltimore, MA 21287-9131, USA
Classification:
9.2.1 Ocular hypertension (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)