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Editors Selection IGR 16-3

Clinical Examination Methods: Factors affecting IOP

Comment by Minguang He on:

56379 Changes in intraocular pressure and associated systemic factors over 10 years in subjects without ocular disease at baseline, Kitamura K; Yokomichi H; Yamagata Z et al., Journal of Glaucoma, 2014; 23: 185-189

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Kitamura et al. investigated the ten-year IOP changes in 3785 Japanese people aged 23 to 80 years and found that the mean IOP reduced significantly by about 0.7 mmHg after ten years. Given the fact that the risk of glaucoma will increase exponentially with IOP, the findings may somehow suggest the risk of glaucoma will decrease with aging. The authors also found an association of IOP changes with the level of BMI, SBP and DBP and further point to the statement that further lowering these systemic factors or perhaps changing lifestyle may help reduce IOP. However, an interpretation of the results and their implications for the prevention of glaucoma should be understood at least in the context of dose-response effect. For instance, we are not sure how much benefit there is on the risk of glaucoma if the mean IOP decreases with 0.7 mmHg in ten years, similarly, what level of decrease on BMI and blood pressure is required to have clinically meaningful decrease on IOP and risk of glaucoma? A further analysis on the optic disc and visual field changes among the participants with greatest increase of IOP, such as five mmHg in ten years, will be interesting in terms of understanding the impact of increased IOP among the 'normal' people at baseline. On the other hand, the results should also be interpreted carefully in the scenario of a better understanding of the study methodology. The study participants were recruited from a group of health checkup people with high dropout, 3845 in ten years among 20700 at baseline. IOP was measured using the non-contact method where a proper calibration of the tonometer device can be challenging and difficult for a ten-year period of time. These challenges may somehow affect the quality of the results.

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