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Editors Selection IGR 17-3

Clinical Examination Methods: IOP and Venous Pulsation Pressure

Comment by Ingeborg Stalmans & Luís Abegão Pinto on:

66237 Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure, Morgan WH; House PH; Hazelton ML et al., PLoS ONE, 2016; 11: e0147915

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Increased venous pulse pressure (VPP) has been consistently linked to glaucoma severity and disease progression. As part of a larger, ongoing prospective study, the authors have used an ophthalmodynamometer-based methodology to determine VPP in both glaucoma and glaucoma suspects. Sixty eyes from 31 patients had a baseline VPP measurement followed by an IOP lowering intervention (medical or surgically) and scheduled visits every three to four months before a second VPP measurement performed at the last visit (mean follow-up of 13 months).

In this sample, decreasing IOP over nearly one year was significantly associated with a decrease in VPP in glaucoma patients (odds ratio of a reduced VPP being 1.60 per mmHg IOP reduction (95% confidence intervals 1.22 to 2.08). Interestingly, these findings could not be replicated in glaucoma suspects, where no association was found (p = 0.62).

these preliminary shows promise as they hint IOP-lowering strategies could be used to modulate this increased VPP parameter

Analyzing ophthalmodynamometry data is an inherently challenging task in subjects showing a spontaneous venous pulsation (SVP), which occurs in nearly half of the glaucoma population. With no outside pressure needed to collapse the already pulsating veins, the force needed to apply in the dynamometry is arbitrarily set to 0. Accordingly, this creates a number of data having to be censored as fluctuations in applied pressure cannot be numerically calculated. The authors have tried addressing the issue by analyzing these separately using a binary system, but at the expense of further decreasing their limited sample size.

As we wait the final results of the five-year Vein Pulsation Study Trial in Glaucoma (SPSTG), these preliminary shows promise as they hint IOP-lowering strategies could be used to modulate this increased VPP parameter.

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