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Editors Selection IGR 9-4

Risk Factors in Glaucoma: IOP Variation and Glaucoma

Comment by Arthur Sit on:

75758 Variation in Intraocular Pressure and the Risk of Developing Open-Angle Glaucoma: The Los Angeles Latino Eye Study, Jiang X; Torres M; Varma R et al., American Journal of Ophthalmology, 2018; 188: 51-59

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Fluctuations in intraocular pressure (IOP) have long been suggested as potential risk factors for the development of glaucoma. However, the availability of longitudinal data to study this issue has been limited, and the reported results have been contradictory.^1-3 Jaing et al. report on the relationship between IOP variability and the risk for developing open angle glaucoma among the participants of the Los Angeles Latino Eye Study (LALES), a cross-sectional, population- based study with a follow-up study after four years.

A total of 3666 individuals without glaucoma at baseline were included. IOP was measured a total of six times: three times within minutes at baseline, and three times within minutes at the fouryear follow-up exam. Open angle glaucoma was diagnosed based on optic disc appearance on stereoscopic fundus photographs and/or characteristic visual field changes. Mean, maximum, standard deviation, and range of IOP were calculated, and univariate and multivariate logistic regression models were used to assess the association between these variables and the risk of glaucoma.

This study provides further evidence that IOP variability contributes to the risk of developing glaucoma, and this effect appears to be more important in patients with low mean IOP

The authors reported that glaucoma occurred in 73 of the study participants. Both standard deviation and range of IOP were found to be significant risk factors for the development of glaucoma, even after adjustment for mean IOP. However, in the multivariate model only maximum IOP remained a significant independent predictor of glaucoma, while mean, standard deviation and range dropped out. A subgroup analysis was also performed to differentiate participants with low and high IOP. For participants with mean IOP < 15 mmHg, maximum, standard deviation and range of IOP were all associated with higher risk of glaucoma but mean IOP was not. For patients with mean IOP of > 15 mmHg, mean and maximum IOP were associated with the development of glaucoma while standard deviation and range were not.

This study provides further evidence that IOP variability contributes to the risk of developing glaucoma, and this effect appears to be more important in patients with low mean IOP. What is remarkable about the results from this study is that IOP variation was detected as a risk factor for glaucoma based on only six IOP measurements at two time points for each patient. However, this may be a reflection of the large sample size rather than the predictive ability of a small number of individual IOP measurements. One potential confounder in this study is that the measures of IOP variability included both short and long-term variations. While the authors demonstrated that inter-visit variability provided a greater contribution than intra-visit variability, it is not clear which of these two types of variations may be more predictive of glaucoma development. Fully understanding the role of IOP variations in glaucoma development and progression will likely require technology to continuously monitor IOP over extended time periods.

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