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Editors Selection IGR 7-1
Medical treatment: Target pressure
Comment by Joseph Caprioli on:
12420 Intraocular pressure variability in patients who reached target intraocular pressure, Malerbi FK; Hatanaka M; Vessani RM et al., British Journal of Ophthalmology, 2005; 89: 540-542
Malerbi et al. (600) conducted a retrospective analysis of their clinical data of 65 patients with POAG. Patients had four IOP office measurements between 8.00 am and 5.00 pm; so these measurements are clearly not diurnal, by definition. Patients also underwent a water drinking test, presumably as a stress test of the functionality of the outflow system. Not surprisingly, additional pressure measurements yielded a wider range of IOPs, some of which were above the individual's target pressure. Also not surprisingly, the water drinking test caused a significant elevation of IOP in these treated patients with POAG at target pressure. The main message here is that additional IOP measurements will reveal a wider range of IOP fluctuation. It is not clear, however how to use this finding in practice. There is accumulating evidence that long-term IOP fluctuation is an important risk factor for glaucomatous progression (Nouri-Mahdavi et al. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmol 2004; 111: 1627-1635). As for the water drinking test, this was largely abandoned long ago along with tonography, since they added little to the sacred glaucoma triumvirate of carefully evaluated pressure, disc, and field.
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