Diurnal Intraocular Pressure Profiles in Chronic Open-Angle Glaucoma

Jonas, Jost B.; Budde, Wido M.; Stroux, Andrea; Oberacher‐Velten, Isabel; Jünemann, Anselm

doi:10.1097/apo.0b013e31823e4cb0

Cited by 19 publications

(21 citation statements)

References 29 publications

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“…Similarly, we found IOP peak at 0900 hours in the untreated PACS group. The around noon IOP peak in our POAG group was comparable to one study, 8 but was in contrast to another, 10 which reported IOP peak in early morning in treated POAG group. In the latter study, most of the patients were receiving topical β-blockers twice daily and the early morning IOP readings were obtained just before the morning dose of medication.…”

Section: Discussionmentioning

confidence: 49%

“…These results compare well with earlier studies on treated POAG. [8][9][10] However, these studies 8,9 except the one by Jonas et al 10 have reported IOP fluctuation during office hours in patients with POAG whose visual fields deteriorated despite acceptable office IOP levels or cases when a suspicious optic disc is discovered with normal office IOP. These patient groups may not truly represent treated POAG glaucoma as a whole.…”

Section: Discussionmentioning

confidence: 87%

“…These patient groups may not truly represent treated POAG glaucoma as a whole. Jonas et al 10 reported diurnal IOP profiles in open-angle and normal tension glaucoma. The range of circadian IOP fluctuation in 46 eyes under treatment for POAG was 5.74 ± 3.44 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…The treated POAG patients in previous studies on IOP fluctuation either do not truly represent treated POAG glaucoma as a whole or have issues in data collection. [8][9][10] Baskaran et al 6 enrolled study subjects after LPI but before commencement of any medical or surgical treatment. Current consensus recommends LPI in selected PACS eyes.…”

Section: Introductionmentioning

confidence: 99%

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Diurnal intraocular pressure fluctuation and its risk factors in angle-closure and open-angle glaucoma

Srinivasan

Choudhari

Baskaran

et al. 2015

Eye

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Purpose To evaluate intraocular pressure (IOP) fluctuation during office hours and its predictive factors in untreated primary angleclosure suspects (PACS); post-iridotomy primary angle closure (PAC) and primary angle-closure glaucoma (PACG) eyes with or without IOP-lowering medication(s) as appropriate and medically treated primary open-angle glaucoma (POAG) eyes. Methods One-hundred seventeen eyes (29 PACS, 30 PAC, 28 PACG, and 30 POAG) of 117 patients were included in this crosssectional study. The subjects underwent hourly IOP measurements with Goldmann tonometer from 0800 to 1700 hours. Subjects with PAC and PACG had laser peripheral iridotomy at least 2 weeks prior to the inclusion. SD of office-hour IOP readings was the main outcome measure. Results IOP fluctuation differed between the groups (P = 0.01; Kruskal-Wallis Test). Post hoc Mann-Whitney U-tests showed significantly less IOP fluctuation in PACS compared with PACG (Po0.01). Peak office-hour IOP was observed in the morning in untreated subjects and in the early afternoon in treated subjects. A stepwise linear regression model identified the presence of peripheral anterior synechiae (PAS), thickness of lens, large vertical cup-to-disc ratio (VCDR), and PAC category as significant predictive factors associated with office-hour IOP fluctuation. Conclusions Diurnal IOP fluctuation in asymptomatic PACSs was less than that in treated PACG subjects and was at least comparable to that in treated PAC and POAG subjects. The greater the amount of PAS, the thicker the lens, the larger the VCDR, the greater was the IOP fluctuation during office hours.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diurnal intraocular pressure fluctuation and its risk factors in angle-closure and open-angle glaucoma

Srinivasan

Choudhari

Baskaran

et al. 2015

Eye

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“…IOP fluctuates throughout the day in both healthy subjects and patients with glaucoma. 6,[20][21][22][23][24] In our study, we found that after adjusting for age, sex, eye, SE, and AL, only the area and diameter of the SC at the inferior quadrant were negatively associated with changes in IOP (P < 0.05). We speculated that the SC of the inferior part was more easily affected by the gravity and the fluid dynamics of the AH.…”

Section: Discussionmentioning

confidence: 56%

Diurnal Variations in the Morphology of Schlemm's Canal and Intraocular Pressure in Healthy Chinese: An SS-OCT Study

Gao

Aung

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To characterize the diurnal variations in the dimensions of the Schlemm's canal (SC) and its association with intraocular pressure (IOP) using swept-source optical coherence tomography (SS-OCT).METHODS. The temporal, nasal, inferior, and superior limbus of 102 eyes of 51 healthy subjects were imaged in vivo by SS-COT at 5 time points of 8 AM, 11 AM, 2 PM, 5 PM, and 8 PM. IOP was measured at the same time by Goldmann applanation tonometry (GAT). The diameter and the cross-sectional area of the SC were measured in ImageJ. The associations between changes in the SC parameters, IOP, and other biometric parameters were determined using a general estimating equations model. The temporal and inferior limbus of 94 eyes of 47 healthy subjects were also imaged before and during the Valsalva maneuver (VM) at 8 PM. RESULTS.Mean IOPs at different time points were 13.37, 12.89, 11.9, 12.02, and 12.36 mm Hg. Of all four quadrants, the detectable rate of SC was highest in the superior quadrant (85.3%) and lowest in the inferior quadrant (75.5%). We found that changes in the SC area and diameter were negatively associated with IOP changes only in the inferior quadrant (P ¼ 0.0046 and P ¼ 0.0332, respectively), after adjusting for age, sex, eye, spherical equivalent, and axial length. The mean SC area and diameter during the VM were significantly higher than prior to the VM (P < 0.001).CONCLUSIONS. The changes in the SC parameters were negatively associated with IOP changes only in the inferior quadrant. The VM could expand the SC in healthy subjects. Imaging of the SC may be a useful method to discover the reason why IOP fluctuates, and how SC changes morphologically during the daytime in the future.Keywords: Schlemm's canal, intraocular pressure, Valsalva maneuver T he rate of ocular aqueous humor (AH) drainage can affect intraocular pressure (IOP).1 In normal people, the aqueous humor is mainly drained through trabecular meshwork into the Schlemm's canal (SC), and then it flows into collector canals and episcleral veins. Aging, inflammation, and other immune factors could change the structural component in the outflow pathway of the AH, leading to imbalance in AH dynamics. [2][3][4] Blockage in any of the structures above will lead to the obstruction of AH drainage, causing ocular hypertension. 5Elevated IOP is an important risk factor for glaucoma and optic nerve damage. 6 Before the 21st century, the observation of SC in vivo was limited by imaging techniques. With the invention of highresolution optical coherence tomography (OCT), SC imaging in vivo became possible. Previous studies using OCT demonstrated that the SC area in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma was decreased compared to normal people. [7][8][9] In addition, the morphology of SC can be affected by the application of prostaglandins and surgery. A study by Chen et al. 10 showed that the SC area expanded following the use of travoprost in healthy subjects. Similarly, expansion of SC was also detected after trab...

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Single vs Multiple Intraocular Pressure Measurements in Glaucoma Surgical Trials

et al. 2014

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IMPORTANCE Little is known about the necessity of multiple same-day intraocular pressure (IOP) measurements in describing the effect of IOP-lowering surgical procedures, and such evidence could affect surgical trial recruitment and retention of participants. OBJECTIVE To determine whether a single IOP measurement might adequately approximate the mean of several measurements in glaucoma surgical trials. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter, interventional cohort from the prerandomization phase of a randomized clinical trial evaluating use of a supraciliary implant for treatment of IOP was conducted at multiple ophthalmology clinics. A total of 609 patients (609 eyes) with primary open-angle glaucoma and cataract were included. INTERVENTIONS One IOP measurement was made while patients were receiving their usual medications to lower IOP, and 3 IOP measurements were made at 8 AM, 12 PM, and 4 PM after patients underwent washout of all IOP-lowering eyedrops. MAIN OUTCOMES AND MEASURES The proportion of eyes in which the increase in IOP after washout, using the mean of the 3 measurements, differed by more than 0.5, 1.0, 1.5, or 2.0 mm Hg from the increase in IOP after washout using only 1 of the postwashout measurements. A proportion of 10% or less at the 1.5-mm Hg cutoff was considered clinically acceptable. The hypothesis was formulated after data collection but before the data were examined. RESULTS The mean (SD) IOP before washout was 18.5 (4.0) mm Hg. The mean increase in IOP after washout, using the mean of the 3 measurements, was 5.3 (4.2) mm Hg. The percentage of eyes in which the increase in IOP using a single postwashout IOP differed from the increase in IOP using the mean of 3 measurements by more than 1.5 mm Hg was 35.1%, 25.6%, 34.2%, 30.0%, and 31.4% when the single measurement was made at 8 AM, 12 PM, 4 PM, a randomly chosen single measure of those 3 times, and the time closest to that of the prewashout IOP, respectively. By logistic regression, the 12 PM postwashout IOP had the lowest proportion of eyes differing from the mean (P < .001) and thus most closely approximated the mean diurnal IOP. CONCLUSIONS AND RELEVANCE Although eliminating multiple IOP measurements would simplify the conduct of surgical trials in glaucoma, our data show that using a single IOP measurement after washout does not adequately approximate the mean of multiple IOP measurements.

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Diurnal Intraocular Pressure Profiles in Chronic Open-Angle Glaucoma

Cited by 19 publications

References 29 publications

Diurnal intraocular pressure fluctuation and its risk factors in angle-closure and open-angle glaucoma

Diurnal intraocular pressure fluctuation and its risk factors in angle-closure and open-angle glaucoma

Diurnal Variations in the Morphology of Schlemm's Canal and Intraocular Pressure in Healthy Chinese: An SS-OCT Study

Single vs Multiple Intraocular Pressure Measurements in Glaucoma Surgical Trials

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