Large diurnal variation of intraocular pressure in open angle glaucoma in subjects with type a behaviour pattern

Abstract

Aim:To evaluate the possible causes of the greater perimetric damage found in OAG subjects with type A behaviour and the possible role of psycho-physiological stress. Materials and methods: 80 patients with OAG, 44 women and 36 men, 40 with type A behaviour and 40 with type B studied with the Type A/B Personality Questionnaire (A modified version of the Jenkins Activity Survey), underwent a complete ophthalmologic examination consisting of bio-microscopy, tonometry and daily tonometric curve, examination of the visual field by means of Octopus 1-2-3 computerised perimeter and its assessment with the Glaucoma Staging System 2 (GSS2), morphological monitoring of the Retinal Nerve Fibre Layer (RNFL) with GDxVCC and monitoring of arterial tension (times 8.30 am-10.30 am-12.30 pm-3 pm-5 pm and 7 pm) with a UA-1010 automatic Digital Blood Pressure Monitor device. Results: In subjects with type A behaviour fluctuation in IOP values is observed in the daytime hours in concomitance with similar oscillations in arterial pressure values. In the subjects with type B behaviour both IOP and the arterial pressure values remain more or less constant with oscillations that are not statistically significant. In GSS2 more significant impairment of the visual field is observed in subjects with type A behaviour. In the same subjects, GDxVCC examination shows statistically significant impairment of the values. The NFI index is positively correlated with the perimetric damage (r=0.74). Conclusions: Personality study is an extremely important part of the diagnostic work-up and treatment of OAG. The frequent oscillations in IOP observed in subjects with type A behaviour could constitute a risk factor in the evolution of perimetric damage.

Predictors for elevation of Intraocular Pressure (IOP) on glaucoma patients; a retrospective cohort study design

“…Identifying socio-demographic, individual behavior and clinical risk factors affecting elevation of IOP is crucial for detecting progression of glaucoma patients under treatment and to understanding the path physiology of glaucoma [ 23 ]. Previously, a research was also conducted on how the progression of glaucoma is detected using a rate of visual field and rate of structural loss without considering how the elevation of IOP reading used to indicate the progression of glaucoma [ 24 ]. This indicates that, a glaucoma patient with normal IOP reading ( < = 25 mm of HG) indicates that a therapy given to a glaucoma patient was sufficient/adequate and a patient with an elevated IOP(> 25 mm HG) indicates that a therapy given to glaucoma patients was inadequate [ 25 ].…”