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Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Graefe's Archive for Clinical and Experimental Ophthalmology volume 243, pages 513–518 (2005)Cite this article

Abstract

Purpose

To establish whether intraocular pressure (IOP) fluctuations contribute to the risk of developing glaucoma in patients with high-risk ocular hypertension.

Methods

Ninety patients included in the Malmö Ocular Hypertension Study were examined every 3 months with office-hours diurnal tension curves and computerised perimetry. Patients were followed up prospectively for 10 years or until glaucomatous visual field loss could be demonstrated. Poststudy data were included in the analyses, extending maximum follow-up to 17 years.

Results

After 17 years, 37 patients had developed glaucomatous visual field defects. When applying univariate Cox regression analyses, mean IOP of all measurements during the prospective part of the study was a significant risk factor for developing glaucoma (95% confidence interval [CI] 1.08–1.39), while IOP fluctuations were almost significant (95% CI 0.98–1.93). When separating effects of mean IOP level and mean IOP fluctuation using Cox multiple regression analysis, only IOP level came out as significant (95% CI 1.09–1.38), and IOP fluctuations did not contribute to the risk (95% CI 0.80–1.60). IOP fluctuation depended linearly on IOP level (p<0.0001), i.e. IOP fluctuation was larger in eyes with higher IOP levels.

Conclusion

IOP fluctuations were not an independent risk factor for the incidence of glaucomatous visual field loss in subjects with ocular hypertension.

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Fig. 1

References

  1. AGIS investigators. The Advanced Glaucoma Intervention Study (AGIS) (2000) The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 130:429–440

    Google Scholar 

  2. Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K (2000) Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma 9:134–142

    Google Scholar 

  3. Bengtsson B, Heijl A (2001) Lack of long-term drift in timolol’s effectiveness in patients with ocular hypertension. Invest Ophthalmol Vis Sci 42:2839–2842

    Google Scholar 

  4. Bergeå B, Bodin L, Svedbergh B (1999) Impact of intraocular pressure regulation on visual fields in open-angle glaucoma. Ophthalmology 106:997–1005

    Google Scholar 

  5. Daugeliene L, Yamamoto T, Kitazawa Y (1999) Risk factors for visual field damage progression in normal-tension glaucoma eyes. Graefes Arch Clin Exp Ophthalmol 237:105–108

    Google Scholar 

  6. De Vivero C, O’Brien C, Lanigan L, Hitching R (1994) Diurnal intraocular pressure variation in low-tension glaucoma. Eye 8:521–523

    Google Scholar 

  7. Drance SM (1960) The significance of the diurnal tension variations in normal and glaucomatous eyes. Arch Ophthalmol 64:494–501

    Google Scholar 

  8. Drance SM (1963) Diurnal variation of intraocular pressure in treated glaucoma. Significance in patients with chronic simple glaucoma. Arch Ophthalmol 70:302–311

    Google Scholar 

  9. Duke Elder S (1952) The phasic variations in the ocular tension in primary glaucoma. Am J Ophthalmol 35:2–8

    Google Scholar 

  10. Gonzalez I, Pablo IE, Pueyo M, Ferrer B, Melcon E, Abecia E, Honrubia FM (1997) Assessment of diurnal tension curve in early glaucoma damage. Int Ophthalmol 20:113–115

    Google Scholar 

  11. Heijl A, Bengtsson B (2000) Long-term effects of timolol therapy in ocular hypertension a double-masked, randomised trial. Graefes Arch Clin Exp Ophthalmol 238:877–883

    Google Scholar 

  12. Heijl A, Drance SM (1981) A clinical comparison of three computerized automatic perimeters in the detection of glaucoma defects. Arch Ophthalmol 99:832–836

    Google Scholar 

  13. Heijl A, Drance SM, Douglas GR (1980) Automatic perimetry (Competer). Ability to detect early glaucomatous field defects. Arch Ophthalmol 98:1560–1563

    Google Scholar 

  14. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M (2002) Reduction of intraocular pressure and glaucoma progression. Results from the early manifest glaucoma trial. Arch Ophthalmol 120:1268–1279

    PubMed  Google Scholar 

  15. Heijl A, Lindgren G, Olsson J (1986) A package for the statistical analysis of visual fields. Doc Ophthalmol Ser 49:153–168

    Google Scholar 

  16. Ishida K, Yamamoto T, Kitazawa Y (1998) Clinical factors associated with progression of normal-tension glaucoma. J Glaucoma 7:372–377

    Google Scholar 

  17. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK, Wilson MR, Gordon MO (2002) The ocular hypertension treatment study: a randomised trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120:701–713

    PubMed  Google Scholar 

  18. Katavisto M (1964) The diurnal variations of ocular tension in glaucoma. Acta Ophthalmol 46 [Suppl 78]:1–130

    Google Scholar 

  19. Langley D, Swanljung H (1951) Ocular tension in glaucoma simplex. Br J Ophthalmol 35:445–458

    Google Scholar 

  20. Liu JHK, Zhang X, Kripke DF, Weinreb RN (2003) twenty-four-hour intra ocular pressure pattern associated with early glaucomatous changes. Invest Ophthalmol Vis Sci 44:1586–1590

    Google Scholar 

  21. Maslenikow AZ (1904) Ueber Tagesschwankungen des intraokularen Druckes bei Glaukom. Augenheilk 11:564

    Google Scholar 

  22. Mills RP, Hopp RH, Drance SM (1986) Comparison of quantitative testing with the Octopus, Humphrey, and Tubingen perimeters. Am J Ophthalmol 102:496–504

    Google Scholar 

  23. Nouri-Mahdavi K, Hoffman D, Coleman AL, Liu G, Li G, Gaasterland D, Caprioli J (2004) Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology 111:1627–1635

    Google Scholar 

  24. Saccà SC, Rolando M, Marletta A, Cerqueti P, Ciurlo G (1998) Fluctuations of intraocular pressure during day in open-angle glaucoma, normal-tension glaucoma and normal subjects. Ophthalmologica 212:115–119

    Google Scholar 

  25. Smith J (1985) Diurnal intraocular pressure. Correlation to automated perimetry. Ophthalmology 92:858–861

    Google Scholar 

  26. Wax MB, Camras CB, Fiscella RG, Girkin C, Singh K, Weinreb R (2002) Emerging perspectives in glaucoma: optimizing 24-hour control of intraocular pressure. Am J Ophthalmol 133 [Suppl]:S1–S10

    Google Scholar 

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Acknowledgements

This study was supported by grant K2002-74X-10426-10A from the Swedish Research Council, by the Järnhardt Foundation and by funds administered by Malmö University Hospital.

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Affiliations

  1. Department of Ophthalmology, Malmo University Hospital, Lund University, 20502, Malmo, Sweden

    Boel Bengtsson & Anders Heijl

Authors
  1. Boel Bengtsson
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  2. Anders Heijl
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Correspondence to Boel Bengtsson.

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Bengtsson, B., Heijl, A. Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension. Graefe's Arch Clin Exp Ophthalmol 243, 513–518 (2005). https://doi.org/10.1007/s00417-004-1103-8

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  • DOI: https://doi.org/10.1007/s00417-004-1103-8

Keywords

  • Ocular hypertension
  • Glaucoma
  • Risk factor
  • IOP fluctuation