Applied Psychophysiology and Biofeedback

, Volume 43, Issue 1, pp 49–56 | Cite as

Could White Coat Ocular Hypertension Affect to the Accuracy of the Diagnosis of Glaucoma? Relationships Between Anxiety and Intraocular Pressure in a Simulated Clinical Setting

  • Jorge Luis Méndez-Ulrich
  • Antoni Sanz
  • Albert Feliu-Soler
  • María Álvarez
  • Xavier Borràs


Sixty-one healthy subjects participated in a laboratory study carried out in a simulated clinical setting. Anticipatory anxiety-state was assessed at the arrival and immediately after, with no brief phase of adaptation, measurements of intraocular pressure, heart rate, systolic and diastolic blood pressure were collected. At the end of the procedure, anxiety-trait was also assessed. Results suggest that high levels of both anxiety-state and anxiety-trait significantly predicted a clinically relevant increase of intraocular pressure. Anxiety-state mediated the relationship between anxiety-trait and intraocular pressure, which also was found to be related with heart rate but not related to both systolic and diastolic blood pressure. These results suggest a common mechanism of regulation underlying anxiogenic variability found on both intraocular pressure and heart rate. A reduction in parasympathetic activity appears as a possible mechanism underlying to this phenomenon. This anxiety-enhanced intraocular pressure could be considered a phenomenon analogous to white coat hypertension found in the measurement of blood pressure; therefore, it probably should be taken into account in the clinical context to prevent errors in the diagnosis of glaucoma. Further research on cognitive and emotional regulation of intraocular pressure is needed to best characterize this hypothetical phenomenon.


Glaucoma Intraocular pressure Anxiety-state and trait White coat hypertension Cardiovascular reactivity 



Albert Feliu-Soler has a “Sara Borrell” research contract from the ISCIII (CD16/00147). Thanks to Carlos Lugo for his contribution to the linguistic revision.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of Ethics Commission in Animal and Human Experimentation of the Autonomous University of Barcelona and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Research Group on Stress and Health, Department of Basic, Developmental and Educational Psychology, Faculty of PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Teaching, Research & Innovation UnitParc Sanitari Sant Joan de DéuSt. Boi de LlobregatSpain
  3. 3.Primary Care Prevention and Health Promotion Research Network, RedIAPPMadridSpain
  4. 4.Office B5/045, Departament de Psicologia Bàsica, Evolutiva i de l’EducacióBarcelonaSpain

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