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      Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression

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          Abstract

          Purpose

          Since the role of short- and long-term intraocular pressure (IOP) fluctuation as a predictor of glaucoma progression is still controversial, the purpose of this study was to investigate the role of IOP fluctuation in a non-selected patient cohort.

          Materials and methods

          Two-hundred and forty eyes of 120 glaucoma patients (51% female) with a mean age of 64.5 years were included. Inclusion criteria were at least a visual field (VF) and a 48-hour diurnal phasing of IOP including nocturnal measurement. Glaucoma progression was defined as – if available – confirmed progression of reproducible VF defects in at least three VF examinations or increase of cup area on optic nerve imaging (Heidelberg Retina Tomograph [HRT]) with at least two images after baseline. If results were stable or less than previously mentioned VF or HRT examinations were available, it was classified as “no progression”.

          Results

          Glaucoma progression was seen in seven of 240 eyes in the VF analysis and ten of 240 eyes on HRT. Of all 240 eyes, 92 and 41 eyes fulfilled the criteria to be included for progression evaluation on VF and HRT analysis, respectively. Mean time to progression ± standard error was 3.6±0.2 years on VF and 4.5±0.3 years on HRT. Univariate and multivariate Cox regression analyses revealed short-term IOP fluctuation ( P<0.0001) and maximum IOP ( P<0.001) as risk factors for glaucoma progression on VF. There was no significant influence of demographic characteristics, ocular or general health on glaucoma progression.

          Conclusion

          Short-term IOP fluctuation was associated with the progression of glaucoma in this non-selected cohort of glaucoma patients receiving phasing of IOP.

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          Most cited references35

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          The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators.

          (2000)
          To investigate the association between control of intraocular pressure after surgical intervention for glaucoma and visual field deterioration. In the Advanced Glaucoma Intervention Study, eyes were randomly assigned to one of two sequences of glaucoma surgery, one beginning with argon laser trabeculoplasty and the other trabeculectomy. In the present article we examine the relationship between intraocular pressure and progression of visual field damage over 6 or more years of follow-up. In the first analysis, designated Predictive Analysis, we categorize 738 eyes into three groups based on intraocular pressure determinations over the first three 6-month follow-up visits. In the second analysis, designated Associative Analysis, we categorize 586 eyes into four groups based on the percent of 6-month visits over the first 6 follow-up years in which eyes presented with intraocular pressure less than 18 mm Hg. The outcome measure in both analyses is change from baseline in follow-up visual field defect score (range, 0 to 20 units). In the Predictive Analysis, eyes with early average intraocular pressure greater than 17.5 mm Hg had an estimated worsening during subsequent follow-up that was 1 unit of visual field defect score greater than eyes with average intraocular pressure less than 14 mm Hg (P =.002). This amount of worsening was greater at 7 years (1.89 units; P <.001) than at 2 years (0.64 units; P =.071). In the Associative Analysis, eyes with 100% of visits with intraocular pressure less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up, whereas eyes with less than 50% of visits with intraocular pressure less than 18 mm Hg had an estimated worsening over follow-up of 0.63 units of visual field defect score (P =.083). This amount of worsening was greater at 7 years (1.93 units; P <.001) than at 2 years (0.25 units; P =.572). In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intraocular pressure in visual field deterioration.
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            Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study.

            Kouros Nouri-Mahdavi, Douglas Hoffman, Anne L. Coleman … (2004)
            To investigate the risk factors associated with visual field (VF) progression in the Advanced Glaucoma Intervention Study (AGIS) with pointwise linear regression (PLR) analysis of serial VFs. Prospective, multicenter, randomized clinical trial. Five hundred nine eyes of 401 patients from the AGIS with a baseline VF score of or=7 VF examinations, and >or=3 years of follow-up were selected. Visual field progression. This is a cohort study of patients enrolled in a prospective randomized clinical trial (AGIS). Worsening of a test location on PLR analysis was defined as a change of threshold sensitivity of >or=1.00 decibels a year, with P
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              Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study.

              Joseph Caprioli, Laura Coleman (2008)
              To investigate the relationship of intraocular pressure (IOP) fluctuation and mean IOP to visual field (VF) progression in patients enrolled in the Advanced Glaucoma Intervention Study (AGIS). Retrospective analysis of a prospective randomized clinical trial. Three hundred one eyes of 301 patients enrolled in the AGIS were included. Eyes with more than one surgical intervention were excluded. Worsening of the VF was detected with pointwise linear regression. Long-term IOP fluctuation was defined as the standard deviation of IOP (millimeters of mercury) at all visits after initial intervention until the time of VF worsening or end of follow-up, whichever came first. A multivariate linear regression model was performed to identify predictors of VF progression. Terciles of mean IOP were identified, and the average IOP fluctuation in each stratum was calculated. Terciles of long-term IOP fluctuation were similarly evaluated. The proportion of eyes showing VF progression in each stratum was determined and compared. Visual field progression. Visual field progression was detected in 78 eyes (26%). There were statistically significant differences, between progressing and nonprogressing eyes, for mean IOP (P = 0.006), IOP fluctuation (P<0.001), mean length of follow-up (P = 0.013), mean number of VFs (P = 0.005), and mean number of medications (P = 0.006). Three variables were associated with a higher probability of VF progression: greater IOP fluctuation (P = 0.009), argon laser trabeculoplasty (P = 0.004), and older age (P = 0.05). In this model, mean IOP was of borderline statistical significance (P = 0.09). Within the lower and upper terciles of mean IOP, IOP fluctuation was associated with VF progression in the low mean IOP group (P = 0.002) but not in the high mean IOP group (P = 0.2). When subjects were stratified according to IOP fluctuation, there was a statistically significant difference between lower and upper terciles of IOP fluctuation with respect to progression (P = 0.05). There was a weak correlation between mean IOP and IOP fluctuation (r(2) = 0.025, P = 0.01). In the AGIS, long-term IOP fluctuation is associated with VF progression in patients with low mean IOP but not in patients with high mean IOP.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (iso-abbrev): Clin Ophthalmol
                Journal ID (publisher-id): Clinical Ophthalmology
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove Medical Press
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date Collection: 2019
                Publication date (Electronic): 18 December 2018
                Volume: 13
                Pages: 9-16
                Affiliations
                [1 ]Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany, juliane.matlach@ 123456unimedizin-mainz.de
                [2 ]Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
                [3 ]Institute of Medical Biometry and Statistics, Medical Center – University of Freiburg, Freiburg, Germany
                Author notes
                Correspondence: Juliane Matlach, Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany, Tel +49 6131 17 3324, Fax +49 6131 17 3455, Email juliane.matlach@ 123456unimedizin-mainz.de
                Article
                Publisher ID: opth-13-009
                DOI: 10.2147/OPTH.S186526
                PMC ID: 6302802
                PubMed ID: 30587914
                SO-VID: 9df66973-3e9c-44a4-b7c8-a0994b47ccb2
                Copyright © © 2019 Matlach et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: glaucoma progression,short-term iop fluctuation,long-term iop fluctuation,glaucoma imaging,visual field
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: glaucoma progression, short-term iop fluctuation, long-term iop fluctuation, glaucoma imaging, visual field

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