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      Short- and Long-Term Phasing of Intraocular Pressure in Stable and Progressive Glaucoma

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          Abstract

          Aims: To evaluate short- (ST) and long-term (LT) intraocular pressure (IOP) in patients with stable (SG) and progressive glaucoma (PG). Materials and Methods: Fifty-two patients with treated glaucoma received a baseline 24-hour IOP curve and, every 6 months for 2 years, office-hour curve plus visual field test. Based on field changes, they were divided into 24 SG and 28 PG. ST and LT IOP mean, peak and fluctuation (standard deviation of measurements) were calculated. Parameters determining progression were evaluated by logistic regression. Results: At ST, SG and PG, respectively, had mean IOP of 16.8 ± 2.2 and 15.3 ± 1.8 mm Hg; peak of 19.7 ± 3.3, 17.4 ± 2.3 mm Hg; fluctuation of 2.3 ± 1.2, and 1.6 ± 0.6 mm Hg. LT parameters did not change in SG, whereas a significant increase of mean (+1.0 ± 1.5 mm Hg, p = 0.05), peak (2.0 ± 2.4 mm Hg, p = 0.0002), and fluctuation (0.5 ± 1.1 mm Hg, p = 0.008) occurred in PG. Mean, peak, and fluctuation were correlated, except mean and fluctuation in the long term. Association with progression was shown for change in mean IOP between ST and LT, and ST peak. Conclusions: SG and PG may show different IOP parameters when intensively measured at baseline and follow-up. Mean IOP change between ST and LT periods and ST peak were the parameters associated with progression.

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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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              Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial.

              M. Leske, Anders Heijl, … (2007)
              To investigate whether increased fluctuation of intraocular pressure (IOP) is an independent factor for glaucoma progression. A cohort of patients was followed up in a randomized clinical trial. Two hundred fifty-five glaucoma patients from the Early Manifest Glaucoma Trial (EMGT; 129 treated and 126 control patients). Study visits, conducted every 3 months, included ophthalmologic examinations, IOP measurements, and standard automated perimetry, with fundus photography every 6 months. Intraocular pressure values were included only until the time of progression in those eyes that showed such progression. Individual mean follow-up IOP and IOP fluctuation, calculated as the standard deviation of IOP at applicable visits, were the variables of main interest. Cox regression with time-dependent variables was used to evaluate the association between IOP fluctuation and time to progression, both with and without IOP mean in the models. These analyses also controlled for other significant variables. Glaucoma progression, as defined by a predetermined visual field criterion, worsening of the disk, assessed by an independent disc reading center, or both. Median follow-up time was 8 years (range, 0.1-11.1 years). Sixty-eight percent of the patients progressed. When considering mean follow-up IOP and IOP fluctuation in the same time-dependent model, mean IOP was a significant risk factor for progression. The hazard ratio (HR) was 1.11 (95% confidence interval [CI], 1.06-1.17; P<0.0001). Intraocular pressure fluctuation was not related to progression, with an HR of 1.00 (95% CI, 0.81-1.24; P = 0.999). These results confirm our earlier finding that elevated IOP is a strong factor for glaucoma progression, with the HR increasing by 11% for every 1 mmHg of higher IOP. Intraocular pressure fluctuation was not an independent factor in our analyses, a finding that conflicts with some earlier reports. One explanation for the discrepancy is that our analyses did not include postprogression IOP values, which would be biased toward larger fluctuations because of more intensive treatment. In contrast, in this EMGT report, no changes in patient management occurred during the period analyzed.
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                Author and article information

                Journal
                Journal ID (publisher-id): OPH
                Journal ID (nlm-ta): Ophthalmologica
                Journal ID (doi): 10.1159/issn.0030-3755
                Title: Ophthalmologica
                Publisher: S. Karger AG
                ISSN (Print): 0030-3755
                ISSN (Electronic): 1423-0267
                Publication date Subscription-year: 2013
                Publication date (Print): August 2013
                Publication date (Electronic): 21 June 2013
                Volume: 230
                Issue: 2
                Pages: 87-92
                Affiliations
                aEye Clinic, Department of Medicine, Surgery and Odontology, Ospedale San Paolo, University of Milan, Milan, and bG.B. Bietti Foundation, IRCCS, and cEye Clinic, Tor Vergata University of Rome, Rome, Italy
                Author notes
                *Paolo Fogagnolo, MD, Eye Clinic, Ospedale San Paolo, Via di Rudini' 8, IT-20142 Milan (Italy), E-Mail fogagnolopaolo@googlemail.com
                Article
                Publisher ID: 351647 Other ID: Ophthalmologica 2013;230:87-92
                DOI: 10.1159/000351647
                PubMed ID: 23796507
                SO-VID: d2749b47-53a1-4130-8737-13942cd95b46
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 17 December 2012
                Date accepted : 26 March 2013
                Page count
                Tables: 3, Pages: 6
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Visual field,Long-term phasing,Intraocular pressure,Progressive glaucoma,Short-term phasing
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Visual field, Long-term phasing, Intraocular pressure, Progressive glaucoma, Short-term phasing

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