Intraocular Pressure Fluctuation: A Risk Factor for Visual Field Progression at Low Intraocular Pressures in the Advanced Glaucoma Intervention Study

Intraocular pressure (IOP) is the main risk factor for the development and progression of glaucoma. Treatment is based on IOP reduction and isolated tonometric readings are usually performed for clinical management of the disease. However, IOP is not a static parameter and varies considerably throughout the day. This variability, or fluctuation, has classically been considered a risk factor for glaucoma. Nevertheless, recent studies demonstrate that pressure peaks are the most relevant IOP parameter for the prediction of visual field progression. The lack of a standard definition of IOP fluctuation compromises its clinical assessment and may explain in part the contradictory results found in the literature. This review will analyse options for IOP fluctuation assessment, their limitations and the impact of this parameter on the management of glaucoma.

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Corneal hysteresis as a risk factor for optic nerve head surface depression and retinal nerve fiber layer thinning in glaucoma patients

Scientific Reports ◽

10.1038/s41598-021-90588-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guihua Xu ◽

Zilin Chen

Keyword(s):

Risk Factor ◽

Visual Field ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Corneal Hysteresis ◽

Visual Field Progression ◽

Increased Risk ◽

Head Surface ◽

Sd Oct ◽

Surface Depression

AbstractTo evaluate the role of corneal hysteresis (CH) as a risk factor for progressive ONH surface depression and RNFL thinning measured by confocal scanning laser ophthalmoscopy (CSLO) and spectral-domain optical coherence tomography (SD-OCT), respectively in glaucoma patients. Prospective study. A total of 146 eyes of 90 patients with glaucoma were recruited consecutively. The CH measurements were acquired at baseline and 4-months interval using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Eyes were imaged by CSLO (Heidelberg Retinal Tomograph [HRT]; Heidelberg Engineering, GmbH, Dossenheim, Germany) and SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec AG, Dublin, CA) at approximately 4-month intervals for measurement of ONH surface topography and RNFL thickness, respectively. Significant ONH surface depression and RNFL thinning were defined with reference to Topographic Change Analysis (TCA) with HRT and Guided Progression Analysis (GPA) with Cirrus HD-OCT, respectively. Multivariate cox proportional hazards models were used to investigate whether CH is a risk factor for ONH surface depression and RNFL progression after adjusting potential confounding factors. All patients with glaucoma were followed for an average of 6.76 years (range, 4.56–7.61 years). Sixty-five glaucomatous eyes (44.5%) of 49 patients showed ONH surface depression, 55 eyes (37.7%) of 43 patients had progressive RNFL thinning and 20 eyes (13.7%) of 17 patients had visual field progression. In the cox proportional hazards model, after adjusting baseline diastolic IOP, CCT, age, baseline disc area and baseline MD, baseline CH was significantly associated with ONH surface depression and visual field progression (HR = 0.71, P = 0.014 and HR = 0.54, P = 0.018, respectively), but not with RNFL thinning (HR = 1.03, P = 0.836). For each 1-mmHg decrease in baseline CH, the hazards for ONH surface depression increase by 29%, and the hazards for visual field progression increase by 46%. The CH measurements were significantly associated with risk of glaucoma progression. Eyes with a lower CH were significantly associated with an increased risk of ONH surface depression and visual field progression in glaucoma patients.

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