Diurnal Fluctuation as a Risk Factor for Glaucoma Progression
Reference:
Nouri-Mahdavik, K., et al. “Predictive Factors for Glaucomatous
Visual Field Progression in the Advanced Glaucoma Intervention
Study.” Ophthalmology, September, 2004.
Select Quotes:
“We found that greater intervisit IOP fluctuation and older
age at the time of first intervention were the most consistent
predictors for visual field progression.
In this study, the analysis suggested that, “xIOP fluctuation
is an independent and stronger predictor [of glaucoma worsening]
than mean IOP for visual field progression.”
M & T Commentary
It has long been thought that greater swings in the diurnal
IOP curve caused more damage to the optic nerve than a flatter
curve. A benefit of prostaglandin therapy is that they tend
to flatten the diurnal IOP curve more than other therapies.
This study certainly underscores how important it is for us
to gain a good understanding of each patient’s IOP behavior
prior to therapeutic intervention. In almost all cases, we
try to obtain 3 or 4 IOP readings at various times of the day
prior to initiation of therapy. This can be done all in one
day or, probably better, at several visits over several weeks
or months, depending on the stage of the glaucoma. |
