Higher Mean Intraocular Pressure Research Articles

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

PurposeTiming of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention. DesignRetrospective cohort study. MethodsAdult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry (SAP) data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time (AFT) models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record. ResultsA total of 10,553 eyes from 6,934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3±13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0±2.1 years, with time to surgery of 3.2±1.9 years. Multivariable AFT models demonstrated that higher mean intraocular pressure (time ratio (TR) 0.27 per 5 mmHg higher; 95% CI: 0.23-0.31, p<0.001), faster SAP rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, p<0.001), moderate (TR 0.69; 95% CI: 0.56-0.85, p<0.001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, p<0.001), and thinner central corneal thickness (TR 0.85 per 50µm thinner; 95% CI: 0.77-0.95, p=0.003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, p=0.006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, p=0.037) and 4 (TR 1.11; 95% CI: 1.03-1.19, p=0.006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, p=0.002). ConclusionsResidence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.

Correlation between retinal nerve fiber layer thickness and anterior segment parameters in patients with pseudoexfoliation: A cross-sectional comparative study.

The purpose of this study was to assess the retinal nerve fiber layer (RNFL) thickness in patients with pseudoexfoliation (PXF) and to correlate it with anterior segment parameters such as intraocular pressure (IOP), central corneal thickness (CCT), pigments in angle structures, and grades of PXF. This was a cross-sectional comparative study in a tertiary care center. Patients having unilateral PXF were categorized as group 1. Age- and sex-matched healthy controls were categorized as group 2. All subjects underwent IOP measurement, CCT measurement, and retinal nerve fiber thickness measurement. Subjects in group 1 also underwent gonioscopy and perimetry. Data were entered and analyzed using the IBM-SPSS program (version 20.0); Chicago, IL. Mean RNFL thickness in group 1 was 85.91 ± 22.237 μ and in group 2 was 106.65 ± 6.1 μ. The mean RNFL thickness in patients with PXF syndrome was 103.38 ± 5.815 μ and in patients with PXF glaucoma was 67.82 ± 17.984 μ. The mean CCT in patients with PXF syndrome was 516.41 ± 23.03 μ and in patients with PXF glaucoma was 507 ± 33.05 μ and control group was 526.6 m. The mean IOP in patients with PXF syndrome was 8 ± 6.01 mmHg; in patients with PXF glaucoma was 17.21 ± 7.33 mmHg; and in the control group was 14.12 ± 2.693 mmHg. There was a negative correlation between IOP and RNFL thickness, and a positive correlation between CCT and RNFL thickness, but it was not statistically significant. A statistically significant correlation was found between grades of PXF and RNFL thinning with a correlation coefficient of 0.437 (P = 0.001). Patients with PXF have a lower CCT, higher mean IOP, and RNFL thinning compared to normal subjects. The presence of grade 3 PXF (on the lens surface edge) showed a statistically significant correlation with RNFL thinning.

Intraocular pressure increases the rate of macular vessel density loss in glaucoma

Background/aimsTo evaluate the relationship over time between intraocular pressure (IOP) and the rate of macula whole image vessel density (wiVD) loss and whole image ganglion cell complex (wiGCC) thinning in...

Correlation of ganglion cell complex thinning with baseline deep and superficial macular vessel density in glaucoma

Background/aimsTo investigate the relationship between ganglion cell complex (GCC) thinning and baseline deep and superficial macular vessel density (VD) in glaucoma.Methods97 eyes of 69 primary open-angle glaucoma (POAG) and glaucoma...

Factors Associated With Differences in the Initial Location of Structural Progression in Normal-Tension Glaucoma.

Précis:Different clinical factors are associated with the location of the first structural progression in glaucoma.Purpose:The aim was to investigate the underlying clinical parameters affecting the location of the initial structural progression of glaucoma in patients with normal-tension glaucoma (NTG).Methods:This retrospective study included 228 eyes of 228 patients with NTG. In total, 130 eyes of 130 patients demonstrated structural progression (as determined by event-based guided progression analysis using Cirrus HD-optical coherence tomography) in the peripapillary retinal nerve fiber layer (ppRNFL) or macular ganglion cell inner plexiform layer (mGCIPL). Depending on where the progression occurred first, it was defined as either ppRNFL first progression or mGCIPL first progression. Clinical parameters associated with each first progression were identified using logistic regression.Results:In total, 50 eyes showed ppRNFL first progression and 64 eyes showed mGCIPL first progression. ppRNFL first progression was significantly associated with female sex [odds ratio (OR)=5.705, P=0.015], lack of systemic hypertension (OR=0.199, P=0.014), disc hemorrhage (OR=4.188, P=0.029), higher mean intraocular pressure (OR=1.300, P=0.03), and lower pattern SD (OR=0.784, P=0.028). In contrast, male sex (OR=0.450, P=0.043), lower central corneal thickness (OR=0.987, P=0.032), higher intraocular pressure fluctuation (OR=1.753, P=0.047), lower systolic blood pressure fluctuation (OR=0.839, P=0.002), and higher diastolic blood pressure fluctuation (OR=1.208, P=0.015) were significantly associated with mGCIPL first progression.Conclusions:Different clinical factors were associated with the initial site of structural glaucoma progression in patients with NTG depending on its peripapillary or macular location, and these findings suggest possible differences in underlying mechanisms of glaucoma damage.

Risk factors for hypertensive phase after Ahmed glaucoma valve implantation.

To investigate the risk factors and the clinical characteristics of the hypertensive phase (HP) after Ahmed glaucoma valve (AGV) implantation. This retrospective study included 60eyes of 57 patients who underwent AGV implantation and with at least 1-year follow-up. HP was defined as intraocular pressure (IOP) > 21mmHg in the first 3months after the surgery. Independent samples t-test and Chi-square test were used to compare differences in patients with the HP and the non-HP groups. Univariable and multivariable logistic regression analyses were used to determine the risk factors for the development of the HP. Statistical significance was assumed at p < 0.05 level. HP was observed in 31 eyes (51.7%) with an average peak IOP of 27.6 ± 4.5mmHg (range 22-40mmHg). The resolution of HP was noted in 27eyes (87.1%) at the 3rd month postoperative visit. The number of glaucoma medications at the last postoperative visit and IOP values from 1month to 1year were significantly higher in the HP group (all p < 0.05). Patients with traumatic glaucoma showed the highest rate (83.3%) of HP development. In the multivariable analysis, a preoperative IOP > 30mmHg (p = 0.03, OR:5.82; reference: ≤ 25mmHg) and younger age (41-64years, p = 0.02, OR:8.49; ≤ 40years, p = 0.001, OR:19.62; reference: ≥ 65years) were independently associated with the occurrence of HP. Hypertensive phase was observed in half of the patients undergoing AGV implantation. A higher mean preoperative IOP and younger age were risk factors for HP development. Although the majority resolved at the 3-month visit, eyes with HP had higher mean IOPs and required more IOP lowering medications.

Intraocular Pressure Control Predicts Retinal Nerve Fiber Layer Thinning in Primary Angle Closure Disease: The CUPAL Study

To determine the relationship of intraocular pressure (IOP) control with subsequent retinal nerve fiber layer (RNFL) thinning in patients with primary angle closure disease (PACD). Prospective cohort study. The study monitored 517 treated PACD eyes from 280 Chinese patients at least 24 months. IOP was measured every 3 months using Goldmann applanation tonometry, and RNFLs were measured by spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering) every 6 months. IOP mean and fluctuation were calculated as the average and the coefficient of variation of IOP measurements during the first 18 months of the study period. The relationship between IOP and subsequent RNFL changes over time were examined using multivariable linear mixed models. Intraclass correlations at the patient and eye levels were also controlled using nested random intercepts in the models. IOP mean (β=-1.20 µm/y per 1 mm Hg, P < .001) and IOP fluctuation (β=-3.10 µm/y per 10% unit change in the coefficient of variation, P < .001) were independently negatively associated with subsequent progressive global RNFL changes, after adjustment for age, sex, and baseline RNFL thickness. In the sectoral analysis, both higher mean IOP and IOP fluctuation predicted progressive RNFL thinning in the inferotemporal, superotemporal, superonasal, and temporal sectors in the order of strength of association. In the subgroup analysis by disease category, IOP fluctuation showed greater association with global RNFL thinning in eyes with primary angle closure glaucoma (P=.010) than in eyes without glaucomatous changes (P=.07). In treated PACD eyes, large IOP fluctuation is an independent predictor for subsequent progressive RNFL thinning in addition to high mean IOP during follow-up.

Population-based associations between progression of normal-tension glaucoma and Yang-deficient constitution among Chinese persons

PurposeTo explore the association between constitution types as defined by traditional Chinese medicine (TCM) and risk for normal-tension glaucoma (NTG).DesignPopulation-based cohort study.MethodsPersons were identified in a population cohort aged ≥30...

Macular Thickness and Microvasculature Loss in Glaucoma Suspect Eyes

To characterize the change of ganglion cell complex (GCC) thickness and macular vessel density in glaucoma suspect eyes with ocular hypertension (OHT) or glaucomatous optic neuropathy (GON). Prospective, longitudinal study. Eight-three eyes (24 healthy, 30 OHT, and 29 GON) of 65 patients who underwent at least 3 visits were included from the Diagnostic Innovations in Glaucoma Study. The mean follow-up was at least 3 years. OCT angiography (OCTA)-based vessel density and OCT-based structural thickness of the 3× 3-mm1 GCC scan slab were evaluated at each visit. The rates of vessel density and thickness change were compared across diagnostic groups using a linear mixed-effects model. Change rates of macula GCC thickness and superficial vessel density. Significant mean rates of both GCC thinning and vessel density loss were detectable in OHT and GON groups. Of the individual suspect eyes, 49.1% showed significant loss (P < 0.05) with either vessel density or GCC thickness. Of the GON eyes, 31.0% showed both significant GCC loss and vessel density loss, 51.7% showed only significant GCC loss, whereas 17.2% showed only significant vessel density loss. Vessel density loss was faster than GCC thinning in half of the suspect eyes based on percent loss analysis. The age and scan quality-adjusted GCC thinning rates of the OHT group (-0.59 μm/year; P= 0.025) and GON group (-0.79 μm/year; P= 0.058) were faster than those of the healthy group (-0.11 μm/year), whereas the rate of vessel density loss was not significantly different among the diagnostic groups (all P > 0.2). Higher mean intraocular pressure during follow-up was associated with faster GCC thinning in the OHT group (P=0.065) and GON groups (P=0.015), but was not associated with the rate of vessel density decrease. Whereas the rate of GCC thinning was faster on average in suspect eyes than in healthy eyes, some suspect eyes showed significant loss of vessel density and faster vessel density loss than GCC thinning. OCT and OCTA are complementary and useful for evaluating eyes with OHT or GON.

Study of prevalence of raised IOP in post cataract patients following topical steroid usage

To evaluate the rise in intraocular pressure (IOP) in post cataract surgery patients who received topical steroids.Patients in the age group of 50-75 years and both sexes who were coming to ophthalmology OPD at a tertiary care hospital of Western Maharashtra were studied. 500 subjects who underwent uncomplicated cataract surgery were taken into consideration; both age and sex matched. All patients were screened for raised intraocular pressure by Perkin’s tonometer preoperatively and at 5th day, 2nd week, 4th week, 6th week and 8th week postoperatively. Patients were allocated into two groups: either topical Prednisolone acetate e/d (1%) (Group I) or Dexamethasone e/d (0.1%) (Group II) started six times for 1st week (considering the cells in anterior chamber &amp;#60;2+) &amp; then tapered off subsequently in the following weeks for a period of 5 weeks (starting with six times for 1st week, then tapering to 4 times for the next week, 3 times for the next week, 2 times for the next week, 1 time for the next week and then stopped).In our study group, the prevalence of steroid-responders was 3.6% with 0.8% showing mild rise, 2.8% showing moderate rise in IOP on the fourth week of topical steroid usage. There was no difference in the mean IOP rise with the usage of two different topical steroids (E/d Prednisolone acetate (1%) and E/d Dexamethasone(0.1%)) in our study. The highest mean IOP was noted at the 5th postoperative day (20.26 mmHg) which was due to inflammation &amp; there was a gradual decrease in IOP in the subsequent weeks of follow-up till 8th week. While as duration after cataract surgery progress till 8th week of follow up, moderate rise in IOP occurs which gradually comes down to mild rise till 8th week of follow-up.Steroid-induced IOP elevation typically occurs after 4 weeks of beginning steroid therapy and the prevalence of steroid responders in post cataract surgery patients was established.

Distribution and analysis of intraocular pressure and its possible association with glaucoma in children.

To analyze intraocular pressure (IOP) and glaucoma-associated factors in children. A total of 4438 children aged 7-16years (2321 boys and 2117 girls) were included in this study. Various ophthalmologic [IOP, central corneal thickness (CCT), etc.] and demographic (body mass index, etc.) parameters were evaluated. IOP increased between the ages of 7 and 9years, peaking at 9years. IOP increased after reaching a trough at 11years and subsequently stabilized after 14years. Girls exhibited thinner CCT (534.28 ± 30.84µm vs. 537.04 ± 31.33µm, P = 0.003), thicker lens thickness (3.56 ± 0.21mm vs. 3.54 ± 0.20mm, P = 0.001), shorter axial length (22.91 ± 0.93mm vs. 23.32 ± 0.89mm, P < 0.001), shallower anterior chamber depth (2.92 ± 0.27mm vs. 3.00 ± 0.26mm, P < 0.001), higher refraction (- 0.57 ± 1.48 D vs. 0.16 ± 1.35 D, P < 0.001), and higher mean corneal curvature (43.77 ± 1.39 vs. 43.03 ± 1.35, P < 0.001). Multivariable analysis assessed the following IOP-associated factors: thicker CCT [standardized correlation coefficient (SRC) = 0.201, P < 0.001), deeper anterior chamber depth (SRC = 0.059, P = 0.009), shorter axial length (SRC = - 0.086, P = 0.036), lower mean corneal curvature (SRC = - 0.123, P < 0.001), higher refraction (SRC = - 0.090, P < 0.001). IOP fluctuated in children, and a trend toward a higher mean IOP between the ages of 9 and 11years, which stabilized after 14years, was observed. IOP was associated with CCT, anterior chamber depth, axial length, lens thickness, mean corneal curvature, spherical equivalent, and systolic blood pressure.

English

BACKGROUND Glaucoma is a chronic, progressive optic neuropathy leading to irreversible blindness. Raised intraocular pressure is one of the modifiable risk factors of developing glaucoma. Regulation of intraocular pressure (IOP) is influenced by various factors and, systolic hypertension is one of them. The objectives of the study was to assess the relationship between systolic hypertension and IOP, also to see the effect of controlled and uncontrolled systolic blood pressure (SBP) on IOP in adults above 40 years of age. METHODS This study included a total of 230 known systemic hypertensive patients of age above 40 years. All the patients underwent detailed history taking, careful systemic and ocular examination. IOP was measured by Goldmann applanation tonometer, central corneal thickness (CCT) by anterior segment optical coherence tomography (OCT) and blood pressure (BP) was recorded after 5 minutes of rest. The data was recorded. RESULTS Correlation coefficient for SBP and IOP in right eye (RE) was 0.290 and for left eye (LE) was 0.354 with a probability value of P &lt; 0.0001 which was statistically highly significant. Mean IOP for controlled SBP was 17.76 mmHg in both eyes (BE) which increased to 20.19 mmHg in RE and 20.64 mmHg in LE in uncontrolled SBP. The Z score value between controlled and uncontrolled systolic hypertensive patients in RE and LE was 6.11 and 7.06 respectively (P &lt; 0.0001). There was an increment of IOP for every 10 mmHg in SBP by 0.56 mmHg in right eye and 0.73 mmHg in left eye. CONCLUSIONS Systolic blood pressure is significantly correlated with IOP. The uncontrolled SBP was related to higher mean IOP and mean IOP was found to increase with rise in SBP. Therefore, patients with known hypertension and glaucoma have to be regularly followed-up and should keep their BP in normal range to prevent disease progression. KEYWORDS Intraocular Pressure, Central Corneal Thickness, Systolic Blood Pressure, Adults Above 40 Years

Relationship between the 24-h variability of blood pressure, ocular perfusion pressure, intraocular pressure, and visual field defect in thyroid associated orbitopathy.

To evaluate the relationship between the 24-h variability of blood pressure (BP), ocular perfusion pressure (OPP), intraocular pressure (IOP), and visual field (VF) defect in thyroid-associated orbitopathy (TAO). Thirty patients (60 eyes) with TAO were clinically examined in the Eye Hospital of Wenzhou Medical University. Patients were divided into two groups: one with VF defect (A) and the other without (B). Clinical parameters measured include 24-h IOP, 24-h blood pressure, orbital computed tomography (CT) scan, optical coherence tomography (OCT), and VFs. The pulse pressure (PP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and 24-h fluctuations were calculated by formula. The MOPP and MAP fluctuation were greater in group A than B (p< 0.05) and had significant negative correlation to mean deviation (MD) of VF (R= - 0.434 P= 0.001*). There was no statistical difference in the muscle index, medial rectus muscle thickness, and blood pressure between two groups. Although there were no significant differences in the mean IOP and IOP fluctuation between two groups, the incidence of IOP abnormalities has higher trend in group A. Patients with 24-h IOP fluctuation ≥8mmHg and the mean IOP > 21mmHg in the group A were more than group B. Dysthyroid optic neuropathy (DON) might have multiple pathogenic mechanisms. In this study, 24-h MOPP fluctuation and medial rectus maximal diameter were all the risk factors for DON. Higher mean IOP and 24-h IOP fluctuation might be risk factors for DON.

The influence of corneal geometrical and biomechanical properties on tonometry readings in keratoconic eyes.

To identify the effect of corneal geometrical and biomechanical parameters on the intraocular pressure (IOP) measurements obtained by Goldmann Applanation Tonometer (GAT), non-contact tonometer, iCare Pro Rebound Tonometer (IRT), Tonopen and Ocular Response Analyzer (ORA, Goldmann-correlated IOP: IOPg, corneal compensated IOP: IOPcc). We prospectively recruited patients with a tomographically confirmed diagnosis of keratoconus. IOP measurements were performed in the following order: non-contact tonometry, ORA, IRT, GAT and Tonopen. The means of the three IOP measurements were used for the analysis. Correlation analyses were performed to assess the association between tonometer readings and the corneal geometrical and biomechanical parameters including ORA waveform parameters. Tonometer variability was assessed using a stepwise linear regression analysis. Fifty-one patients with keratoconus (27 females, mean age 30.8 ± 8.7years) were evaluated. The highest mean IOP was measured by IOPcc (14.6 ± 2.3mmHg) followed by IRT IOP (13.0 ± 3.2mmHg), Tonopen IOP 12.0 ± 2.6mmHg), GAT IOP (11.7 ± 3.1mmHg), NCT IOP (10.2 ± 3.2mmHg) and IOPg (10.2 ± 3.6mmHg). NCT and IOPg were affected from all corneal parameters including thickness, curvature and biomechanical parameters. While GAT and IRT had significant correlations with corneal resistance factor (CRF) and corneal hysteresis, IOPcc only had a significant correlation with CRF. None of the corneal factors had any statistically significant correlation with Tonopen. CRF predicted tonometer measurement variability in 7 of the 15 inter-device variability assessments. Tonopen was the least affected from the corneal parameters followed by IOPcc and GAT. CRF was a strong determinant of tonometer variability.

Association between Rates of Retinal Nerve Fiber Layer Thinning after Intraocular Pressure–Lowering Procedures and Disc Hemorrhage

To compare the rates of retinal nerve fiber layer (RNFL) thinning after intraocular pressure (IOP) lowering procedures in eyes with or without disc hemorrhage (DH) history. Observational cohort study. A total of 166 primary open angle glaucoma (POAG) eyes and glaucoma suspect eyes (37 eyes with DH history (DH group) and 129 eyes without DH (non-DH group)) were included from the African Decent and Glaucoma Evaluation Study (ADAGES) and the Diagnostic Innovations in Glaucoma Study (DIGS). Subjects underwent stereoscopic optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were compared in eyes with and without DH using univariate and multivariable linear mixed effects models. The rates of RNFL thinning. The mean follow-up of DH group and non-DH group was 4.6 years and 4.2 years, respectively. DH group had more procedures (2.4 vs. 1.9, P= 0.080) before follow-up, and more medications (1.8 vs. 1.4, P= 0.052) and lower mean IOP (12.69 mmHg vs. 14.41 mmHg, P= 0.012) during follow-up compared to non-DH group. When mean IOP was adjusted as a covariate in the model, the RNFL thinning rate in the DH group was 2-fold faster than in the non-DH group (-0.61 μm /year vs. -0.33 μm /year, P= 0.025). Higher mean IOP during follow-up was associated with a faster rate of RNFL thinning after procedures. POAG or glaucoma suspect eyes with a history of DH should be carefully followed after IOP-lowering procedures. Additional IOP-lowering may be needed to slow structural progression of the DH eyes to the same rate as the non-DH eyes.

Visual acuity outcomes in Coats disease by classification stage in 160 patients

PurposeTo assess visual outcomes of Coats disease by classification stage.MethodsA retrospective review was conducted on consecutive patients with Coats disease, classified according to Shields classification and with available Snellen visual...

Effect of Antiplatelet/Anticoagulant Use on Glaucoma Progression in Eyes With Optic Disc Hemorrhage.

To assess whether the use of antiplatelets (APs)/anticoagulants (ACs) affects glaucoma progression in eyes with optic disc hemorrhage (DH). One hundred and nineteen eyes from 119 patients with primary open-angle glaucoma in whom a DH was observed at least once during the follow-up period (mean follow-up duration: 6.2 y) were included in this retrospective observational study. Cox proportional hazard models were used to identify the association between putative factors, including AP/AC use, and glaucoma progression. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field. Nineteen of the 119 patients took AP/AC drugs daily [AP/AC use group (AG)], while the others did not [no use group (NG)]. The follow-up period to progression was significantly different between the 2 groups (61.2±23.5 mo for the AG and 47.6±22.0 mo for the NG; P=0.016). Kaplan-Meier analysis revealed a greater cumulative probability of glaucoma progression in the NG than in the AG, with borderline statistical significance (P=0.081). Higher mean intraocular pressure during the follow-up period was a risk factor for glaucoma progression (hazard ratio, 1.107; P=0.014), while AP/AC drug use protected against glaucoma progression (hazard ratio, 0.576; P=0.046). According to our result, use of AP/AC drugs was associated with lower risk of glaucoma progression in eyes with DH.

Long-term clinical course of normotensive preperimetric glaucoma

AimsTo evaluate the long-term clinical course of normotensive preperimetric glaucoma (PPG).MethodsWe retrospectively analysed 130 eyes of 130 patients initially diagnosed as having preperimetric normal tension glaucoma and followed these cases...

Association of Systemic Medication Use With Intraocular Pressure in a Multiethnic Asian Population

There is limited understanding of the associations between systemic medication use and intraocular pressure (IOP) in the general population. To examine the association between systemic medication use and IOP in a multiethnic Asian population. In this post hoc analysis of the Singapore Epidemiology of Eye Diseases study, a population-based study of 10 033 participants (78.7% response rate) from 3 racial/ethnic groups (Chinese [recruited from February 9, 2009, through December 19, 2011], Malays [recruited from August 16, 2004, though July 10, 2006], and Indians [recruited from May 21, 2007, through December 29, 2009]), participants with glaucoma, previous ocular surgery, or trauma and an IOP asymmetry greater than 5 mm Hg between eyes were excluded. Intraocular pressure was measured using Goldmann applanation tonometry. An interviewer-administered questionnaire was conducted to collect data on medication and other variables. Data analysis was performed from August 1 through October 31, 2015. Associations between medication and IOP were assessed using linear regression models adjusted for age, sex, body mass index, ethnicity, and the medical condition for which the medication was taken (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], and β-blockers adjusted for blood pressure, statins adjusted for lipids, and biguanides, sulfonylureas, α-glycosidase inhibitors [AGIs], and insulin adjusted for glycosylated hemoglobin). Medications associated with significant IOP differences were incorporated into regression models adjusted for concomitant use of multiple medications. Generalized estimating equation models were used to account for correlation between eyes. Of the 10 033 participants, we analyzed 8063 (mean [SD] age, 57.0 [9.6] years; 4107 female [50.9%]; 2680 Chinese [33.2%], 2757 Malay [34.2%], and 2626 Indian [32.6%] individuals). Systemic β-blocker use was independently associated with an IOP of 0.45 mm Hg lower (95% CI, -0.65 to -0.25 mm Hg; P < .001). Conversely, higher mean IOP was associated with use of ACEIs (0.33 mm Hg higher; 95% CI, 0.08 to 0.57 mm Hg; P = .008), ARBs (0.40 mm Hg higher; 95% CI, 0.40-0.75 mm Hg; P = .02), statins (0.21 mm Hg higher; 95% CI, 0.02-0.4 mm Hg; P = .03), and sulfonylureas (0.34 mm Hg higher; 95% CI, 0.05-0.63 mm Hg; P = .02). An interaction between medication classes for additive, synergistic, or antagonistic effects on IOP was not identified. Although systemic β-blocker use was associated with lower IOP and systemic ACEI, ARB, statin, and sulfonylurea use was associated with higher IOP in this study, the associations were modest at best. Only the associations with systemic hypoglycemic agents were greater than 1 mm Hg, a threshold that has translated to a 14% greater risk of incident glaucoma across 5 years in other studies. At this point, the effect of systemic medication on IOP in eyes with glaucoma is not well elucidated but important. Our findings indicate that patients with glaucoma may potentially be at risk of higher or lower IOP, depending on medication class, and this would in turn affect management of IOP control.

Effects of obesity on retrobulbar flow hemodynamics: color Doppler ultrasound evaluation.

To evaluate intraocular pressure (IOP) and extraocular orbital vessels with color Doppler ultrasound (CDU) and investigate the effects of obesity on retrobulbar blood flow. Fifty-nine patients were included in this prospective study. Patients were divided into two groups according to body mass index: Group 1 (31 obese patients) and Group 2 (28 non-obese patients). IOP was measured with a Goldmann applanation tonometer, and CDU was used to evaluate the retrobulbar vessels. The mean IOP was 18 ± 6.68 mmHg in the obese group and 13.71 ± 1.60 mmHg in the control group (p<0.001). When the CDU values for the central retinal artery were compared between the groups, the pulsatility index was found to be significantly lower in the obese group than in the control group (p<0.001). When the CDU values for the ophthalmic artery (OA) were compared between the groups, the peak systolic velocity (p<0.001) and end-diastolic velocity (p=0.002) values were found to be significantly lower in the obese group than in the control group. Obese patients have a higher mean IOP and lower flow velocity than non-obese patients. Increased IOP together with decreased retrobulbar blood flow, particularly in obese individuals, may increase the risk of glaucoma development.