Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Apr-Jun;13(2):170-174.
doi: 10.4103/jovr.jovr_35_18.

Intraocular Pressure Fluctuation: Is It Important?

Ji Hyun Kim  1   2 , Joseph Caprioli  1
Affiliations
Review

Intraocular Pressure Fluctuation: Is It Important?

Ji Hyun Kim et al. J Ophthalmic Vis Res. 2018 Apr-Jun.

Abstract

Elevated intraocular pressure (IOP) is a major risk factor for the development and progression of glaucoma. Previous prospective, randomized, long-term studies have demonstrated the strength of IOP reduction in slowing the progression of disease. It is well known that IOP is not a fixed value but fluctuates considerably over time. Although there have been some studies on IOP fluctuation and the progression of glaucoma, whether IOP fluctuation is an independent risk factor for glaucomatous damage and disease progression remains controversial. In this article, we reviewed the definition of IOP fluctuation, and both the evidence and the speculation for and against the effect of IOP fluctuation on glaucoma progression. Although conclusions seem to vary from study to study, we considered that different studies examined different groups of patients, at different stages of disease, and at different IOP levels. Our conclusion is that these apparently disparate results are not conflicting, but rather can be viewed as complementary. In clinical care, we recommend the consideration of IOP "modulation" rather than just IOP "reduction" when glaucoma patients are treated. Quality-based IOP control may be more effective than quantity-based IOP reduction to prevent or retard disease progression.

Keywords: Fluctuation; Intraocular Pressure; Review.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The correlation between short-term (IOP fluctuation with CLS) and long-term IOP fluctuation (standard deviation of IOP). The Spearman correlation coefficient was 0.3272, P = 0.0061. IOP: intraocular pressure; CLS: contact lens sensor. (From Tojo et al, Clin Ophthalmol 2016).
Figure 2
Figure 2
Scattergram showing the relationship between intraocular pressure (IOP) fluctuation (standard deviation of IOP measurements) and mean IOP. There was a weak but statistically significant correlation observed (Spearman r2 = 0.025, P = 0.006). Long-term IOP fluctuation is associated with VF progression in patients with low mean IOP (area shaded in color), but not in patients with high mean IOP. IOP: intraocular pressure. (From Caprioli et al, Ophthalmology 2008).
Figure 3
Figure 3
Forest plot of odd ratios (ORs) and 95% confidence intervals (CIs) for the association of individual IOP summary measures with a worsening of mean deviation (≥3 dB decrease) from baseline. IOP: intraocular pressure; MD: mean deviation. (From Musch et al Ophthalmology 2011).
Figure 4
Figure 4
(a) The relationship between the mTD progression rate and mean IOP. There was no significant relationship between the mTD progression rate and mean IOP (P = 0.32, linear mixed model). (b) The relationship between the mTD progression rate and SD of IOP. There was a significant relationship between the mTD progression rate and SD of IOP (P = 0.011, linear mixed model). IOP: intraocular pressure; mTD: mean total deviation; SD: standard deviation. (From Fujino et al Invest Ophthalmol Vis Sci 2016).
See this image and copyright information in PMC

References

    1. Goldberg I. Relationship between intraocular pressure and preservation of visual field in glaucoma. Surv Ophthalmol. 2003;48(Suppl 1):S3–7. - PubMed
    1. AGIS7. The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2010;130:429–440. - PubMed
    1. Ernest PJ, Schouten JS, Beckers HJ, Hendrikse F, Prins MH, Webers CA. An evidence-based review of prognostic factors for glaucomatous visual field progression. Ophthalmology. 2013;120:512–519. - PubMed
    1. Buguet A, Py P, Romanet JP. 24-Hour (Nyctohemeral) and Sleep-Related Variations of Intraocular Pressure in Healthy White Individuals. Am J Ophthalmol. 1994;117:342–347. - PubMed
    1. Liu JHK, Kripke DF, Hoffman RE, Twa MD, Loving RT, Rex KM, et al. Nocturnal elevation of intraocular pressure in young adults. Investig Ophthalmol Vis Sci. 1998;39:2707–2712. - PubMed