Association of Ultra-Short-Term Intraocular Pressure Fluctuation With Disease Progression in Primary Angle Closure Glaucoma: The CUPAL Study

Abstract

Prcis: This study demonstrated significant differences in ultra-short-term IOP fluctuations, measured by a contact lens sensor between progressive and stable PACG eyes, during the first one hour after falling asleep.

Purpose: To identify the most sensitive period for detecting significant ultra-short-term intraocular pressure (IOP) fluctuation associated with disease progression in primary angle closure glaucoma (PACG).

Materials and methods: PACG eyes, which had been followed up for over 2 years under the CUHK PACG Longitudinal (CUPAL) Study, were recruited. Eyes with or without functional or structural glaucomatous progression were classified into 'progressive' or 'stable' groups on the basis of serial visual field and retinal nerve fiber layer (RNFL) thickness documentations, respectively. Ultra-short-term IOP fluctuations were recorded by Sensimed Triggerfish sensors (Sensimed AG, Lausanne, Switzerland) with 288 readings over 30 seconds, at 5-minute intervals, over a 24-hour period. In each of 7 activity-related 1-hour periods during the examining day, the mean value of the amplitude-frequency profiles of the signal fluctuations in twelve 30-second intervals was calculated by semivariogram/semi-variance. The 'progressive' and 'stable' groups were compared by permutation tests on functional t-statistics.

Results: Among the 25 recruited PACG eyes, 16 eyes were classified as RNFL 'progressive' group (the mean rate of change in global RNFL thickness: -0.199 ±0.128 μm/mo). Higher signal fluctuations, in terms of amplitude-frequency, were found during the first 1-hour period of sleeping in the RNFL 'progressive' group compared with the RNFL 'stable' group ( P =0.028).

Conclusions: Between RNFL 'progressive' and 'stable' PACG eyes, significant differences in ultra-short-term IOP fluctuation at the 1-hour period after falling asleep were identified. The first hour of sleeping may be the most sensitive period for detecting significant ultra-short-term IOP fluctuation in PACG eyes.