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
. 2025 Mar 12;5(2):142-148.
doi: 10.1016/j.aopr.2025.03.002. eCollection 2025 May-Jun.

The impact of intraocular pressure fluctuations on the progression of glaucoma and associated factors

Tong Liu  1   2 , YiLu Cai  3 , MengYuan Hu  1   2 , Zongrong Wang  4 , Xin Liu  1   2 , Min Chen  1   2 , Kaijun Wang  1   2
Affiliations
Review

The impact of intraocular pressure fluctuations on the progression of glaucoma and associated factors

Tong Liu et al. Adv Ophthalmol Pract Res. .

Abstract

Background: In recent years, remarkable advancements in the comprehension of glaucoma pathophysiology have highlighted the necessity of looking beyond the conventional focus on mean intraocular pressure (IOP) levels. IOP fluctuations have been identified as a potential factor that could exert a substantial impact on the progression of glaucoma.

Main text: IOP exhibits dynamic variations throughout a 24-h cycle. Glaucoma patients exhibit substantially more pronounced IOP fluctuations compared to healthy individuals, even when the mean IOP remains within the normal range. This implies that IOP fluctuations may play a role in glaucoma progression through mechanisms independent of elevated mean IOP. In this review, an exhaustive examination of studies spanning the past decade was conducted to analyze the relationship between IOP fluctuations and disease progression in primary open-angle glaucoma (POAG), ocular hypertension (OHT), normal tension glaucoma (NTG), and primary angle-closure glaucoma (PACG). While a few studies present conflicting results, the majority of research supports the notion that elevated IOP fluctuations significantly contribute to disease progression in POAG patients. This association has also been confirmed in PACG patients. However, in NTG or OHT patients, other risk factors may outweigh IOP fluctuations in disease progression or glaucoma conversion. Additionally, we summarized common factors affecting IOP fluctuations to provide a basis for the identification of patients prone to significant daily IOP variations. Finally, the efficacy of various IOP-lowering interventions in modulating IOP fluctuations is concisely summarized, offering insights for the formulation of comprehensive treatment strategies that incorporate IOP fluctuation management.

Conclusions: IOP fluctuations play a significant role in disease progression in POAG and PACG. Individuals with certain systemic or ocular characteristics are more predisposed to pronounced and recurrent IOP fluctuations. Consequently, a comprehensive assessment of IOP fluctuation that transcends mean IOP values, as well as the integration of IOP fluctuations management into glaucoma treatment strategies are of paramount importance.

Keywords: 24-h IOP; Glaucoma; Glaucoma progression; Intraocular pressure fluctuation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Similar articles

See all similar articles

References

    1. Jayaram H., Kolko M., Friedman D.S., et al. Glaucoma: now and beyond. Lancet. 2023;402(10414):1788–1801. doi: 10.1016/S0140-6736(23)01289-8. - DOI - PubMed
    1. Chen X., Wu X., Lin X., et al. Outcome, influence factor and development of CLS measurement in continuous IOP monitoring: a narrative review. Contact Lens Anterior Eye. 2021;44(4) doi: 10.1016/j.clae.2020.10.006. - DOI - PubMed
    1. Sit A.J. Intraocular pressure variations: causes and clinical significance. Can J Ophthalmol. 2014;49(6):484–488. doi: 10.1016/j.jcjo.2014.07.008. - DOI - PubMed
    1. Nishida T., Moghimi S., Chang A.C., et al. Association of intraocular pressure with retinal nerve fiber layer thinning in patients with glaucoma. JAMA Ophthalmol. 2022;140(12):1209–1216. doi: 10.1001/jamaophthalmol.2022.4462. - DOI - PMC - PubMed
    1. Tan S., Yu M., Baig N., et al. Circadian intraocular pressure fluctuation and disease progression in primary angle closure glaucoma. Investig Ophthalmol Vis Sci. 2015;56(8):4994–5005. doi: 10.1167/iovs.15-17245. - DOI - PubMed

LinkOut - more resources