Positional Change of Intraocular Pressure and Its Relationship to Ocular Pulse Amplitude

Jae Hong Ahn; Hyun Kyung Kil; Mar Vin Lee

doi:10.3341/jkos.2015.56.2.234

Journal List > J Korean Ophthalmol Soc > v.56(2) > 1010191

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Kil, and Lee: Positional Change of Intraocular Pressure and Its Relationship to Ocular Pulse Amplitude

Original Article

J Korean Ophthalmol Soc 2015;56(2):234-240.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.234

Positional Change of Intraocular Pressure and Its Relationship to Ocular Pulse Amplitude

Jae Hong Ahn, MD, PhD¹, Hyun Kyung Kil, MD², Mar Vin Lee, MD^2,

¹Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

²Department of Ophthalmology, Bundang Jesaeng General Hospital, Seongnam, Korea

Address reprint requests to Mar Vin Lee, MD, Department of Ophthalmology, Bundang Jesaeng General Hospital, #20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 463-774, Korea, Tel: 82-31-779-0292, Fax: 82-31-779-0896 E-mail: mvejhw@dmc.or.kr

Received 16 May 201411 August 2014 Accepted 28 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the postural change of intraocular pressure (IOP) from sitting to supine position and determine the relationship to other ocular parameters including ocular pulse amplitude (OPA) in glaucoma suspect and open angle glaucoma patients.

Methods

The present study included 46 eyes of 46 patients. First, we measured IOP and OPA using Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer and TonoPen^®. Using TonoPen^®, the IOP was measured immediately after the subjects were placed in a supine position and 10 minutes and 30 minutes thereafter. We also investigated the correlation between positional change of IOP and axial length (AL), refractive error (RE), and OPA.

Results

IOPs of patients in a sitting position measured with GAT and TonoPen^® were 15.3 ± 3.3 mm Hg and 16.6 ± 2.9 mm Hg, respectively, and OPA was 2.57 ± 0.89 mm Hg. IOPs measured with TonoPen^® were 17.6 ± 2.9 mm Hg immediately after position change, 18.2 ± 3.7 mm Hg after 10 minutes and 17.5 ± 2.7 mm Hg after 30 minutes. Each IOP change was statistically significant and the largest change was after 10 minutes. Changes of IOP after 10 minutes were positively correlated with OPA (R = 0.340) and RE (R = 0.330) and negatively correlated with AL (R = -0.410).

Conclusions

When placed in a supine position, the IOP of patients increased and then decreased over time. Positional IOP change was influenced by AL and OPA and variable hemodynamic factors and apparently influenced OPA and ocular perfusion pressure.

Keywords: Intraocular pressure fluctuation, Ocular blood flow, Ocular pulse amplitude, Positional intraocular pressure

References

1. Allingham RR, Damji KF. Shields textbook of glaucoma. 6th ed.Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins;2011. chap. 2.

2. Leonard TJ, Kerr Muir MG, Kirkby GR, Hitchings RA. Ocular hypertension and posture. Br J Ophthalmol. 1983; 67:362–6.

3. Tsukahara S, Sasaki T. Postural change of IOP in normal persons and in patients with primary wide open-angle glaucoma and low-tension glaucoma. Br J Ophthalmol. 1984; 68:389–92.

4. Carlson KH, McLaren JW, Topper JE, Brubaker RF. Effect of body position on intraocular pressure and aqueous flow. Invest Ophthalmol Vis Sci. 1987; 28:1346–52.

5. Lee JY, Yoo C, Kim YY. The effect of lateral decubitus position on intraocular pressure in patients with untreated open-angle glaucoma. Am J Ophthalmol. 2013; 155:329–35.e2.

6. Heijl A, Leske MC, Bengtsson B. . Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002; 120:1268–79.

7. Jonas JB, Budde WM, Stroux A. . Diurnal intraocular pressure profiles and progression of chronic open-angle glaucoma. Eye (Lond). 2007; 21:948–51.

8. Dumskyj MJ, Mathias CJ, Doré CJ. . Postural variation in in-traocular pressure in primary chronic autonomic failure. J Neurol. 2002; 249:712–8.

9. Grieshaber MC, Katamay R, Gugleta K. . Relationship between ocular pulse amplitude and systemic blood pressure measurements. Acta Ophthalmol. 2009; 87:329–34.

10. Dastiridou AI, Ginis HS, De Brouwere D. . Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of intraocular pressure. Invest Ophthalmol Vis Sci. 2009; 50:5718–22.

11. Stalmans I, Harris A, Vanbellinghen V. . Ocular pulse amplitude in normal tension and primary open angle glaucoma. J Glaucoma. 2008; 17:403–7.

12. Lee M, Cho EH, Lew HM, Ahn J. Relationship between ocular pulse amplitude and glaucomatous central visual field defect in normal-tension glaucoma. J Glaucoma. 2012; 21:596–600.

13. Araie M, Sekine M, Suzuki Y, Koseki N. Factors contributing to the progression of visual field damage in eyes with normal-tension glaucoma. Ophthalmology. 1994; 101:1440–4.

14. Daugeliene L, Yamamoto T, Kitazawa Y. Risk factors for visual field damage progression in normal-tension glaucoma eyes. Graefes Arch Clin Exp Ophthalmol. 1999; 237:105–8.

15. Grieshaber MC, Flammer J. Blood flow in glaucoma. Curr Opin Ophthalmol. 2005; 16:79–83.

16. Harris A, Rechtman E, Siesky B. . The role of optic nerve blood flow in the pathogenesis of glaucoma. Ophthalmol Clin North Am. 2005; 18:345–53. v.

17. Flammer J, Orgül S, Costa VP. . The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002; 21:359–93.

18. Galassi F, Giambene B, Varriale R. Systemic vascular dysregulation and retrobulbar hemodynamics in normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2011; 52:4467–71.

19. Jain MR, Marmion VJ. Rapid pneumatic and Mackey-Marg appla-nation tonometry to evaluate the postural effect on intraocular pressure. Br J Ophthalmol. 1976; 60:687–93.

20. Krieglstein GK, Waller WK, Leydhecker W. The vascular basis of the positional influence of the intraocular pressure. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1978; 206:99–106.

21. Hvidberg A, Kessing SV, Fernandes A. Effect of changes in PCO2 and body positions on intraocular pressure during general anaesthesia. Acta Ophthalmol (Copenh). 1981; 59:465–75.

22. Sawada A, Yamamoto T. Posture-induced intraocular pressure changes in eyes with open-angle glaucoma, primary angle closure with or without glaucoma medications, and control eyes. Invest Ophthalmol Vis Sci. 2012; 53:7631–5.

23. Kiuchi T, Motoyama Y, Oshika T. Postural response of intraocular pressure and visual field damage in patients with untreated nor-mal-tension glaucoma. J Glaucoma. 2010; 19:191–3.

24. Kiuchi T, Motoyama Y, Oshika T. Relationship of progression of visual field damage to postural changes in intraocular pressure in patients with normal-tension glaucoma. Ophthalmology. 2006; 113:2150–5.

25. Fontana L, Poinoosawmy D, Bunce CV. . Pulsatile ocular blood flow investigation in asymmetric normal tension glaucoma and normal subjects. Br J Ophthalmol. 1998; 82:731–6.

26. Park SC, De Moraes CG, Teng CC. . Initial parafoveal versus peripheral scotomas in glaucoma: risk factors and visual field characteristics. Ophthalmology. 2011; 118:1782–9.

27. Lam AK, Chan ST, Chan B, Chan H. The effect of axial length on ocular blood flow assessment in anisometropes. Ophthalmic Physiol Opt. 2003; 23:315–20.

28. Dastiridou AI, Ginis H, Tsilimbaris M. . Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of axial length. Invest Ophthalmol Vis Sci. 2013; 54:2087–92.

29. Jang SR, Lee MV, Ahn JH. Comparison of dorzolamide-timolol fixed combination and latanoprost, effects on intraocular pressure and ocular pulse amplitude. J Korean Ophthalmol Soc. 2014; 55:854–9.

30. Lu LC, Wei TM, Li S. . Differences in blood pressure readings between supine and sitting positions in hypertensive patients. Acta Cardiol. 2008; 63:707–11.

Figure 1.

Illustration of postural change of our subjects. (A) Sitting in-traocular pressure (IOP) was measure while subjects sitting on chair vertically. (B) Supine IOP was measured while subjects lying on the bed without a pillow.

Figure 2. ( A) Correlation between ocular pulse amplitude and change of intraocular pressure (IOP) between sitting IOP and supine IOP 10 minutes after taking supine position. (B) Correlation between axial length and changes of IOP between sitting IOP and supine IOP 10 minutes after taking supine position.

Table 1.

Descriptive statistics of 46 subjects

	Minimum	Maximum	Average	Standard deviation
Age (years)	17	81	47.9	±13.6
MD (dB)	-28.26	2.90	-4.68	±8.17
PSD (dB)	0.97	17.17	5.59	±5.45
VFI (%)	14.00	100.00	84.67	±23.07
BCVA	0.40	1.00	0.95	±0.12
SE (diopter)	-13.38	2.88	-2.53	±3.72
CCT (μ m)	458.7	636.0	545.6	±35.4
AL (mm)	20.35	27.87	24.64	±1.54
ACD (mm)	2.57	4.41	3.43	±0.45

MD = mean deviation; PSD = pattern standard deviation; VFI = visual field index; BCVA = best corrective visual acuity; SE = spherical equivalent; CCT = central corneal thickness; AL = axial length; ACD = anterior chamber depth.

Table 2.

IOP and OPA measured at each time point

	Sitting	Supine-0 minute	Supine-10 minutes	Supine-30 minutes
GAT IOP (mm Hg)	15.3 ± 3.3	-	-	-
DCT IOP (mm Hg)	18.8 ± 4.1	-	-	-
DCT OPA (mm Hg)	2.6 ± 0.8	-	-	-
TonoPen® IOP (mm Hg)	16.6 ± 2.9	17.1 ± 2.9^∗	18.2 ± 3.7^∗	17.5 ± 2.8^∗

Values are presented as mean ± SD. IOP = intra ocular pressure; OPA = ocular pulse amplitude; GAT = Goldmann applanation tonometer; DCT = dynamic contour tonometer.

^∗ Difference from sitting Tonopen® IOP was statisticaly significant with paired sample t-test.

Table 3.

Correlation between positional IOP change and ocular parameters

	GAT IOP	DCT IOP	TonoPen® IOP	OPA	CCT	AL	ACD
Supine-0 minute	0.121 (0.423)	0.204 (0.173)	-0.227 (0.130)	0.025 (0.870)	-0.093 (0.541)	-0.042 (0.782)	0.149 (0.324)
Supine-10 minutes	0.186 (0.215)	0.154 (0.306)	-0.162 (0.283)	0.340 (0.021)	0.174 (0.246)	-0.410 (0.005)	-0.123 (0.416)
Supine-30 minutes	-0.023 (0.882)	-0.068 (0.653)	-0.248 (0.163)	0.092 (0.545)	0.063 (0.680)	-0.161 (0.284)	-0.165 (0.274)

Pearson correlation coefficient r (p-value).

IOP = intra ocular pressure; GAT = Goldmann applanation tonometer; DCT = dynamic contour tonometer; OPA = ocular pulse amplitude; CCT = central corneal thickness; AL = axial length; ACD = anterior chamber depth.

Table 4.

Correlation between positional IOP change and severity of glaucomatous visual field defects

	MD	PSD	VFI
Supine - 0 minute	-0.015 (0.922)	-0.036 (0.817)	0.009 (0.951)
Supine - 10 minutes	-0.170 (0.265)	0.213 (0.161)	-0.150 (0.326)
Supine - 30 minutes	-0.161 (0.290)	0.241 (0.111)	-0.150 (0.324)

Pearson correlation coefficient r (p-value).

IOP = intra ocular pressure; MD = mean deviation; PSD = pattern standard deviation; VFI = visual field index.

TOOLS

Similar articles