Diurnal Variation in Intraocular Pressure Measured by Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

Yeon Jung Choi; Kyu Ryong Choi

doi:10.3341/jkos.2015.56.12.1913

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Choi and Choi: Diurnal Variation in Intraocular Pressure Measured by Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2015;56(12):1913-1920.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1913

Diurnal Variation in Intraocular Pressure Measured by Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

Yeon Jung Choi, M.D, Kyu Ryong Choi, M.D, PhD

Department of Ophthalmology and The Institute of Ophthalmology and Optometry, Ewha Womans University School of Medicine, Seoul, Korea

Address reprint requests to Kyu Ryong Choi, MD, PhD Department of Ophthalmology, Ewha Womans University Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: 82-2-2650-5154, Fax: 82-2-2650-4334 E-mail: Ckrey02@ewha.ac.kr

‗ This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 30 April 20157 July 2015 Accepted 22 September 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 analyze the diurnal change in intraocular pressure (IOP) and corneal biomechanical properties measured using the Ocular Response Analyzer (ORA; Reichert Inc., Depew, NY, USA) in Korean patients with normal tension glaucoma (NTG) patients.

Methods

Intraocular pressure (Goldmann applanation tonometer IOP [GAT IOP], Goldmann-correlated IOP [IOPg], cor-neal-compensated IOP [IOPcc]) and corneal hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT) were measured in 21 eye of NTG patients (12 males, 9 female) at 3 hour intervals for 48 hours using ORA. We recorded the time of each parameter that showed the lowest and the highest values of during the 48 hour testing period (Day 1 and Day2) and evaluated the change of diurnal variation using Repeated measures analysis of variance (Re-ANOVA).

Results

Peak IOP measured with GAT and ORA occurred at 6 AM-9 AM, 3 PM-6 PM and the trough IOP at 9 PM-12 AM during the 48 hour period. CCT, GAT IOP, IOPcc and IOPg measurements showed statistically significant variations ( p<0.05). CH and CRF variations were not statistically significant ( p>0.05).

Conclusions

In Korean NTG patients, IOP exhibits significant diurnal variation, with higher values during the dawn and after-noon and lower values before retiring. Clinically, measurements of IOP performed in the afternoon could aid in the detection of relatively elevated IOP.

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Keywords: Biomechanical properties, Diurnal variation, Intraocular pressure, Ocular response analyzer

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Figure 1.

Diurnal measurements of GAT IOP, IOPcc, IOPg and CCT in normal tension glaucoma patients during 1st 24-hr period. IOP (GAT IOP, IOPcc, IOPg) reaches its peak at 6 AM on the 1st day and the time of the peak IOP measurements matched the time of peak CCT measurements. CCT = central corneal thickness; NTG = normal tension glaucoma; IOP = in-traocular pressure; GAT = Goldman applanation tonometer; IOPg = Goldman-correlated intraocular pressure; IOPcc = corneal-compensated intraocular pressure factor.

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Figure 2.

Diurnal measurements of GAT IOP, IOPcc, IOPg and CCT in normal tension glaucoma patients during 2nd 24-hr period. IOP (GAT IOP, IOPcc, IOPg) reached its peak at 6 AM and 6 PM on 2nd day. But the time of the peak IOP measurements are not matched with the time of peak CCT measurements thoroughly. CCT = central corneal thickness; NTG = normal tension glaucoma; IOP = intraocular pressure; GAT = Goldman applanation tonometer; IOPg = Goldman-cor-related intraocular pressure; IOPcc = corneal-compensated in-traocular pressure factor.

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Figure 3.

Diurnal measurements of CH and CRF in normal tension glaucoma patients during 48-hr period (Day 1 and Day 2). Diurnal fluctuation of CH and CRF show no significantly dif-ference on Day 1 and Day 2 (Day 1 CH: p = 0.183; Day 2 CH: p = 0.139; Day 1 CRF: p = 0.514; Day 2 CRF: p = 0.706). IOP = intraocular pressure; CH = corneal hysteresis; NTG = normal tension glaucoma; CRF = corneal resistant factor.

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Table 1.

Clinical and ocular characteristics of the eyes in NTG groups

	NTG patients (n = 21)
Age (years)	48.71 ± 10.53
Sex (n, %)
Male	12 (57.1)
Female	9 (42.9)
SE (diopter)	-3.87 ± 1.61
CCT (μ m)	551.81 ± 30.74
GAT (mm Hg)	13.49 ± 1.80
IOPg (mm Hg)	16.41 ± 2.18
IOPcc (mm Hg)	17.06 ± 1.46
CH (mm Hg)	10.17 ± 0.80
CRF (mm Hg)	10.49 ± 1.19

Values are presented as mean ± SD unless otherwise indicated. NTG = normal tentsion glaucoma; SE = spherical equivalent; CCT = central corneal thickness; GAT = Goldman applanation tonometer; IOPg = Goldman-correlated intraocular pressure; IOPcc = corneal-compensated intraocular pressure factor; CH = corneal hysteresis; CRF = corneal resistant factor.

Table 2.

Variation of the intraocular and corneal structural properties measurements during 24 hours in normal tension glaucoma group

	Day 1	Day 2	p-value^*
△ CCT (μ m)	45.52 ± 29.34	26.09 ± 9.28	0.015
△ GAT IOP (mm Hg)	4.33 ± 1.53	3.29 ± 1.15	0.018
△ ORA IOPg (mm Hg)	6.80 ± 2.63	4.91 ± 1.72	0.033
△ ORA IOPcc (mm Hg)	7.76 ± 3.12	5.67 ± 2.06	0.128
△ CH (mm Hg)	2.85 ± 1.63	2.27 ± 0.68	0.034
△ CRF (mm Hg)	2.53 ± 1.11	2.10 ± 0.86	0.007

Values are presented as mean ± SD unless otherwise indicated. CCT= central corneal thickness; GAT = Goldman applanation tonometer; IOP = intraocular pressure; ORA = ocular response analyzer; IOPg = Goldman-correlated intraocular pressure; IOPcc = corneal-compensated intraocular pressure factor; CH = corneal hysteresis; CRF = corneal resistant factor. ^* p-value based on t-test.

Table 3.

Pairwise comparison of mean IOP fluctuation measurements (△ GAT IOP, △ ORA IOPg, △ ORA IOPcc) on Day 1 and Day 2

Comparison	Day 1		Day 2
	Mean ± SD (μ m)	p-value^*	Mean ± SD (μ m)	p-value^*
△ GAT IOP (mm Hg) and △ ORA IOPg (mm Hg)	-2.46 ± 2.76	p = 0.001	-1.63 ± 2.04	p = 0.002
△ GAT IOP (mm Hg) and △ ORA IOPcc (mm Hg)	-3.42 ± 3.45	p < 0.001	-2.39 ± 2.21	p < 0.001

Values are presented as mean ± SD unless otherwise indicated. IOP = intraocular pressure; GAT = Goldman applanation tonometer; ORA = ocular response analyzer; IOPg = Goldman-correlated intra-ocular pressure; IOPcc = corneal-compensated intraocular pressure; SD = stamdard deviation.^* p-value based on t-test

Table 4.

Change of IOP and biomechanical the study period parameters during

	Day 1	Day 2
CCT (μ m)	p = 0.100	p < 0.001
GAT IOP (mm Hg)	p = 0.025	p = 0.052
ORA IOPg (mm Hg)	p = 0.040	p = 0.056
ORA IOPcc (mm Hg)	p = 0.047	p = 0.001
CH (mm Hg)	p = 0.183	p = 0.139
CRF (mm Hg)	p = 0.514	p = 0.706

p-value by repetaed measures analysis of variance (ANOVA). IOP = intraocular pressure; CCT = central corneal thickness; GAT = Goldman applanation tonometer; ORA = ocular response analyzer; IOPg = Goldman-correlated intraocular pressure; IOPcc = corneal-compensated intraocular pressure factor; CH = corneal hysteresis; CRF = corneal resistant factor.

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