The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression

Nam Yeong Kim; Hong Ryung Seo; Sae Heun Rho

doi:10.3341/jkos.2015.56.1.70

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Kim, Seo, and Rho: The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression

Original Article

J Korean Ophthalmol Soc 2015;56(1):70-79.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.1.70

The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression

Nam Yeong Kim, MD¹, Hong Ryung Seo, MD, PhD², Sae Heun Rho, MD, PhD^1,

¹Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

²Department of Ophthalmology, Wallace Memorial Baptist Hospital, Busan, Korea

Address reprint requests to Sae Heun Rho, MD, PhD, Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea, Tel: 82-51-240-5227, Fax: 82-51-254-1987 E-mail: shrho@dau.ac.kr

Received 17 January 201414 May 2014 Accepted 20 December 2014

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 effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure.

Methods

30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glauco-ma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects.

Results

The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger tem-perature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients.

Conclusions

When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma.

Keywords: Autonomic dysregulation, Hand cold provocation test, Nocturnal dip, Vascular dysregulation

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Figure 1.

(A) TONOPORT V.™, (B) 24 hrsambulatory blood pressure monitoring performed.

Figure 2.

Hand Cold Provocation Tester (Rose HCPT™). (A) Rose HCPT™, (B) hand cold provocation test performed, (C) information about date, time and temperature is displayed on screen, (D) temperature date printed every 20 second (preset time).

Figure 3.

Ear Thermometer (Anytem™ MS Tec-Vision, Korea).

Figure 4.

The measurement process of hand cold provocation test. (A) Sensor of finger thermometer placed at proximal portion of middle finger, (B) baseline finger temperature is measured for about 5 minutes, (C) immersion process for 5 minutes in 10℃ cold water, (D) after immersion process, finger temperature recovery for 20 minutes.

Figure 5.

ROC curve of finger temperature recovery rate in normal controls. Cut off value of delayed recovery rate of finger temperature: over 15%, sensitivity: 0.667, AUC: 0.732. ROC = receiver operating characteristic; AUC = area under the ROC curve.

Table 1.

Demographics of patients in NTG & POAG

	NTG	POAG	Control
M:F (eyes)	4:34	7:17	12:12
Mean age (years)	55.55 ± 11.62	58.72 ± 12.90	54.55 ± 10.32
Mean baseline IOP (mm Hg)	17.13 ± 2.78	22.78 ± 5.42	16.84 ± 3.84
Mean controlled IOP (mm Hg)	12.24 ± 1.89	15.03 ± 2.51	-
Mean Δ IOP decrease (mm Hg)	4.82 ± 1.59	7.46 ± 3.74	-
Mean Δ IOP decrease (%)	28.54 ± 2.57	32.02 ± 3.41	-
Mean deviation of visual field (dB)	-6.87 ± 4.21	-7.42 ± 5.49	-0.48 ± 1.07
Pattern standard deviation of visual field (dB)	-4.07 ± 2.74	-4.92 ± 3.48	-0.37 ± 0.89
Mean deviation change of visual field (dB)	-2.48 ± 1.58	-4.42 ± 1.84	-0.04 ± 0.00-
Mean AGIS score change (scores)	-3.34 ± 3.16	-3.82 ± 2.56	-0.12 ± 0.00
Mean nocturnal dip of SBP (%)	8.42 ± 10.81	8.21 ± 8.8	4.24 ± 3.54
Mean nocturnal dip of DBP (%)	9.2 ± 8.67	8.63 ± 8.94	6.41 ± 4.25

Values are presented as mean ± SD unless otherwise indicated.

NTG = normal tension glaucoma; POAG = primary open angle glaucoma; IOP = intraocular pressure; AGIS = Advanced Glaucoma Intervention Study; SBP = systolic blood pressure; DBP = diastolic blood pressure; Mean Δ IOP decrease = the difference between baseline IOP and controlled IOP.

Table 2.

Result of hand cold provocation test in all subjects

	Baseline (℃)		Immersion (℃)	Recovery (℃)
	Ear	Hand	Immersion (℃)	5 min	10 min	15 min	20 min
NTG	36.24 ± 0.43	34.52 ± 2.16	19.37 ± 4.10	26.24 ± 5.33	30.51 ± 5.32	32.14 ± 5.08	33.24 ± 4.22
				(45.55 ± 27.11%)	(71.99 ± 31.34%)	(82.58 ± 29.02%)	(88.78 ± 23.43%)
				(p < 0.000)^∗	(p < 0.000)^∗	(p = 0.013)^∗	(p = 0.057)^∗
POAG	36.18 ± 0.44	34.63 ± 2.19	20.42 ± 4.10	27.78 ± 4.87	32.02 ± 3.94	33.33 ± 3.20	34.44 ± 2.29
				(56.59 ± 27.65%)	(79.14 ± 26.28%)	(91.63 ± 26.06%)	(93.91 ± 14.63%)
				(p = 0.285)^∗	(p = 0.552)^∗	(p = 0.968)^∗	(p = 0.812)^∗
Control	35.90 ± 0.67	35.83 ± 0.52	20.99 ± 4.98	31.87 ± 2.75	35.03 ± 0.73	35.49 ± 0.73	35.89 ± 0.41
				(75.18%)	(94.25%)	(97.28%)	(99.83%)

Values are presented as mean ± SD. NTG = normal tension glaucoma; POAG = primary open angle glaucoma.

^∗ Mann-Whitney’s test, statistical significance is p < 0.05.

Table 3.

Relationship of HCPT and nocturnal dip in NTG & POAG

	Dipper		Chi-square test
	Yes	No	p-value^∗	Odds ratio	CI^†
NTG
Abnormal HCPT	30	9	0.020	7.000	2.070-32.748
Normal HCPT	5	14
POAG
Abnormal HCPT	7	2	0.063	2.571	1.293-37.909
Normal HCPT	4	11

HCPT = hand cold provocation test; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; Dipper = nocturnal dip over 10%; CI = confidence interval.

^∗ Pearson’s chisquare test, statistical significance: p < 0.05

^† Calculated at 95 percentile.

Table 4.

Relationship of nocturnal dip and VF progression in NTG & POAG

	VF progression		Chi-square test
	Yes	No	p-value^∗	Odds ratio	CI^†
NTG
Dipper	23	12	0.028	6.000	1.172-30.725
Non-dipper	5	18
POAG
Dipper	5	6	0.805	0.750	0.084-6.710
Non-dipper	8	5

VF = visual field; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; Dipper = nocturnal dip over 10%; Non-dipper = nocturnal dip under 10%; CI = confidence interval.

^∗ Pearson’s chisquare test, statistical significance: p < 0.05

^† Calculated at 95 percentile.

Table 5.

Relationship of HCPT and VF progression in NTG & POAG

	VF progression		Chi-square test
	Yes	No	p-value^∗	Odds ratio	CI^†
NTG
Abnormal HCPT	25	14	0.022	7.429	1.226-45.005
Normal HCPT	3	16
POAG
Abnormal HCPT	7	2	0.151	6.667	0.487-91.331
Normal HCPT	6	9

HCPT = hand cold provocation test; VF = visual field; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; CI = confidence interval.

^∗ Pearson’s chisquare test, statistical significance: p < 0.05

^† Calculated at 95 percentile.

Table 6.

Risk factors associated with glaucomatous VF progression in NTG & POAG

	p-value^∗	Odds ratio	CI^†
NTG
Sex	0.395	0.527	0.012-2.304
Age over 60 years	0.428	0.544	0.121-2.450
Dipper	0.135	3.237	0.694-15.101
Abnormal HCPT	0.002	11.845	2.428-57.774
POAG
Sex	0.871	1.226	0.105-14.369
Age over 60 years	0.414	2.649	0.255-27.486
Dipper	0.563	2.435	0.120-49.617
Abnormal HCPT	0.632	0.486	0.025-9.312

VF = visual field; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; Dipper = nocturnal dip over 10%; HCPT= hand cold provocation test; CI = confidence interval.

^∗ Binary logistic regression test, statistical significance: p < 0.05

^† Calculated at 95 percentile.

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