Peak intraocular pressure and glaucomatous progression in primary open-angle glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Intraocular Pressure Monitoring

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Accurate prediction of POAG progression is essential for timely and effective treatment.
• Intraocular pressure (IOP) is a key modifiable risk factor in glaucoma management.

Purpose of the Study:

• To determine the impact of 24-hour peak intraocular pressure (IOP) on the progression of primary open-angle glaucoma (POAG).
• To identify specific 24-hour time points that best predict peak IOP levels.
• To assess the clinical utility of daytime IOP measurements in predicting long-term POAG outcomes.

Main Methods:

• Retrospective analysis of clinical data from patients with POAG.
• Inclusion criteria: ≥3 treated 10 AM IOP measurements over 5 years, untreated 24-hour baseline, and treated 24-hour curve data.
• Utilized IOP readings from 2 AM, 6 AM, 10 AM, 2 PM, 6 PM, and 10 PM.

Main Results:

• Patients who progressed in POAG had significantly higher mean 24-hour peak IOP (19.9±2.7 mmHg) compared to non-progressed patients (18.3±2.0 mmHg).
• Daytime peak IOP (≤18 mmHg) was associated with non-progression in 75%-78% of cases.
• 24-hour peak IOP was identified as an independent risk factor for POAG progression (P=0.002).
• Nocturnal IOP peaks were infrequent (20%) and generally close to daytime peaks (≤2 mmHg difference in 98% of cases).

Conclusions:

• Daytime peak IOP is a clinically significant factor in predicting long-term POAG progression.
• Daytime peak IOP measurements can be as valuable as daytime mean IOP and, in most instances, 24-hour peak IOP for guiding POAG treatment.
• Routine monitoring of daytime IOP may enhance clinical decision-making for managing POAG.