The Water Drinking Provocation Test- an aid to decision making in the management of OHT and POAG

To study response to water drinking provocation in primary open angle glaucoma (POAG), ocular hypertensives and glaucoma suspects and establish the role of water drinking provocation test (WDPT) as a relevant supplementary tool in glaucoma management.

319 eyes of 161 patients were included in the study after retrospectively analyzing hospital records of patients who underwent WDPT. The patients were categorized into Group A (POAG on treatment), Group B (treatment-naïve POAG), Group C (Ocular hypertensives), Group D (glaucoma suspects). All patients were asked to drink 1 liter of water within 5 min and intraocular pressures (IOP) were recorded after 20 and 30 min of water intake. The baseline, peak and IOP fluctuation were analysed. A fluctuation of ≥ 5 mm Hg was considered positive response.

19 eyes were categorized as Group A, 58 as Group B, 96 and 146 eyes as groups C and D respectively. Baseline IOP in different groups differed significantly. Mean peak IOP was higher in Groups B and C, followed by Groups A and D. Mean IOP fluctuation differed significantly across groups being maximum in Group A (7.0 ± 2.5) and minimum in Group D (4.8 ± 2.9). Positive WDPT response was seen in 89.5% eyes in Group A, 77.6% of those in Group B, 55.2% and 48.6% in Groups C and D respectively. The baseline IOP had a significant positive correlation with the peak IOP across all groups.

The WDPT is an inexpensive practical tool which serves as an invaluable aid in glaucoma management.