Abstract #91626 Published in IGR 21-4

Seasonal Fluctuation in Intraocular Pressure and Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma

Terauchi R; Ogawa S; Noro T; Ito K; Kato T; Tatemichi M; Nakano T
Ophthalmology. Glaucoma 2020; 0:

See also comment(s) by Kaweh Mansouri

PURPOSE: To detect seasonal fluctuations in intraocular pressure (IOP) in healthy eyes and eyes with primary open-angle glaucoma (POAG) and to evaluate whether these seasonal fluctuations affect retinal nerve fiber layer (RNFL) thinning in eyes with POAG. DESIGN: Observational, retrospective cohort study. PARTICIPANTS: Healthy population who underwent a comprehensive health check-up and patients with POAG using only topical medications were enrolled. METHODS: Kaplan-Meier survival analysis was used to compare the cumulative incidence probabilities of RNFL thinning between different seasonal IOP fluctuation groups. A Cox proportional hazards model, with adjustments for potential confounding factors, was used to evaluate the association between seasonal fluctuations in IOP and RNFL thinning. MAIN OUTCOME MEASURES: Intraocular pressure fluctuation rate calculated from winter and summer IOPs and RNFL thinning as determined by event-based analysis with high-definition OCT. RESULTS: A total of 12 686 healthy eyes and 179 eyes of 179 POAG patients showed a significantly higher IOP in winter than in summer (healthy, 13.2 ± 3.0 mmHg vs. 12.5 ± 2.9 mmHg [P < 0.001]; POAG, 13.1 ± 2.7 mmHg vs. 11.8 ± 2.3 mmHg [P < 0.001]). In POAG patients, the mean age at initial OCT and follow-up duration were 55.1 ± 11.7 years and 98.4 ± 26.4 months, respectively. The mean deviation (MD) at first visit, MD slope, and RNFL thinning rate were -2.2 ± 3.4 dB, -0.07 ± 0.44 dB/year, and -0.44 ± 0.88 μm/year, respectively. During the study period, 85 eyes (47.5%) showed RNFL thinning progression. Kaplan-Meier analysis showed that a high seasonal IOP fluctuation rate significantly suppressed RNFL thinning (P < 0.05, log-rank test). After adjusting for confounders in the Cox analysis, the seasonal IOP fluctuation rate still showed a significantly negative association with RNFL thinning (hazard ratio, 0.98; 95% confidence interval, 0.96-0.99; P = 0.005). CONCLUSIONS: Winter IOP was higher than summer IOP in both healthy and POAG eyes. The temporary IOP decline in summer, rather than a constant IOP throughout the year, may prevent glaucoma progression.

Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan. Electronic address:

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6.1.2 Fluctuation, circadian rhythms (Part of: 6 Clinical examination methods > 6.1 Intraocular pressure measurement; factors affecting IOP)
2.13 Retina and retinal nerve fibre layer (Part of: 2 Anatomical structures in glaucoma)

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