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Yap TE, Gao Y, Ahmad H, Susanna F, Susanna R, Normando EM, Bloom PA, Cordeiro MF. Comparison of intraocular pressure profiles during the water drinking test and the modified diurnal tension curve. Eye (Lond) 2024; 38:1567-1574. [PMID: 38454171 PMCID: PMC11126618 DOI: 10.1038/s41433-024-02954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES To compare intraocular pressure (IOP) during the water drinking test (WDT) and modified diurnal tension curve (mDTC) in open-angle glaucoma (OAG) patients, using multimodal, observer-masked tonometry. METHODS Open-angle glaucoma subjects were prospectively enroled, excluding those who had undergone glaucoma filtration or laser surgery. Two-hourly mDTC Goldmann applanation (GAT) and rebound tonometry (RT) was performed between 8:00 and 16:00, and every 15 min for 45 min after ingestion of 800mls of water. Blood pressure, heart rate, pupillometry measurements, and optical coherence tomography (AS-OCT) were also recorded. RESULTS Forty-two subjects' right eyes were included. 48% were using topical glaucoma medication. Mean baseline IOP was 14.9 ± 4.52 mmHg, with mean visual field mean deviation (±SD) -5.05 ± 5.45 dB. Strong association was found between maximum IOP during mDTC and WDT (r = 0.90, 95% CI 0.82-0.95 p < 0.0001) with agreement (mDTC-WDT) bias -0.82 mmHg, 95% LoA -1.46 to -0.18. During the WDT, mean systolic blood pressure (±SD) increased from 140.0 ± 20.0 to 153.3 ± 24.0 mmHg (p < 0.0001), mean heart rate ( ± SD) reduced from 69.5 ± 11.3 bpm to 63.6 ± 10.0 bpm (p < 0.0001), and temporal iridocorneal angle increased from 29.2 ± 6.0° to 29.6 ± 5.2° (p = 0.04). CONCLUSION This study presents repeated, observer-masked IOP data showing strong correlation between maximum IOP during mDTC and WDT using multimodal tonometry. This supports WDT as a meaningful alternative to mDTC when investigating diurnal IOP characteristics in clinic, with reduced time requirements and associated costs.
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Affiliation(s)
- Timothy E Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK.
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK.
| | - Yuan Gao
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
| | - Hanif Ahmad
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
| | - Fernanda Susanna
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Remo Susanna
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Eduardo M Normando
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
| | - Philip A Bloom
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
| | - Maria Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, EC1V 9EL, UK
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Hemoglobin Video Imaging Detects Differences in Aqueous Outflow Between Eyes With and Without Glaucoma During the Water Drinking Test. J Glaucoma 2022; 31:511-522. [PMID: 35394459 DOI: 10.1097/ijg.0000000000002029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/22/2022] [Indexed: 01/31/2023]
Abstract
PRCIS Hemoglobin video imaging (HVI) demonstrates increased aqueous outflow (AO) in response to the water drinking test (WDT) in patients with and without glaucoma. In glaucomatous eyes, increased AO was not sustained, and characteristic flow patterns were seen. PURPOSE To observe how variations in intraocular pressure (IOP) correlate with the flow of aqueous in episcleral veins. DESIGN Prospective observational cohort study. PARTICIPANTS The WDT increased AO into the episcleral venous system in 30 eyes recruited from Sydney Eye Hospital. A comparison was made between glaucomatous (n=20) and nonglaucomatous eyes (n=10). METHODS Each patient had baseline IOP and HVI before drinking 10 mL/kg body weight of water. IOP and HVI were then repeated every 15 minutes for 1 hour. Aqueous column cross-sectional area (AqCA) of the most prominent nasal and temporal aqueous veins was used to semi-quantify conventional AO. MAIN OUTCOME MEASURES Change in IOP and AqCA from baseline during the WDT. Aqueous flow characteristics were also observed. RESULTS Peak IOP elevation above baseline was significantly higher in the glaucoma group, with an average IOP rise of 39.7% on 1.6 1.1 medications, compared with 22.9% in the control group ( P =0.04). AqCA significantly increased for glaucomatous and nonglaucomatous eyes in response to water ingestion ( P <0.05). AqCA fell by 50% in glaucomatous eyes ( P =0.003) and 33% in nonglaucomatous eyes ( P =0.08) at study completion compared with the peak measurement. IOP remained >30% elevated in 8 glaucomatous eyes (40%) after 60 minutes and no control eyes. Variations in qualitative aqueous flow patterns were observed in glaucomatous eyes but not in controls. CONCLUSIONS AO volume, estimated by AqCA, increases in response to IOP elevation induced by an ingested water bolus in patients with and without glaucoma. The increase in aqueous drainage was not sustained in glaucomatous eyes and may have led to incomplete recovery of IOP. Using HVI in combination with the WDT may assist with clinical decision-making and facilitate the monitoring of responses to treatment.
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Intraocular Peak Pressure in Patients under Treatment with Fixed Combination of Bimatoprost/ Timolol/ Brimonidine once Daily versus Twice Daily. J Glaucoma 2022; 31:e96-e100. [PMID: 35513899 DOI: 10.1097/ijg.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
PRECIS We investigate the efficacy of triple-fixed-combination of Bimatoprost/Brimonidine/Timolol once and twice a day, demonstrating higher intraocular pressure reduction with once-a-day use, and discuss possible implications based on previous literature. PURPOSE To compare the efficacy of fixed combination bimatoprost-timolol-brimonidine (Triplenex ®) instilled once-daily with twice-daily in primary open-angle glaucoma. PATIENTS AND METHODS Randomized clinical trial at a public eye care institution. Thirty patients with primary open-angle glaucoma were followed-up for three-months. The right and left eyes of these patients were randomly assigned to once-daily, (10:00 PM) or twice-daily, (10:00 AM; 10:00 PM) regimens of fixed combination bimatoprost-timolol-brimonidine. Intraocular pressure peaks were obtained with the water drinking test before the introduction of this medication (basal WDT0), one month (WDT 1), 2 months (WDT2) and 3 months (WDT3) after starting the use of the fixed combination of Bimatoprost/ Timolol/ Brimonidine (Triplenex®). Variation from peak intraocular pressure at WDT3 to peak at WDT0 was compared within groups of two versus once daily regimen. RESULTS Sixty eyes of 30 patients (age 70.67±9.70▒y) were included in this study. Baseline clinical characteristics were comparable between groups. Mean reduction in peak intraocular pressure from WDT0 to WDT3 was 6.1±6.1▒mmHg (30.5%) in the eyes receiving one drop per day and 4.3 ±5.7▒mmHg (21.5%) in the eyes receiving two drops per day (P=0.023). Mean reduction in peak intraocular pressure considering all WDT was also higher in the group with once-a-day treatment (5.90±6.03▒mmHg vs. 4.46±4.28▒mmHg, P=0.006). CONCLUSION Fixed combination of bimatoprost 0.01%, brimonidine tartrate 0.15% and timolol maleate 0.5% once-a-day is more effective in reducing peak intraocular pressure as measured by the WDT than twice-a-day dosing.
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Ortiz Arismendi GE, Tirado Sandino JE, Córdoba-Ortega CM, Albis-Donado O. Duration of the hypotensive effect of prostaglandin analogues measured with the water drinking test in glaucoma patients. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:133-139. [PMID: 35248394 DOI: 10.1016/j.oftale.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To measure the magnitude and duration of the hypotensive effect of two prostaglandin analogues in glaucoma patients using the water drinking test (WDT). METHODS Patients received latanoprost or travoprost every 24 h and then every 48 h. Untreated WDT were performed at 7 am and with treatment 12, 36 and 44 h after the last dose; intraocular pressure (IOP) peak, fluctuation and the difference between peak and isolated IOP measurements at consultation times were calculated. RESULTS Forty-one eyes of 21 patients with primary open-angle glaucoma were included; 22 eyes received latanoprost, and 19 received travoprost. Mean untreated isolated IOP was 17.20 standard deviation (S.D.) 3.73 and 16.95 S.D. 2.61 mmHg and peak pressure 22.45 S.D. 2.91 and 21.58 S.D. 3.79 mmHg, for the latanoprost and travoprost groups, respectively. With treatment, peak pressure was reduced by 22.64% and 20.29% at 12 h, 18.44% and 14.64% at 36 h and 16.17% and 14.46% at 44 h, respectively. The fluctuation without treatment was 4.36 and 5.11 mmHg, and with treatment at 12 h was reduced to 2.77 and 2.89 mmHg, increasing again at 36 and 44 h. CONCLUSIONS A hypotensive effect was evident up to 44 h after the last dose of latanoprost and travoprost, similar for the two drugs and decreasing over time. IOP fluctuation was only reduced at 12 h.
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Affiliation(s)
- G E Ortiz Arismendi
- Oftalmólogo, especialista en glaucoma, Universidad Nacional de Colombia, Bogotá, Colombia; Unidad de Oftalmología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - J E Tirado Sandino
- Unidad de Oftalmología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Oftalmólogo, Universidad Nacional de Colombia, Bogotá, Colombia
| | - C M Córdoba-Ortega
- Unidad de Oftalmología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Residente de Oftalmología, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - O Albis-Donado
- Unidad de Oftalmología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Oftalmólogo, especialista en glaucoma, Universidad Nacional de Colombia, Mexico City, Mexico
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Susanna CN, Susanna BN, Susanna FN, Susanna R, De Moraes CG. Peak Intraocular Pressure Time during Water Drinking Test and Its Relationship with Glaucoma Severity. J Ophthalmic Vis Res 2022; 17:27-32. [PMID: 35194493 PMCID: PMC8850851 DOI: 10.18502/jovr.v17i1.10167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between the time of occurrence of intraocular pressure (IOP) peaks during the water-drinking test (WDT) and visual field damage in a cohort of primary open-angle glaucoma (POAG) patients. Methods In this retrospective, cross-sectional study, 98 eyes from 49 consecutive POAG patients were followed in a referral clinical practice. The relationship between the time when IOP peaks occurred during the WDT and the visual field mean deviation (MD) assessed with 24-2 visual field was tested with mixed-effects models. Results MD value was significantly associated with the time of IOP peak occurrence (P = 0.020) when adjusting for the number of medications, but not with the IOP peak values (P = 0.238). Conclusion The time of IOP peaks occurrence during the WDT was associated with glaucoma severity among treated POAG patients.
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Affiliation(s)
| | | | | | - Remo Susanna
- Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Koh A, Verzosa C. Comparison of intraocular pressure peak and fluctuations among Filipino patients with non-glaucomatous eyes and glaucoma suspects using water drinking test and diurnal intraocular pressure. Int J Ophthalmol 2021; 14:1729-1734. [PMID: 34804863 DOI: 10.18240/ijo.2021.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the intraocular pressure (IOP) peaks and fluctuations using water drinking tests (WDTs) and mean diurnal IOP among Filipino patients with normal eyes and glaucoma suspects. METHODS This prospective study included normal and glaucoma suspect patients. Each patient underwent both WDT and mean diurnal examination on separate visits. For mean diurnal examination, IOP was recorded every 2h for 8h while in WDT, IOP was recorded prior to WDT, and post-WDT at 5, 15, 30, 45, and 60min. IOP peak was recorded as the highest IOP for both methods, and IOP fluctuation was recorded as highest IOP minus lowest IOP. RESULTS With the comparison of diagnostic tests, both normal eyes and glaucoma suspect groups, the peak IOP was caught at 15min. Comparative analysis of both groups also showed that the peak IOP measurements were statistically higher for the WDT compared to mean diurnal IOP (P=0.039, P=0.048 under normal group and P=0.032 and P=0.031 under glaucoma suspect group). Similarly, the WDT had a statistically higher mean IOP fluctuation score than the mean diurnal IOP method in both groups (P=0.003, P=0.011 under normal group; P=0.002 and P=0.005 under glaucoma suspect group). CONCLUSION This study shows that WDT is a comparable diagnostic exam in predicting IOP fluctuations than mean diurnal measurement. WDT is a promising diagnostic procedure for risk assessment in glaucoma.
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Affiliation(s)
- Anelisa Koh
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila 1003, Philippines
| | - Cynthia Verzosa
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila 1003, Philippines
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Kadambi SV, Balekudaru S, Lingam V, George R. Comparison of intraocular pressure variability detected by day diurnal variation to that evoked by water drinking. Indian J Ophthalmol 2021; 69:1414-1417. [PMID: 34011711 PMCID: PMC8302309 DOI: 10.4103/ijo.ijo_1149_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine correlation and agreement between intraocular pressure (IOP) peak and fluctuations detected by day diurnal variation (day DVT) to that after the water-drinking test (WDT). Methods Patients (18-80 years) with glaucoma, suspects, and ocular hypertension (OHT) were enrolled. IOP readings were taken on applanation tonometer, at 2-h intervals, from 8 AM to 3 PM (DVT). 3 PM IOP served as WDT baseline. Patients consumed water (10 mL/kg) in 5-15 min, at 3 PM, after they fluid fasted for 2 h. IOP was recorded every 15 min, from 3.30 to 4.30 PM. Results A total of 200 eyes (100 patients) were included. 58.5% were established glaucoma, 32% suspects, 9.5% OHT. Correlation between mean and peak IOP by WDT and day DVT was strong and significant (r = 0.89, P < 0.00; r = 0.73, P < 0.00) while it was weak for fluctuation (r = 0.12, P < 0.07). Agreement on Bland and Altman plots was limited for mean IOP and poor for peak and fluctuations. Conclusion An exaggerated WDT response may indicate a compromised outflow facility and warrant close patient monitoring but the WDT cannot substitute day DVT in our clinical practice.
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Affiliation(s)
- Sujatha V Kadambi
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Shantha Balekudaru
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Vijaya Lingam
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Ronnie George
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Firat PG, Dikci S, Firat İT, Demirel S, Firat M, Öztürk E, Gök ZE. Correlation between intraocular pressure obtained with water drinking test versus modified diurnal tension curve measurement in pseudoexfoliation glaucoma. Int Ophthalmol 2021; 41:2879-2886. [PMID: 33877501 DOI: 10.1007/s10792-021-01847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. METHODS This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO min, and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland-Altman plots were used for statistical analysis. RESULTS The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 ± 6.8 years, and the mean central corneal thickness was 517.7 ± 29.1 µm. The mean values with the mDTC and WDT measurements were 15.05 ± 2.75 mmHg and 17.17 ± 3.25 mmHg (p ≤ 0.0001, r = 0.884) for IOPmean, 16.76 ± 3.45 mmHg and 18.92 ± 3.94 mmHg (p ≤ 0.0001, r=0.787) for IOPpeak, and 13.61 ± 2.56 mmHg and 15.11 ± 2.84 mmHg (p ≤ 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. CONCLUSION There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.
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Affiliation(s)
- Penpe Gül Firat
- Department of Ophthalmology, Inonu University School of Medicine, TR-44280, Malatya, Turkey.
| | - Seyhan Dikci
- Department of Ophthalmology, Inonu University School of Medicine, TR-44280, Malatya, Turkey
| | | | | | - Murat Firat
- Department of Ophthalmology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Emrah Öztürk
- Department of Ophthalmology, Malatya State Hospital, Malatya, Turkey
| | - Zarife Ekici Gök
- Department of Ophthalmology, Malatya State Hospital, Malatya, Turkey
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Differences in Optic Nerve Head Blood Flow Regulation in Normal Tension Glaucoma Patients and Healthy Controls as Assessed With Laser Speckle Flowgraphy During the Water Drinking Test. J Glaucoma 2019; 28:649-654. [DOI: 10.1097/ijg.0000000000001258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comparison of Intraocular Pressure Changes During the Water Drinking Test Between Different Fluid Volumes in Patients With Primary Open-angle Glaucoma. J Glaucoma 2018; 27:950-956. [DOI: 10.1097/ijg.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salcedo H, Arciniega D, Mayorga M, Wu L. Role of the water-drinking test in medically treated primary open angle glaucoma patients. J Fr Ophtalmol 2018; 41:421-424. [PMID: 29778281 DOI: 10.1016/j.jfo.2017.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 10/16/2022]
Abstract
PURPOSE The water-drinking test (WDT) has recently re-emerged as a possible way to determine the competency of the trabecular meshwork. We performed a prospective interventional study to test the hypothesis that the WDT could be useful in assessing fluctuations in patients undergoing treatment for primary open angle glaucoma (POAG). METHODS We included 122 patients; 62 on medical treatment for POAG (n=123 eyes) and 60 controls (n=120 eyes). The study group had been on intraocular pressures (IOP) lowering treatment continuously for at least 3months with stable IOP. The WDT was performed during fasting and was considered positive if it fluctuated ≥6mmHg. RESULTS The patients on medical treatment had a mean age of 50.56±18.45 years vs. 51.35±11.22 for the controls (P=0.34); with 71% being female in the study group and 77% in the control group. In the study group; 52% were on beta blockers (n=64), 27% combination of two or more medications (n=33), 19% prostaglandin analogues (n=24) and 2% alpha agonists (n=2). The WDT was positive in 17.07% (n=21) in the study group and 2.5% (n=3) in the control group (P=0.0001). The mean fluctuation was 7.14±2.15mmHg in the study group and 6.00±0mmHg in the controls (P=0.33). A positive WDT was found in 33.33% (n=11) of those on combination therapy; 12.5% (n=3) prostaglandin analogues and 10.94% (n=7) beta blockers (P=0.03). Combination therapy had the highest positive WDT fluctuation (7.54±2.87) followed by prostaglandin analogues (7.00±1.00) and beta blockers (6.57±0.78) with a P value of 0.44. CONCLUSIONS The WDT can identify significant fluctuations in eyes with POAG that are medically treated.
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Affiliation(s)
- H Salcedo
- Instituto de Ciencias de la Visión - Hospital Dr. Rodolfo Robles Valverde, Diagonal 21, 19-19 Zona 11, Anillo Periférico, Guatemala City, Guatemala.
| | - D Arciniega
- Instituto de Ciencias de la Visión - Hospital Dr. Rodolfo Robles Valverde, Diagonal 21, 19-19 Zona 11, Anillo Periférico, Guatemala City, Guatemala
| | - M Mayorga
- Instituto de Cirugía Ocular, Diagonal a la Sala Garbo, Paseo Colón, San José, Costa Rica
| | - L Wu
- Asociados de Macula, Vítreo y Retina de Costa Rica, Primer Piso, Torre Mercedes, Paseo Colón, San José, Costa Rica
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Predictive Value of the Water Drinking Test and the Risk of Glaucomatous Visual Field Progression. J Glaucoma 2017; 26:767-773. [PMID: 28731935 DOI: 10.1097/ijg.0000000000000725] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients. PATIENTS AND METHODS Design: Prospective, longitudinal study. SETTING Clinical practice. STUDY POPULATION Treated POAG patients whose IOP was ≤18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field. INTERVENTION At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing. MAIN OUTCOME MEASURE Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression. RESULTS A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively). CONCLUSIONS IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.
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Author Response, "The Water-drinking Test and Glaucoma Progression: Considerations Regarding the Test Usefulness as an Independent Risk Assessment Tool". J Glaucoma 2017; 27:e26-e28. [PMID: 29088050 DOI: 10.1097/ijg.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Susanna R, Clement C, Goldberg I, Hatanaka M. Applications of the water drinking test in glaucoma management. Clin Exp Ophthalmol 2017; 45:625-631. [PMID: 28164419 DOI: 10.1111/ceo.12925] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 01/18/2023]
Abstract
Intraocular pressure (IOP) peaks and means have been considered important factors for glaucoma onset and progression. However, peak IOP detection depends only on appropriated IOP checks at office visits, whereas the mean IOP requires longitudinal IOP data collection and may be affected by the interval between visits. Also, IOP peak assessment is necessary to verify if the peak pressure of a given patient is in target range, to evaluate glaucoma suspect risk, the efficacy of hypotensive drugs and to detect early loss of IOP control. The water-drinking test has gained significant attention in recent years as an important tool to evaluate IOP peaks and instability. The main objective of this review was to present new findings and to discuss the applicability of the water-drinking test in glaucoma management.
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Affiliation(s)
- Remo Susanna
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - Colin Clement
- Discipline of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Eye Associates, Sydney, New South Wales, Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Eye Associates, Sydney, New South Wales, Australia
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Özyol E, Özyol P, Karalezli A. Reproducibility of the water-drinking test in patients with exfoliation syndrome and exfoliative glaucoma. Acta Ophthalmol 2016; 94:e795-e798. [PMID: 27316559 DOI: 10.1111/aos.13132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the reproducibility of intraocular pressure (IOP) peaks and fluctuations detected during the water-drinking test (WDT) in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). METHODS This prospective study included 34 XFS and 30 XFG patients. Each patient was evaluated twice, with the two WDTs performed on a 30-day interval. We recorded IOP peak (highest IOP during the WDT) and IOP fluctuation (IOP peak minus IOP before the test). Bland-Altman analysis was applied to assess the agreement of IOP peaks and fluctuations between the two consecutive visits. We defined reproducible as within 4 mmHg for IOP peak and within 2 mmHg for IOP fluctuation. RESULTS There were no significant differences in IOP values, IOP peaks and IOP fluctuations between the two visits for both XFS and XFG patients (p > 0.05, for all). The coefficient of repeatability for IOP peak was 2.5 mmHg and 3.5 mmHg in XFS and XFG patients respectively and for IOP fluctuation, it was 2.1 mmHg and 2.2 mmHg. None of the XFS or XFG patients had an IOP peak difference higher than 4 mmHg. Intraocular pressure (IOP) fluctuation differences above 2.0 mmHg were found in 8.8% of XFS patients and 16.6% of XFG patients. CONCLUSIONS Intraocular pressure (IOP) peak and IOP fluctuation have a reproducibility, both in XFS and in XFG.
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Affiliation(s)
- Erhan Özyol
- Department of Ophthalmology; Mugla Sitki Kocman University Training and Research Hospital; Mugla Turkey
| | - Pelin Özyol
- Department of Ophthalmology; Mugla Sitki Kocman University Faculty of Medicine; Mugla Turkey
| | - Aylin Karalezli
- Department of Ophthalmology; Mugla Sitki Kocman University Faculty of Medicine; Mugla Turkey
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Comparison of the Intraocular Pressure Variation Provoked by Postural Change and by the Water Drinking Test in Primary Open-angle Glaucoma and Normal Patients. J Glaucoma 2016; 25:914-918. [DOI: 10.1097/ijg.0000000000000519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Özyol P, Özyol E, Baldemir E. Intraocular pressure dynamics with prostaglandin analogs: a clinical application of the water-drinking test. Clin Ophthalmol 2016; 10:1351-6. [PMID: 27555742 PMCID: PMC4969041 DOI: 10.2147/opth.s108456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical applicability of the water-drinking test in treatment-naive primary open-angle glaucoma patients. METHODS Twenty newly diagnosed primary open-angle glaucoma patients and 20 healthy controls were enrolled in this prospective study. The water-drinking test was performed at baseline and 6 weeks and 3 months after prostaglandin analog treatment. Peak and fluctuation of intraocular pressure (IOP) measurements obtained with the water-drinking test during follow-up were analyzed. Analysis of variance for repeated measures and paired and unpaired t-tests were used for statistical analysis. RESULTS The mean baseline IOP values in patients with primary open-angle glaucoma were 25.1±4.6 mmHg before prostaglandin analog treatment, 19.8±3.7 mmHg at week 6, and 17.9±2.2 mmHg at month 3 after treatment. The difference in mean baseline IOP of the water-drinking tests was statistically significant (P<0.001). At 6 weeks of prostaglandin analog treatment, two patients had high peak and fluctuation of IOP measurements despite a reduction in baseline IOP. After modifying treatment, patients had lower peak and fluctuation of IOP values at month 3 of the study. CONCLUSION Peak and fluctuation of IOP in response to the water-drinking test were lower with prostaglandin analogs compared with before medication. The water-drinking test can represent an additional benefit in the management of glaucoma patients, especially by detecting higher peak and fluctuation of IOP values despite a reduced mean IOP. Therefore, it could be helpful as a supplementary method in monitoring IOP in the clinical practice.
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Affiliation(s)
| | | | - Ercan Baldemir
- Biostatistics Department, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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18
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Selective Laser Trabeculoplasty Reduces Intraocular Pressure Peak in Response to the Water Drinking Test. J Glaucoma 2016; 25:727-31. [PMID: 27552511 DOI: 10.1097/ijg.0000000000000512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) peak and fluctuation induced by the water drinking test (WDT) in patients with open-angle glaucoma and ocular hypertension. METHODS Patients with open-angle glaucoma or ocular hypertension underwent the WDT before and after SLT within a 12-month period. No other changes to therapeutic regimen were permitted. IOP was measured with a Goldmann applanation tonometer at baseline and every 15 minutes for 45 minutes following a fluid challenge of 800 mL over 15 minutes. Baseline, peak, and percentage fluctuation in IOP from baseline were compared using a repeated measures analysis of variance with Bonferroni adjustment. RESULTS Twenty eyes from 20 patients were included in this study. The median patient age was 73±15 years (interquartile range) and 70% of patients were female. Ten eyes (50%) had a diagnosis of primary open-angle glaucoma and 10 eyes had ocular hypertension. Following SLT there was a statistically significant reduction in mean baseline IOP from 16.9±2.4 to 14.2±2.3 mm Hg (P<0.001), peak IOP from 21.9±3.7 to 16.9±3.1 mm Hg (P<0.001). CONCLUSIONS Patients with open-angle glaucoma and ocular hypertension treated with SLT have significantly reduced peak IOPs and fluctuation in IOP in response to the WDT.
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Chong CW, Wang SB, Jain NS, Bank CS, Singh R, Bank A, Francis IC, Agar A. Comparison between intraocular pressure spikes with water loading and postural change. Clin Exp Ophthalmol 2016; 44:768-775. [PMID: 27221762 DOI: 10.1111/ceo.12777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/02/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare the agreement between peak intraocular pressures measured through the water drinking test and the supine test, in patients with primary open angle glaucoma. DESIGN Consecutive, prospective, blinded. PARTICIPANTS Twenty-one patients from the Glaucoma Unit, Prince of Wales Hospital, Sydney, Australia. METHODS For the supine test, intraocular pressure was recorded immediately after the patient had lain down and at 20 and 40 min. At the second evaluation, intraocular pressure was measured in each patient after drinking 10 mL/kg body weight of water for the water drinking test. Again, all patients had their intraocular pressure measured at 20 and 40 min (t = 20 and t = 40, respectively). Patients were excluded from the study if they had pre-existing cardiac, renal or pulmonary complications or had concurrent ocular disease or an anatomical abnormality (including angle recession, peripheral anterior synechiae and developmental anomalies of the angle) that may have influenced intraocular pressure. MAIN OUTCOME MEASURE Bland-Altman analysis. RESULTS Bland-Altman analysis indicated an overall excellent agreement in terms of mean difference between methods (1.0, -1.0 and -0.90 mmHg, at 0, 20 and 40 min, respectively). Further, with the exception of t = 40, all measured time points had 95% confidence intervals within 6.5 mmHg of their mean difference on the Bland-Altman plot. CONCLUSIONS There was close agreement between the intraocular pressure values of the supine test and water drinking test. However, as the water drinking test may be uncomfortable and potentially hazardous, there is potential that the supine test may be a safer and more comfortable alternative.
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Affiliation(s)
- Calum Wk Chong
- The University of New South Wales, Kensington, New South Wales, Australia.,The Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Sarah B Wang
- The Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Neeranjali S Jain
- The University of New South Wales, Kensington, New South Wales, Australia
| | - Cassandra S Bank
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Ravjit Singh
- The University of New South Wales, Kensington, New South Wales, Australia
| | - Allan Bank
- The University of New South Wales, Kensington, New South Wales, Australia.,The Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Chatswood Grove Eye Clinic, Chatswood, New South Wales, Australia
| | - Ian C Francis
- The University of New South Wales, Kensington, New South Wales, Australia.,The Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Chatswood Grove Eye Clinic, Chatswood, New South Wales, Australia
| | - Ashish Agar
- The Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Effect of Switching From Latanoprost to Bimatoprost in Primary Open-Angle Glaucoma Patients Who Experienced Intraocular Pressure Elevation During Treatment. J Glaucoma 2016; 25:e359-66. [DOI: 10.1097/ijg.0000000000000376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Waisbourd M, Savant SV, Sun Y, Martinez P, Myers JS. Water-drinking test in primary angle-closure suspect before and after laser peripheral iridotomy. Clin Exp Ophthalmol 2015; 44:89-94. [DOI: 10.1111/ceo.12639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center; Philadelphia Pennsylvania USA
| | - Shravan V Savant
- Wills Eye Hospital Glaucoma Research Center; Philadelphia Pennsylvania USA
| | - Yi Sun
- Wills Eye Hospital Glaucoma Research Center; Philadelphia Pennsylvania USA
| | - Patricia Martinez
- Wills Eye Hospital Glaucoma Research Center; Philadelphia Pennsylvania USA
| | - Jonathan S Myers
- Wills Eye Hospital Glaucoma Research Center; Philadelphia Pennsylvania USA
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Affiliation(s)
- John Landers
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
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