Frequent pressure shifts increase risk of blindness in glaucoma patients

High pressure alone not the only risk

June 29, 2000 -- The more eye pressure fluctuates during the day, the higher the risk that a glaucoma patient will lose vision, according to a study by researchers at Johns Hopkins and two other academic medical centers.

"For years physicians have been focused on lowering high intraocular pressure associated with glaucoma," says Ran Zeimer, Ph.D., director of the Ophthalmic Physics Laboratory at Hopkins' Wilmer Eye Institute. "Our study shows that's not enough. They also must control the daily variation in pressure. This poses a new challenge in therapy."

Results of the study, supported by the National Institutes of Health, were published recently in the Journal of Glaucoma.

Zeimer's team found that large fluctuations in intraocular pressure during the day or over consecutive days are associated with greater risk of vision loss. These changes also are a good marker for predicting risk after accounting for glaucoma damage that already exists.

Glaucoma is a vision-threatening disorder characterized by a build-up of pressure within the eye that slowly damages optic nerve fibers. Susceptibility to the disease depends on genetics and older age. Glaucoma patients can have pressures up to more than 25 millimeters of mercury (mmHg); by contrast, normal pressures range from 12 to 21 mmHg.

For the study, ophthalmologists recorded the measurements of 105 eyes of 64 glaucoma patients. Because daily monitoring was more practical in the home, patients were taught to use a self-tonometer, a device invented by Zeimer that measures pressure in the eye. They recorded the pressure in their own eyes five times a day for five days, taking measurements in the morning when they woke, around noon, in mid-afternoon, in the evening after supper and at bedtime. After five days, they returned to their ophthalmologist's office for another recording.

During an average day, the pressures recorded

Contact: Karen Infeld
Johns Hopkins Medical Institutions

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