Association of Long-term Intraocular Pressure Variability and Rate of Ganglion Complex Thinning in Patients with Glaucoma.

To evaluate the association of mean intraocular pressure (IOP) and IOP variability (IOP fluctuation (SD of IOP) and the IOP range) with the rate of ganglion cell complex (GCC) layer thinning over time in patients with glaucoma. Prospective cohort study METHODS: :Participants with at least 4 visits and 2 years of follow-up of optical coherence tomography tests were included. A linear mixed-effect model was used to investigate the association of IOP parameters with the rates of GCC thinning. Subgroup analyses were conducted for eyes with early ((MD ≥-6 dB), and moderate to advanced stage (MD <-6 dB) at baseline. The cohort consisted of 369 eyes of 249 glaucoma patients (282 early glaucoma and 87 moderate to advanced glaucoma) with mean [SD] age of 68.2 (10.7) years over 5.1 years of follow-up. The mean rate of GCC change was -0.59 (95%CI, -0.67 to -0.52) μm per year. In multivariable models, faster annual rate of GCC thinning was associated with a higher IOP fluctuation (-0.17[ 95%CI,-0.23 to -0.11] μm per 1-mm Hg higher, P < 0.001) or higher IOP range (-0.07[95%CI, -0.09 to -0.05] μm per 1-mm Hg higher, P <0.001) after adjustment for mean IOP and other confounding factors. Similar results were found for early and moderate to advanced stages of glaucoma. IOP variability showed an independent association with macular change in patients with glaucoma regardless of severity at baseline, even after adjustment for mean IOP, supporting its potential value as a therapeutic target for clinical decision-making.

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Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Funding/Support: This study was supported by National Eye Institute Grants R01EY029058, R01EY034148, R01EY023704, R01EY019869, U10EY014267, R01EY026574, Core Grant P30EY022589, R01EY034146, R01EY028284; R01EY018926; an Unrestricted Grant from Research to Prevent Blindness (New York, NY); Bright Focus Foundation grant #2017122; The Glaucoma Foundation grant (No grant number); and the Tobacco-Related Disease Research Program T31IP1511. Financial Disclosure: Sasan Moghimi reported grants from the National Eye Institute. Takashi Nishida is a consultant for Topcon. Jeffrey M Liebmann is a consultant to Alcon, Allergan, Thea, Genetech, AdvanceSight, and Carl Zeiss Meditech. Massimo A. Fazio reported grants from the National Eye Institute; grants from Heidelberg Engineering and Topcon; nonfinancial support from Wolfram Research. Christopher A. Girkin reported research support from Heidelberg Engineering and Topcon. Linda Zangwill reported grants from the National Eye Institute; grants from Heidelberg Engineering and nonfinancial support from Carl Zeiss Meditec, Optovue, Heidelberg Engineering, and Topcon; and patents from Carl Zeiss Meditec and AiSight Health. Linda Zangwill is a consultant of Abbvie and Topcon. Robert N. Weinreb is a consultant of Abbvie, Alcon, Allergan, Amydis, Editas, Equinox, Eyenovia, Iantrek, IOPtic, Implandata, iSTAR Medical, Nicox, Santen, Ten Point and Topcon. Robert N. Weinreb reported nonfinancial support from Heidelberg Engineering, Carl Zeiss Meditec, Optovue, Centervue, and Topcon; grants from the National Eye Institute, National Institute of Minority Health Disparities, and Research to Prevent Blindness, patents from Toromedes, Carl Zeiss Meditec to UCSD; all outside the submitted work. No other disclosures were reported.