TY  - INPR
Y1  - 2024/02/13/
AV  - public
A1  - Rabiolo, Alessandro
A1  - Montesano, Giovanni
A1  - Crabb, David P
A1  - Garway-Heath, David F
A1  - United Kingdom Glaucoma Treatment Study Investigators, .
KW  - linear mixed models
KW  -  ocular pulse amplitude
KW  -  risk factors
KW  -  visual field progression
SN  - 0161-6420
JF  - Ophthalmology
N1  - This version is the author-accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
TI  - Relationship between intraocular pressure fluctuation and visual field progression rates in the United Kingdom Glaucoma Treatment Study
N2  - Purpose:
To investigate whether intraocular pressure (IOP) fluctuation is independently associated with the rate of visual field (VF) progression in the United Kingdom Glaucoma Treatment Study.//

Design:
Randomized, double-masked, placebo-controlled multicenter trial.//

Participants:
Participants with ?5 VFs (213 placebo, 217 treatment).//

Methods:
Associations between IOP metrics and the VF progression rates (mean deviation (MD) and five fastest locations) were assessed with linear mixed models. Fluctuation variables were mean ocular pulse amplitude (OPA), standard deviation (SD) of diurnal IOP (diurnal fluctuation), and SD of IOP at all visits (long-term fluctuation). Fluctuation values were normalized for mean IOP to make them independent from mean IOP. Correlated non-fluctuation IOP metrics (baseline, peak, mean, supine and peak phasing IOP) were combined with principal component analysis (PCA), and principal component 1 (PC1) was included as a covariate. Interactions between covariates and time from baseline modelled the effect of the variables on VF rates. IOP was measured with Goldmann applanation tonometry and OPA with Pascal tonometry. Analyses were conducted separately in the two treatment arms.//

Main Outcome Measures:
Associations between IOP fluctuation metrics and rates of MD and five fastest test locations.//

Results:
In the placebo arm, only PC1 was significantly associated with the MD rate (estimate [standard error (SE)]: -0.19 [0.04] dB/year, p<0.001), while normalized IOP fluctuation metrics were not. No variable was significantly associated with MD rates in the treatment arm. For the fastest five locations in the placebo group, PC1 (estimate [SE]: -0.58 [0.16] dB/year, p<0.001), CCT (estimate [standard error (SE)]: 0.26 [0.10] dB/year for 10 ?m thicker, p=0.01) and normalized OPA (estimate [SE]: -3.50 [1.04] dB/year, p=0.001) were associated with rates of progression; normalized diurnal and long-term IOP fluctuations were not. In the treatment group, only PC1 (estimate [SE]: -0.27 [0.12] dB/year, p=0.028) was associated with the rates of progression.//

Conclusions:
There is no evidence to support that either diurnal or long-term IOP fluctuation, as measured in clinical practice, are independent factors for glaucoma progression; other aspects of IOP, including mean IOP and peak IOP, may be more informative. OPA may be an independent factor for faster glaucoma progression.
ID  - discovery10188328
UR  - https://doi.org/10.1016/j.ophtha.2024.02.008
PB  - Elsevier BV
ER  -