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. 2022 Dec 1;140(12):1209-1216.
doi: 10.1001/jamaophthalmol.2022.4462.

Association of Intraocular Pressure With Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma

Takashi Nishida  1 , Sasan Moghimi  1 , Aimee C Chang  1 , Evan Walker  1 , Jeffrey M Liebmann  2 , Massimo A Fazio  1   3 , Christopher A Girkin  3 , Linda M Zangwill  1 , Robert N Weinreb  1
Affiliations

Association of Intraocular Pressure With Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma

Takashi Nishida et al. JAMA Ophthalmol. .

Abstract

Importance: Higher intraocular pressure variability may be associated with faster structural changes in patients with glaucoma.

Objectives: To investigate the association of mean intraocular pressure and intraocular pressure variability (defined as the SD of intraocular pressure and the intraocular pressure range) with the rate of retinal nerve fiber layer thinning over time in patients with glaucoma.

Design, setting, and participants: In this retrospective analysis of a longitudinal cohort, patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation study. A total of 815 eyes (564 with perimetric glaucoma and 251 with preperimetric glaucoma) from 508 patients with imaging follow-up for a mean of 6.3 years from December 2008 to October 2020 were studied. Data were analyzed from November 2021 to March 2022.

Main outcomes and measures: In this longitudinal study, eyes with at least 4 visits and 2 years of follow-up optical coherence tomography and intraocular pressure measurement were included. A linear mixed-effect model was used to investigate the association of intraocular pressure parameters with the rates of retinal nerve fiber layer thinning. Dominance analysis was performed to determine the relative importance of the intraocular pressure parameters.

Results: Of 508 included patients, 280 (55.1%) were female, 195 (38.4%) were African American, 24 (4.7%) were Asian, 281 (55.3%) were White, and 8 (1.6%) were another race or ethnicity; the mean (SD) age was 65.5 (11.0) years. The mean rate of retinal nerve fiber layer change was -0.67 (95% CI, -0.73 to -0.60) μm per year. In multivariable models adjusted for mean intraocular pressure and other confounding factors, faster annual rate of retinal nerve fiber layer thinning was associated with a higher SD of intraocular pressure (-0.20[ 95% CI, -0.26 to -0.15] μm per 1-mm Hg higher; P < .001) or higher intraocular pressure range (-0.05 [95% CI, -0.06 to -0.03] μm per 1-mm Hg higher; P < .001).

Conclusions and relevance: In this study, intraocular pressure variability was independently associated with structural change in patients with glaucoma, even after adjustment for mean intraocular pressure, supporting its potential value in clinical management.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Liebmann has received grants from the National Eye Institute and Research to Prevent Blindness; nonfinancial support from Bausch & Lomb, Carl Zeiss Meditec, Heidelberg Engineering, Novartis, Optovue, and Reichert Technologies; and personal fees from Alcon, Allergan, Carl Zeiss Meditec, and Heidelberg Engineering. Dr Fazio has received grants from the National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness as well as personal fees from Heidelberg Engineering. Dr Girkin has received grants from the National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness as well as personal fees from Heidelberg Engineering. Dr Zangwill has received grants from the National Eye Institute; grants and nonfinancial support from Heidelberg Engineering; nonfinancial support from Carl Zeiss Meditec, Optovue, and Topcon; and consulting fees from AbbVie. Dr Weinreb has received grants from the National Eye Institute and National Institute of Minority Health and Health Disparities; nonfinancial support from Heidelberg Engineering, Carl Zeiss Meditec, Konan Medical, Optovue, Centervue, and Topcon; personal fees from AbbVie, Aerie Pharmaceuticals, Allergan, Eyenovia, Nicox, and Topcon; and is a consultant for Toromedes, Iantrek, IOPtic, and Implandata. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of Intraocular Pressure (IOP) Fluctuation Among Optical Coherence Tomography Progressor Groups
Figure 2.
Figure 2.. Contour Plots Illustrating the Estimated Association of Different Levels of Mean Intraocular Pressure (IOP) and IOP Fluctuation With Retinal Nerve Fiber Layer (RNFL) Slope
Warmer colors represent faster rates of RNFL thinning.
See this image and copyright information in PMC

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