Long-term intraocular pressure fluctuation in patients with stable glaucoma: the impact of regression to the mean on glaucoma management

Abstract

Despite the growing awareness regarding the risk factors associated with the development and progression of glaucoma, intraocular pressure (IOP) remains the only modifiable risk factor; however, the method for managing it in routine clinical practice remains debatable(1). of IOP fluctuations as a risk factor for glaucomatous progression is controversial and depends on attributes such as the damage level(2,3). Moreover, there is no consensus on the optimum approach to analyze support. In this regard, clinicians must consider that IOP constantly changes because of several factors daily and inter-visit fluctuations(4). Considering these inter-visit fluctuations, regression to the mean, could influence the clinician’s perception of IOP to change over time(5); moreover, the following question arises: what would be an acceptable peak for treated stable glaucoma clinical practice? To achieve a deeper understanding of IOP behavior between visits in patients treated for glaucoma, we open-angle glaucoma (OAG) to determine their long-term IOP profile over 5 years. The included patients had neither anatomical nor functional evidence of progression (measured using disc photos/retinography and reliable visual field tests) within the inspected interval, and no changes were made in the medical regimen during the follow-up period. Eyes with previous laser or filtering glaucoma surgery were excluded. All IOP measurements were performed, and for each patient, we calculated the mean long-term and peak IOP values. The IOP measurement visit after the peak was also following were the major outcome measures: (1) analyses of the IOP distribution values, based on central tendency (mean and median) and dispersion metrics (standard deviation measurements and the mean IOP values (paired t-test). The study was conducted according to the principles in the Helsinki Declaration.