Peak Intraocular Pressure and Glaucomatous Progression in Primary Open-Angle Glaucoma

Purpose: To evaluate the effect of 24-h peak intraocular pressure (IOP) on the progression of primary open-angle glaucoma (POAG) and the 24 h time points that best predict peak pressure. Methods: A retrospective analysis of clinical data evaluating long-term glaucomatous progression in patients with POAG who were previously in a 24-h study of the authors (IOP readings at 2/6/10 A. M. and 2/6/10 PM); had >= 3 treated 10 A. M. (+/- 1 h) IOP measurements over 5-years after an untreated 24-h baseline; and had a treated 24-h curve with a 10 A. M. IOP +/- 2mmHg within the 10 A. M. mean IOP over 5-years. Results: We included 98 nonprogressed and 53 progressed patients with POAG (n = 151). The mean 24-h peak IOP (mmHg) was 19.9 +/- 2.7 for progressed and 18.3 +/- 2.0 for nonprogressed patients (P < 0.001). Progressed patients also showed a higher mean 24-h IOP. Generally, patients with a mean or peak daytime (readings at 10 A. M., 2 and 6 P. M.) or 24-h peak IOP of <= 18 remained nonprogressed in 75%-78% of cases. Further, measuring IOP at night found a higher peak in only 20% of cases, which was <= 2 of the daytime peak in 98% of cases. A multivariate regression analysis showed only 24-h peak IOP as an independent risk factor for progression (P = 0.002). Conclusions: This study suggests that daytime peak IOP may be clinically important in predicting long-term glaucomatous progression. Further, daytime peak IOP may assist, as much as daytime mean IOP and, in most cases, 24-h peak IOP, in helping to guide long-term treatment in POAG.