Variability of Intraocular Pressure Measurements in Observation Participants in the Ocular Hypertension Treatment Study

Purpose: To describe variability of intraocular pressure (IOP) measurements within the same eye and between right and left eyes over a 60-month period in participants in the Ocular Hypertension Treatment Study. Design: Analysis of data from a prospective, randomized clinical trial. Participants: Eight hundred ten participants randomized to the observation group. Methods: Intraocular pressure measurements were obtained at the baseline visit and every 6 months thereafter. Pearson correlation coefficients were calculated for IOP measurements in the same eye between visits and for IOP measurements between right and left eyes of participants at each visit. Differences in IOP measurements between visits are reported in percent change (>15%, >20%, and >30%) and in millimeters of mercury (<3 mmHg, 3-5 mmHg, and >5 mmHg). The effects of regression to the mean, consistency in time of day, and sequence of IOP measurement of right and left eyes were examined. Main Outcome Measures: Correlation of IOP measurements between consecutive 6-month visits. Results: The correlation of IOP measurements within the same eye between consecutive visits wets r = 0.62, whereas the correlation of IOP measurements between right and left eyes at the same visit was r = 0.72. Thirteen percent of eyes had >20% change in IOP between consecutive visits. Sixty-six percent of eyes had a change in IOP within 3 mmHg, and 10% of eyes had a change in IOP >5 mmHg between visits. Eyes with a higher baseline IOP had a lower IOP at 6 months. There was a stronger correlation of IOP measured within 2 hours of the time of clay between visits (r = 0.56) than >2 hours apart (r = 0.39). IOP of the right eye, which was measured first, was 0.3 +/- 2.8 mmHg higher than the left eye. Conclusions: The variability of IOP measurements in the same eye between consecutive visits is moderate and is greater than the variability of IOP measurements between right and left eyes at the same visit. Factors affecting the variability of IOP measurement include regression to the mean, time of day, and measurement order, Knowledge of,variability in IOP and its measurements may help clinicians establish a more accurate baseline IOP, target IOP, and assessment of medication effect. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references, Ophthalmology 2009;116:717-724 (C) 2009 by the American Academy of Ophthalmology.