Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
We read with great interest the editorial by Caprioli1 on the role of the fluctuations of intraocular pressure (IOP) in glaucoma progression. Based on the articles by Bengtsson et al2 and Hong et al,3 Caprioli suggested that fluctuation may be a risk factor for progression, particularly in patients with low IOP. In these patients, modulation of IOP would be more appropriate than simple reduction.
An alternative explanation of how IOP fluctuations may affect the progression of the disease is suggested in the Figure, which shows patients A and B exhibiting the same mean IOP but different fluctuations. While the lower fluctuations for patient A never enter the IOP risk zone for progression, this occurs with variable frequency for patient B. Progression would therefore arise not from fluctuations per se but from intermittent exposures to higher-than-endurable IOP values. Patients with low-tension glaucoma may have risk zones closer to the regimen of the mean IOP, so that even limited fluctuations may represent a nonindependent risk factor.
Intraocular pressure (IOP) fluctuations and risk of glaucoma progression for patients A and B. The dotted line indicates the mean. Patients A and B have the same mean IOP but different fluctuations.
These considerations may be suitable for both short- and long-term IOP fluctuations, and they may cause reconsideration of the concept of target IOP as suggested by Caprioli. In any case, they point out the inadequacy of our knowledge on the role of fluctuations in the progression of glaucoma and the need for further investigations to clarify the clinical relevance of this topic.
Correspondence: Dr Orzalesi, Eye Clinic, San Paolo Hospital, University of Milan, Italy, via di Rudini' 8, 20142 Milan, Italy (fogagnolopaolo@googlemail.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Ophthalmology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.