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Posture-based change in IOP found in glaucoma patients
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Changes in IOP resulting from posture shifts were comparable among various forms of glaucoma, according to findings published in Optometry Vision and Science.
Ji-Hye Park, MD, PhD, and colleagues investigated the effects of different body postures on the IOP in eyes suspected of having primary angle-closure and those with primary angle closure or primary angle-closure glaucoma.
“Elevated IOP is a key modifiable risk factor for the development or progression of glaucoma,” Park, of the department of ophthalmology at Korea University, and colleagues wrote. “Therefore, IOP measurement constitutes a major component of routine examinations performed in diagnosing or managing glaucoma.”
Park and colleagues measured IOP using Tonopen Avia (Reichert) in sitting, supine and right and left lateral decubitus positions. The main outcome was the difference in IOP among different body postures.
The researchers evaluated the eyes of 31 patients (N = 62 eyes; mean age, 63 years; 83% women) and found that 44 eyes were suspect for primary angle-closure glaucoma, 12 had primary angle-closure and six had primary angle-closure glaucoma.
Park and colleagues wrote that IOP was not significantly different between the two eyes when in the sitting and supine positions. IOP was significantly higher in the lower eye (dependent eye) compared with the upper eye (nondependent eye) when in the lateral decubitus positions.
Compared with measurements in the supine position, there was a greater difference in IOP in the dependent eye in the lateral decubitus position than in the nondependent eye (right lateral decubitus vs. supine; P = .02; left lateral decubitus vs. supine, P = .01), the researchers wrote.
Park and colleagues said there were no significant differences in IOP or IOP differences in both eyes among patients once stratified in the three diagnosis groups. – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Do you typically ask your glaucoma patients about their sleeping habits? What about if they play a wind instrument or practice yoga? I typically review known risk factors with patients that are either new to me or are being diagnosed with the disease. I also delve more in depth about particular hobbies, daily activities and patient lifestyle when IOP appears to be within target but progression is still noted.
What is there to know about sleeping position? The prone position has been shown to increase IOP in primary angle closure (PAC), while the supine position is thought to potentially lower IOP due to a shift in the crystalline lens. Interestingly, Park and colleagues found that PAC patients have an increased IOP when in the supine or lateral decubitus positions as compared to the sitting position. Of note, they found a greater elevation in the lateral decubitus position, suggesting that the anterior chamber angle parameters are altered by this lateral postural shift.
Does this mean that patients with angle closure glaucoma disease should lie on their back to sleep rather than on their side? Possibly. We will see what the data continues to show, but for now it’s better than trying to sleep while sitting up.
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