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Intraocular Pressure Elevation during Lateral Body Posture in Side-sleeping Glaucoma Patients

Park, Ji-Hye, MD, PhD1; Yoo, Chungkwon, MD, PhD1*; Yoo, Eunjoo, MD, PhD1; Kim, Yong Yeon, MD, PhD1

doi: 10.1097/OPX.0000000000001322
ORIGINAL INVESTIGATIONS

SIGNIFICANCE In side-sleeping open-angle glaucoma (OAG) patients, eyes that showed progression exhibited a greater intraocular pressure (IOP) elevation when subjects were rested in the lateral decubitus (LD) posture on the ipsilateral side compared with those eyes that did not progress.

PURPOSE The purposes of this study were to investigate whether lying in the LD position for an extended period affects IOP in side-sleeping patients with OAG when rested on their own pillow and to compare posture-induced IOP variations between eyes with recent glaucomatous progression and those without.

METHODS Twenty-eight bilateral OAG patients who reported a preference for side sleeping were included. We measured IOP in both eyes, with the patient in the sitting and supine positions, 5 and 30 minutes after they had been in the right or left LD position (depending on their sleeping habits) and 5 minutes after they had returned to the supine position. While in the recumbent postures, the patients rested on their own pillows from home. The patients were divided into the correspondence and noncorrespondence subgroups, based on whether the laterality of the progressed eye corresponded with their habitual sleeping side.

RESULTS The IOP of the lower-sided eye increased further (+1.6 ± 1.8 mmHg; P < .001) when the LD posture was maintained for an additional 25 minutes. Such time-dependent IOP elevation in the dependent eye was greater in patients whose LD posture corresponded with glaucoma progression (+2.5 ± 1.7 mmHg) than in those who showed no correspondence or no glaucoma progression (+1.0 ± 1.6 mmHg; P = .03).

CONCLUSIONS Compared with nonprogressed eyes, progressed eyes exhibited a greater IOP elevation when the side-sleeping patients with OAG were rested in the LD posture on the ipsilateral side.

1Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea *ckyoomd@korea.ac.kr

Supplemental Digital Content: Appendix Table A1, available at http://links.lww.com/OPX/A375. Pearson correlation between intraocular pressure differences and other parameters in the dependent eye. Note: When correlations between various parameters and the posture-induced IOP differences in the dependent eyes were assessed, lower head position was related to a greater IOP rise in the dependent eye in the LD posture compared to sitting position.

Appendix Table A2, available at http://links.lww.com/OPX/A375. Pearson correlation between intraocular pressure differences and other parameters in nondependent eyes. Note: When correlations between various parameters and the posture-induced IOP differences in the nondependent eyes were assessed, none of the pillow characteristics were correlated with IOP differences.

Submitted: March 14, 2018

Accepted: July 11, 2018

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: CY; Data Curation: EY; Investigation: J-HP, EY; Methodology: J-HP, CY, EY; Supervision: CY, YYK; Validation: J-HP, CY, YYK; Writing – Original Draft: J-HP; Writing – Review & Editing: J-HP, CY, YYK.

Supplemental Digital Content: Direct URL links are provided within the text.

© 2019 American Academy of Optometry