April 2011
Volume 52, Issue 14
ARVO Annual Meeting Abstract  |   April 2011
Circadian Rhythm Patterns in Patients with Advanced Glaucoma
Author Affiliations & Notes
  • Aaron Y. Lee
    Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri
  • Sidney T. Chang
    Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri
  • Hugh S. Lin
    Department of Ophthalmology, Stanford University, Stanford, California
  • Melike Pekmezci
    Department of Ophthalmology, University of California, San Francisco, Missouri
  • Russell N. Van Gelder
    Department of Ophthalmology, University of Washington Medical School, Seattle, Washington
  • Anjali M. Bhorade
    Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri
  • Footnotes
    Commercial Relationships  Aaron Y. Lee, None; Sidney T. Chang, None; Hugh S. Lin, None; Melike Pekmezci, None; Russell N. Van Gelder, None; Anjali M. Bhorade, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 243. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Aaron Y. Lee, Sidney T. Chang, Hugh S. Lin, Melike Pekmezci, Russell N. Van Gelder, Anjali M. Bhorade; Circadian Rhythm Patterns in Patients with Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):243.

      Download citation file:

      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

To evaluate circadian rhythm patterns in patients with advanced glaucoma and ocular normals using wrist actigraphy.


Glaucoma patients, ages 50 to 90 years, with a cup-to-disc ratio ≥ 0.9 in both eyes and glaucoma stage of ≥ 3 in both eyes using the Glaucoma Staging System and normal age-matched controls with no co-morbid conditions nor medications affecting sleep were consecutively recruited. Patients were required to wear a watch sensitive to movement (i.e. wrist actigraphy) continuously for 14 days. A Hidden Markov Model was used to categorize frequency and duration of activity status into five states: sleeping, sleeping with movement, daytime napping, awake, and vigorous activity. A recurrent event survival analysis was used to model the time from waking each day to the onset of the first nap.


Fifteen advanced glaucoma patients and 14 normal controls (mean ages 74.3 and 67.2 years, respectively) successfully completed the study. The glaucoma cohort had a significantly higher percent of days with naps (50% vs. 15.9%, p=0.0017, t-test) and longer napping times (60.8 vs. 39.5 minutes, respectively, p=0.034, t-test) than normal controls. In addition, advanced glaucoma patients had a 47% greater chance of naping closer to their time of awakening than normal controls (95% confidence interval of hazard ratio: 1.13-1.92, p=0.0042, Figure). There was no significant difference in total sleeping time at night between glaucoma patients and normal controls (8.4 vs. 8.6 hours, respectively, p=0.72, t-test).


Patients with advanced glaucoma nap at a higher frequency, longer duration, and earlier onset from their waking time than patients without glaucoma despite similar hours sleeping at night. Such differences in circadian rhythm patterns may be due to optic nerve pathology.  

Keywords: circadian rhythms • clinical (human) or epidemiologic studies: prevalence/incidence • optic nerve 

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.