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M. Sehi, G.E. Trope, J.G. Flanagan; Optic Nerve Head Topography Shows Diurnal Variation in Untreated Primary Open Angle Glaucoma . Invest. Ophthalmol. Vis. Sci. 2003;44(13):979.
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Purpose: To investigate the diurnal variations and interactions of optic nerve head (ONH) topography, intra-ocular pressure (IOP) and mean ocular perfusion pressure (MOPP) in untreated primary open angle glaucoma (POAG). Methods: The sample consisted of 8 patients with untreated POAG (7 men, age range 40-59, mean 53.3, SD 12.9), 9 glaucoma suspects (8 women, age range 55-83, mean 64.3, SD 9.6) and 11 Normals (9 women, age range 53-73, mean 61.5, SD 6.7). The sectoral analyses of 6 selected HRT parameters (cup and rim volume, maximum cup depth, height variation contour, mean retinal nerve fibre layer thickness and cup shape measure) were used to examine the topography. The IOP, systolic and diastolic blood pressure (SBP, DBP) and ONH topography (HRTII) were measured every hour between 07:00 and 22:00 hours on a single day. The volunteers had two meals at approximately 12:30 and 18:30. Repeated measures ANOVA with Tukey's post-hoc test were used to analyse differences between groups. Results: In the POAG group the cup volume demonstrated the most diurnal change in all locations especially in global, temporal and nasal inferior locations (p<0.037). At 07:00 the cup volume was the smallest and was significantly different from all other hours but 21:00. Cup volume was not significantly correlated to IOP, BP or MOPP. Similar patterns of change were not observed in the Normal or Suspect groups. In untreated POAG the mean diurnal variation in IOP was 9.7mmHg and was significantly greater than for Normals (6.5mmHg) (p=0.04). Suspects had a mean variation of 7.33mmHg. The IOP at 07:00 was significantly higher than all times after 10:00, for all 3 groups. There was no significant difference between groups for SBP (99-180mmHg), DBP (47-92mmHg), and MOPP (21.6-64mmHg). However they were all significantly lower at 13:00 (postprandial) compared to 12:00 for all 3 groups (p<0.006). Conclusions: The topography of the ONH in untreated POAG significantly changed with time of day. Topography was most different early in the morning with the smallest cup volume occurring consistently at this time. A postprandial reduction in MOPP and BP was observed in all 3 groups following lunch.
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