Purpose: To compare the effects of the water-drinking test (WDT) with the 30° inverted body position test on intraocular pressure (IOP) in normal patients, suspected glaucoma patients and glaucoma patients.
Materials and methods: Based on clinical evaluation of the optic disk, IOP, and standard achromatic perimetry (SAP) of 71 eyes, 18 were “normal” (normal SAP and optic disk evaluation, and IOP < 21 mm Hg), 30 were “glaucoma suspect” (GS; normal SAP, cup/disk (C/D) ratio > 0.5 or asymmetry > 0.2 and/or ocular hypertension), and 31 had “early glaucoma” (MD < -6 dB, glaucomatous optic neuropathy). Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Patients fasted before the WDT, and four measurements were performed at basal, 15’, 30, and 45’ after drinking 1 liter of water (WDT) in 5 minutes. In the 30° inverted position, IOP measurement with Perkins applanation tonometer was taken after 5 minutes lying down.
Results: There was a statistical difference in all groups between the basal IOP and peak IOP during the WDT (p < 0.001) and in the inverted position IOP (p < 0.001). Controls (p = 0.50), suspects (p = 0.41) and glaucoma patients (p = 1.0) did not exhibit a difference between WDT-IOP and inverted position IOP.
Conclusion: The 30° inverted position test was as efficient as WDT in detecting peak IOP. This new provocative test is easier, faster and more comfortable for both patients and doctors.
The Advanced Glaucoma Intervention Study 7. The relationship between control of intraocular pressure and visual field deterioration (AGIS). Am J Ophthalmol 2000 Oct;130(4): 429-440.
Leske MC, Heijl A, Hussein M, et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol 2003 Jan;121(1):48-56.
Kidd MN, O'Conner M. Progression of field loss after trabeculectomy: a five year follow-up. Br J Ophthalmol 1985 Nov;69(11):827-831.
Schulzer M, Mikelberg FS, Drance SM. Some observations on the relation between intraocular pressure and the progression of glaucomatous visual field loss. Br J Ophthalmol 1987 Jul;71(1): 486-488.
Drance SM. Diurnal variation of intraocular pressure in treated glaucoma significance in patients with chronic simple glaucoma. Arch Ophthalmol 1963 Sep;70:302-311.
Medeiros FA, Leite CA, Susanna R Jr. Correlation of the IOP peaks between diurnal curve and water drinking test in glaucoma patients under Timolol Maleate and Dorzolamide. Rev Bras Oftal 2001 Jan;60:418-423.
Armaly MF, Krueger DE, Maunder L, et al. Biostatistical analysis of the collaborative glaucoma study—I: summary report of the risk factors for glaucomatous visual-field defects. Arch Ophthalmol 1980 Dec;98(12):2163-2171.
Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma 2000 Apr;9(2):134-142.
Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmol 1991 Jan;98(1):64-69.
Martinez-Bello C, Chauhan BC, Nicolela MT, et al. Intraocular pressure and progression of glaucomatous visual field loss. Am J Ophthalmol 2000 Mar;129(3):302-308.
Brubaker RF. Goldmann's equation and clinical measures of aqueous dynamics. Exp Eye Res 2004 Mar;78(3):633-637.
Medeiros FA, Pinheiro A, Moura FC, et al. Intraocular pressure fluctuations in medical versus surgically treated glaucomatous patients. J Ocul Pharmacol Ther 2002;18(6):489-498.
Kitazawa AY, Horie T. Diurnal variation of intraocular pressure in primary open angle glaucoma. Am J Ophthalmol 1975;79(4):557-566.
Sacca SCB, Rolando M, Marletta A, Macri A, Cerqueti P, Ciurlo G. Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and normal subjects. Ophthalmologica 1998;212(2):115-119.
David RC, Zangwill L, Briscoe D, Dagan M, Yagev R, Yassur Y. Diurnal intraocular pressure variations: an analysis of 690 diurnal curves. Br J Ophthalmol 1992;76(5):280-283.
Bertschinger DR, Mendrinos E, Dosso A. Yoga can be dangerous—glaucomatous visual field defect worsening due to postural yoga. Br J Ophthalmol 2007 Oct;91(10):1413-1414.
Gallardo MJ, Aggarwal N, Cavanagh HD, Whitson JT. Progression of glaucoma associated with the Sirsasana (headstand) yoga posture. Adv Ther 2006 Nov-Dec;23(6):921-925.
Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmol 2006 Aug;113(8):1327-1332.