Effects of different sleeping positions on intraocular pressure in secondary open-angle glaucoma and glaucoma suspect patients

Figures & data

Table 1 Probability values (N=176)

OD	P-value	IOP difference	OS	P-value	IOP difference
Same eye comparisons
Initial vs last sitting IOP	P=0.21		Initial vs last sitting IOP	P=0.86
Initial vs (R) $\text{lateral}$	P<0.001	3.2 mmHg	Initial vs (R) $\text{lateral}$	P<0.001	2.7 mmHg
Initial vs (L) $\text{lateral}$	P<0.001	2.7 mmHg	Initial vs (L) $\text{lateral}$	P<0.001	3.2 mmHg
Initial vs (R) $\text{prone}$	P<0.001	5.8 mmHg	Initial vs (R) $\text{prone}$	P<0.001	5.9 mmHg
Initial vs (L) $\text{prone}$	P<0.001	5.4 mmHg	Initial vs (L) $\text{prone}$	P<0.001	5.9 mmHg
(R) lateral D vs (L) lateral ND	P=0.57		(R) lateral ND vs (L) lateral D	P=0.36
(R) prone ND vs (L) prone D	P=0.69		(R) prone D vs (L) prone ND	P=0.94
(L) lateral ND vs (R) $\text{prone}$ ND	P=0.003	3.1 mmHg	(R) lateral ND vs (L) $\text{prone}$ ND	P=0.001	3.2 mmHg
(L) lateral ND vs (L) $\text{prone}$ D	P=0.005	2.7 mmHg	(R) lateral ND vs (R) $\text{prone}$ D	P=0.002	3.2 mmHg
(R) lateral D vs (L) $\text{prone}$ D	P=0.05	2.2 mmHg	(L) lateral D vs (R) $\text{prone}$ D	P=0.002	2.7 mmHg
(R) lateral D vs (R) $\text{prone}$ ND	P=0.009	2.7 mmHg	(L) lateral D vs (L) $\text{prone}$ ND	P=0.001	2.7 mmHg
All lateral vs all $\text{prone}$	P<0.001	2.7 mmHg	All lateral vs all $\text{prone}$	P<0.001	2.9 mmHg
Opposite eye (D vs ND) comparisons
OD (L) lateral (ND) vs OS (L) lateral (D)	P=0.51		OD (R) lateral (D) vs OS (R) lateral (ND)	P=0.60
OD (L) prone (D) vs OS (L) prone (ND)	P=0.49		OD (R) prone (ND) vs OS (R) prone (D)	P=0.93
Initial sitting all eyes OD vs OS	P=0.95

Note: OD is the right eye, OS is the left eye, D is the dependent or the higher of the pair, ND is the nondependent or the lower of the pair, mmHg is the IOP in millimeters of mercury, positions in red have the higher IOP of the pair, (R) is the right recumbent position ([R] lateral is laying on right side facing left and [R] prone is laying on stomach with right head turn), (L) is the left recumbent position ([L] lateral is laying on left side facing right and [L] prone is laying on stomach with left head turn).

Abbreviation: IOP, intraocular pressure.

Table 2 High responders vs low responders average cohort values and P-values

	Age	Rx	HVF MD	HVF slope	IOP pre-Tx	CCT	C/D	First Ta
OD
High responders	51.3 years	−2.27 D	−1.91 Db	−0.41 Db	19.1 mmHg	−0.85 μm	0.44	15.8
Low responders	53.0 years	−4.04 D	−0.85 Db	−0.08 Db	20.8 mmHg	+0.29 μm	0.49	19.6
P-value	0.82	0.15	0.14	0.13	0.42	0.39	0.69	0.06
OS
High responders	58.3 years	−3.60 D	−1.8 Db	−0.40 Db	19.2 mmHg	−0.27 μm	0.54	15.3
Low responders	54.9 years	−1.47 D	−1.23 Db	−0.32 Db	20.2 mmHg	−1.33 μm	0.39	20.0
P-value	0.63	0.07	0.29	0.76	0.54	0.31	0.16	0.009

Note: OD is the right eye, OS is the left eye, Rx is the glass prescription in diopters, slope is the VFI slope, IOP is expressed in millimeters of mercury, pre-Tx is the average IOP before any IOP-lowering mechanism has been performed, CCT is the corneal thickness with the difference from the pachymeter “average” CCT, and C/D is the highest estimated cup-to-disk ratio on any examination.

Abbreviations: CCT, central corneal thickness; HVF, Humphrey visual field; IOP, intraocular pressure; MD, mean deviation; VFI, visual field index.

Table 3 Changes in clinical variables

Cohort group	Disk hemorrhages	Notches	Family history	Blood vessel changes
Large increase cohort (≥33%)	2	4	2	1
Small increase cohort (<33%)	0	0	4	0

Figure 1 IOP changes (mmHg) from sitting to recumbent positions in this study (N=176 trials).

Abbreviations: IOP, intraocular pressure; PDG, pigmentary dispersion glaucoma; PDS, pigmentary dispersion syndrome.

Figure 2 IOP changes (%) from sitting to recumbent positions in this study (N=176 trials).

Abbreviations: IOP, intraocular pressure; PDG, pigmentary dispersion glaucoma; PDS, pigmentary dispersion syndrome.

Figure 3 Average IOP values in head up (negative) and down (positive) positions in 3 prior studies.

Notes: The image shows an increasing IOP change with increasing body inversion. Red is Carlson et al,⁴³ green is Linder et al,¹⁸ and blue is Tarrkanen and Leikola.⁴⁸ Head position in degrees – negative = up and positive = down.
Abbreviation: IOP, intraocular pressure.

CarlsonKHMcLarenJWTopperJEBrubakerRFEffect of body position on intraocular pressure and aqueous flowInvest Ophthalmol Vis Sci1987288134613523610552

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LinderBJTrickGLWolfMLAltering body position affects intraocular pressure and visual functionInvest Ophthalmol Vis Sci19882910149214973170121

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TarrkanenALeikolaJPostural variations of the intraocular pressure as measured with the Mackay-Marg TonometerActa Ophthalmol19674545695756072270

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