Intraocular Pressure Over the Clinical Range of Blood Pressure: Blue Mountains Eye Study Findings

doi:10.1016/j.ajo.2004.12.088

American Journal of Ophthalmology

Volume 140, Issue 1, July 2005, Pages 131-132

https://doi.org/10.1016/j.ajo.2004.12.088 Get rights and content

Purpose

To quantify the relation of blood pressure (BP) and intraocular pressure (IOP) across the clinical range of BP in an older phakic population not using glaucoma medications.

Design

Cross-sectional population-based study

Methods

Seated BP and applanation IOP were measured, and their relation was assessed in regression models.

Results

Mean IOP of the two eyes increased linearly from 14.3 mm Hg for systolic BP <110 mm Hg to 17.7 mm Hg for systolic BP ≥200 mm Hg, a 3.4-mm Hg excursion over this range. Mean IOP also increased from 15.2 mm Hg for diastolic BP <70 to 18.4 mm Hg for diastolic BP ≥120, a similar variance. There were no changes after age and multivariate adjustments for IOP or after excluding undiagnosed glaucoma cases.

Conclusion

A 3-mm linear IOP increase over the clinical spectrum of BP levels was evident; this variance is greater than with most other systemic and ocular parameters.

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R. Mitchell et al.
Iris color and intraocular pressurethe Blue Mountains Eye Study
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(2003)

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Cited by (75)

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2024, Heliyon
To explore intraocular pressure (IOP) and its associated parameters in an aged population.
The epidemiologic Ural Very Old Study (UVOS) conducted in Bashkortostan/Russia included 1526 participants with an age of ≥85 years. Besides a whole series of ocular and systemic examinations, IOP was determined applying non-contact tonometry. Body mass index, diastolic blood pressure and age were the factors used to estimate the cerebrospinal fluid pressure (CSFP).
The study consisted of 904 participants (age: 88.6 ± 2.7 years) with available IOP readings and without anti-glaucomatous therapy. Mean IOP was 14.5 ± 5.1 mmHg (median: 14 mm Hg; Q1:11; Q3:16; 95%CI:8,25) and 14.8 ± 4.6 mmHg (median: 14 mm Hg; Q1:12; Q3:17; 95%CI:8,28) in the right and left eyes, respectively. Higher IOP correlated (multivariable analysis; correlation coefficient r²:0.32) with female sex (P < 0.001), more sedentary lifestyle (P = 0.006), higher estimated CSFP (P < 0.001), higher total protein serum concentration (P < 0.001), stronger hand grip force (P = 0.01), thicker central cornea (P < 0.001), longer axial length (P = 0.01), absence of previous cataract surgery (P = 0.001), higher degree of pseudoexfoliation (P = 0.02, and thinner peripapillary retinal nerve fiber layer thickness (P = 0.004). Using this that model, IOP reading enlarged by 0.22 mmHg (95% CI: 0.09, 0.35) for each increase in estimated CSFP by 1 mm Hg, by 0.03 mm Hg (95% CI: 0.02,0.05) for each thickening in central corneal thickness by 1 μm, by 0.56 mm Hg (95%CI: 0.13,1.00) for each axial elongation by 1 mm, and by 0.40 mmHg (95% CI: 0.06,0.74) for each increase in the degree of pseudoexfoliation, and it decreased by 0.40 mmHg (95% CI: 0.06,0.74) by cataract surgery.
In this study population aged 85+years, IOP readings showed similar relationships as in younger study populations, including positive associations with higher estimated CSFP and longer axial length and a negative association with cataract surgery.
Ocular blood flow as a clinical observation: Value, limitations and data analysis
2020, Progress in Retinal and Eye Research
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease.
Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
Intraocular Pressure and Its Associations in a Russian Population: The Ural Eye and Medical Study
2019, American Journal of Ophthalmology
To assess the normal distribution of intraocular pressure (IOP) and its associations with ocular, medical, and socioeconomic factors in a Russian population.
Population-based cross-sectional study.
The Ural Eye and Medical Study conducted in a rural and urban area in Ufa/Bashkortostan included 5899 (80.5%) participants out of 7328 eligible individuals aged 40+ years. IOP was measured by noncontact tonometry.
After exclusion of individuals after glaucoma surgery or with antiglaucomatous therapy, mean IOP was 13.6 ± 3.8 mm Hg (median: 13 mm Hg; range: 3-49 mm Hg; 95% confidence interval [CI]: 8-23 mm Hg). The IOP range within the mean ± 2 standard deviations was 6.0-21.2 mm Hg. In multivariable analysis higher IOP was associated (regression coefficient r: 0.40) with the systemic parameters of female sex (nonstandardized regression coefficient B: 0.44; 95%CI: 0.22, 0.66; standardized regression coefficient beta: 0.06; P < .001), urban region of habitation (B: -0.27; 95% CI: 0.51, 0.03; beta: 0.03; P = .03), Russian ethnicity (B: 0.47; 95% CI: 0.20, 0.74; beta: 0.05; P = .001), higher body mass index (B: 0.06; 95% CI: 0.04, 0.08; beta: 0.08; P < .001), lower physical activity score (B: -0.02; 95% CI: -0.03, -0.002; beta: -0.03; P = .02), higher prevalence of diabetes mellitus (B: 0.42; 95% CI: 0.08, 0.76; beta: 0.03; P = .02), higher systolic blood pressure (B: 0.01; 95% CI: 0.01, 0.02; beta: 0.08; P < .001), fewer days with intake of fruits (B: -0.07; 95% CI: -0.12, -0.01; beta: 0.03; P = .01), lower blood concentration of bilirubin (B: -0.01; 95% CI: -0.02, -0.003; beta: -0.04; P = .008) and urea (B: -0.11; 95% CI: -0.17, -0.04; beta: -0.04; P = .003), worse best-corrected visual acuity (B: 0.64; 95% CI: 0.38, 0.90; beta: 0.13; P < .001), thicker central corneal thickness (B: 0.036; 95% CI: 0.033, 0.039; beta: 0.32; P < .001), higher anterior corneal refractive power (B: 0.11; 95% CI: 0.04, 0.18; beta: 0.05; P = .003), lower anterior chamber depth (B: -0.57; 95% CI: -0.83, -0.30; beta: -0.07; P < .001) (or lower prevalence of cataract surgery [B: -0.78; 95% CI: -1.44, -0.13; beta: -0.03; P = .02]), longer axial length (B: 0.30; 95% CI: 0.18, 0.42; beta: 0.07; P < .001), and higher prevalence of pseudoexfoliation (B: 1.08; 95% CI: 0.52, 1.63; beta: 1.01; P < .001). Measured IOP decreased by 0.36 mm Hg (95% CI: 0.33, 0.39) for each increase in central corneal thickness by 10 μm.
IOP was associated with a multitude of systemic and ocular parameters, the associations of which may be considered in defining the normal range of IOP.
Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes
2018, American Journal of Ophthalmology
Citation Excerpt :
5 mm Hg) is considerably higher than the mean IOP of 13.1 mm Hg for male subjects, at the population level, who are underweight, never smoked, and do not have either diabetes or systolic hypertension, but take systemic beta-blockers (15.3 + -1.5 + 0 + 0 + 0 + -0.7 = 13.1 mm Hg). Although cross-sectional studies17,39,44,60–83 have identified a statistical association between systemic disease and IOP, and longitudinal studies39–48 have identified baseline systemic diseases that affect IOP over time (Table 4), our results in a homogenous cohort of older adults with a greater prevalence of systemic disease are novel because they address repeated IOP measurements over a 12-year time period, and they demonstrate the effect of systemic disease on additional IOP parameters beyond mean IOP, such as IOP peak and variability. While systemic beta-blocker use blunted IOP mean and peak, analyses demonstrate diabetes and systolic hypertension affected all IOP variables.
Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status.
Secondary analysis of randomized clinical trial data.
Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed. Study Population: A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data. Main Outcome Measures: Independent systemic disease risk factors associated with IOP.
Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated.
Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.
Alterations of Ocular Hemodynamics Impair Ophthalmic Vascular and Neuroretinal Function
2018, American Journal of Pathology
Hypertension is associated with numerous diseases, but its direct impact on the ocular circulation and neuroretinal function remains unclear. Herein, mouse eyes were challenged with different levels of hemodynamic insult via transverse aortic coarctation, which increased blood pressure and flow velocity by 50% and 40%, respectively, in the right common carotid artery, and reduced those parameters by 30% and 40%, respectively, in the left common carotid artery. Blood velocity in the right central retinal artery gradually increased up to 40% at 4 weeks of transverse aortic coarctation, and the velocity in the left central retinal artery gradually decreased by 20%. The fundus and retinal architecture were unaltered by hemodynamic changes. Endothelium-dependent vasodilations to acetylcholine and adenosine were reduced only in right (hypertensive) ophthalmic arteries. Increased cellularity in the nerve fiber/ganglion cell layers, enhanced glial fibrillary acidic protein expression, and elevated superoxide level were found only in hypertensive retinas. The electroretinogram showed decreased scotopic b-waves in the hypertensive eyes and decreased scotopic oscillatory potentials in both hypertensive and hypotensive eyes. In conclusion, hypertension sustained for 4 weeks causes ophthalmic vascular dysfunction, retinal glial cell activation, oxidative stress, and neuroretinal impairment. Although ophthalmic vasoregulation is insensitive to hypotensive insult, the ocular hypoperfusion causes neuroretinal dysfunction.
Risk of Ocular Hypertension in Adults with Noninfectious Uveitis
2017, Ophthalmology
To describe the risk and risk factors for ocular hypertension (OHT) in adults with noninfectious uveitis.
Retrospective, multicenter, cohort study.
Patients aged ≥18 years with noninfectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics.
Demographic, ocular, and treatment data were extracted from medical records of uveitis cases.
Prevalent and incident OHT with intraocular pressures (IOPs) of ≥21 mmHg, ≥30 mmHg, and increase of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT).
Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21 mmHg and OHT ≥30 mmHg are 14.4% (95% confidence interval [CI], 13.4–15.5) and 5.1% (95% CI, 4.7–5.6) per year, respectively. Statistically significant risk factors for incident OHT ≥30 mmHg included systemic hypertension (adjusted hazard ratio [aHR], 1.29); worse presenting visual acuity (≤20/200 vs. ≥20/40, aHR, 1.47); pars plana vitrectomy (aHR, 1.87); history of OHT in the other eye: IOP ≥21 mmHg (aHR, 2.68), ≥30 mmHg (aHR, 4.86) and prior/current use of IOP-lowering drops or surgery in the other eye (aHR, 4.17); anterior chamber cells: 1+ (aHR, 1.43) and ≥2+ (aHR, 1.59) vs. none; epiretinal membrane (aHR, 1.25); peripheral anterior synechiae (aHR, 1.81); current use of prednisone >7.5 mg/day (aHR, 1.86); periocular corticosteroids in the last 3 months (aHR, 2.23); current topical corticosteroid use [≥8×/day vs. none] (aHR, 2.58); and prior use of fluocinolone acetonide implants (aHR, 9.75). Bilateral uveitis (aHR, 0.69) and previous hypotony (aHR, 0.43) were associated with statistically significantly lower risk of OHT.
Ocular hypertension is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with 1 or more of the several risk factors identified are at particularly high risk and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk within the constraints of the overriding need to control the primary ocular inflammatory disease.

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Brief reportIntraocular Pressure Over the Clinical Range of Blood Pressure: Blue Mountains Eye Study Findings

Purpose

Design

Methods

Results

Conclusion

Ophthalmology

Am J Ophthalmol

Brief report
Intraocular Pressure Over the Clinical Range of Blood Pressure: Blue Mountains Eye Study Findings