Relationship between postural change of the intraocular pressure and visual field loss in primary open-angle glaucoma

Purpose: To determine the relationship between the postural changes of the intraocular pressure and the visual field loss in patients with primary open-angle glaucoma. Methods: Eleven normal subjects and 11 patients with primary open-angle glaucoma were studied. Intraocular pressure was measured in both the sitting and the supine positions. Visual fields were measured with automated perimetry. Results: When patients moved from a sitting to supine position, the intraocular pressure increased by an average of 3.1 ± 0.4 mm Hg (mean ± SEM) in normal subjects and 4.0 ± 0.2 mm Hg in patients with primary open-angle glaucoma. There was a significant difference between the normal subjects and patients with primary open-angle glaucoma (P = 0.049). Intraocular pressure increased by 4.4 ± 0.3 mm Hg (P = 0.02) in the worse eye for mean deviation and 3.6 ± 0.3 mm Hg (P = 0.38) in the better eye for mean deviation. There was no significant difference in intraocular pressure in the sitting position between both groups. Conclusions: The greatest difference in intraocular pressure between the sitting and supine positions was observed in the worse eye of patients with primary open-angle glaucoma. This result suggests that damage to the optic nerve in primary open-angle glaucoma might occur when patients are asleep in the supine position.