An examination of the hypothesis that intraocular pressure elevation episodes can have prognostic significance in glaucoma suspects.

The efficacy of intraocular pressure reduction in retarding the progression of glaucoma has been demonstrated. This review examines the potential for prognostic advantage for glaucoma suspects in reducing their optic nerve head exposure to elevated intraocular pressure associated with activities which have been shown to elevate intraocular pressure. In this observational study, patients examined at the Centre for Eye Health (University of New South Wales) with a diagnosis of glaucoma suspect were surveyed to determine their histories for participation in activities which are known to elevate intraocular pressure. The evidence regarding the pathological significance of these sources of elevation in susceptible patients was examined. Apart from the universality of sleep-related intraocular pressure elevations, the histories from 183 confirmed glaucoma suspects indicate a wide range and variation in frequency of participation in other intraocular pressure elevating activities. A reduction in exposure to elevated intraocular pressure may improve the prognosis for glaucoma suspects. Additional patient specific assessment of the results of this screening could provide an indication of the degree (frequency, intensity level and duration) of exposure to elevated intraocular pressure. Such information may provide the basis for improving a patient's prognosis by helping them to identify opportunities to reduce such exposure to elevated intraocular pressure. Any benefit of reduction of such exposure appears likely to be greater if activities which elevate intraocular pressure are of long duration, occur frequently, occur over a long period of time, and/or involve high levels of intraocular pressure elevation.