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The Relationship between Diurnal Variations in Intraocular Pressure Measurements and Central Corneal Thickness and Corneal Hysteresis

¹From the National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the UCL Institute of Ophthalmology, London, United Kingdom; the ²Department of Optometry and Visual Science, City University London, London, United Kingdom; and the ³Glaucoma Research Unit, Moorfields Eye Hospital, London, United Kingdom.

PURPOSE. To examine the relationship between office-hour changes in IOP, measured with the Goldmann applanation tonometer (GAT) and dynamic contour tonometer (DCT), and the corneal characteristics central corneal thickness (CCT) and corneal hysteresis (CH).

METHODS. Sixty-two eyes of 62 untreated normal subjects and patients with untreated glaucoma had IOP measurements performed with the GAT (mm Hg) and DCT (mm Hg) over an 8-hour period at 2-hour intervals beginning at 9 AM. CCT (micrometers) was measured using a noncontact optical low-coherence reflectometry (OLCR) pachymeter, and CH (mm Hg) was measured with an ocular response analyzer (ORA). The associations between IOP measurements and corneal characteristics for each patient over the measurement period were assessed by using multilevel modeling.

RESULTS. GAT and DCT IOP and CCT changed significantly during office hours (ANOVA; GAT: F = 19.9, P < 0.001; DCT: F = 4.6, P = 0.001; CCT: F = 16.4; P < 0.001). No significant changes were observed in CH (ANOVA; F = 1.8, P = 0.13). Multilevel modeling analysis of the interrelationships between CCT, CH, and age on IOP measurements revealed that both CCT and CH changes were significantly associated with GAT IOP changes (GAT IOP/CCT slope, 0.04 mm Hg/µm; 95% confidence intervals [CIs], 0.02–0.06; GAT IOP/CH slope, 0.20 mm Hg/mm Hg; 95% CI, 0.01–0.39). CCT, but not CH, changes were significantly associated with DCT IOP changes (DCT IOP/CCT slope, 0.03 mm Hg/µm; 95% CI, 0.00–0.05). However, although the association between CCT and GAT IOP was relatively uniform between subjects, association between CCT and DCT IOP showed greater intersubject variability. Age had no effect on the diurnal variation of IOP measured with either device.

CONCLUSIONS. Measured IOP and corneal characteristics covary during office hours. Changes in CCT and CH are associated with changes in GAT IOP and, less consistently, with DCT IOP. The data suggest that variations in corneal characteristics explain a small proportion of the change in IOP measurements made with the GAT during office hours.