Intraocular Pressure Curves of Untreated Glaucoma Suspects and Glaucoma Patients in Sitting and Lateral Decubitus Positions Using the Goldmann Applanation Tonometer

Purpose: Evaluation of data obtained during diurnal intraocular pressure (IOP) measurements by means of the Goldmann Applanation tonometer in sitting and lateral decubitus positions. Patients and Methods: Retrospective cohort study of 41 consecutive untreated subjects (82 eyes) with ocular hypertension or suspicious discs. The IOP was measured by Goldmann Applanation tonometer in sitting position at 9 AM, 12 AM, 3 PM, and 6 PM; and in right lateral decubitus position around 12:15 PM. Results: In the right eye (RE) mean peak IOP was 22.19 +/- 4.68 mm Hg. In the left eye (LE) peak mean IOP was 22.19 +/- 3.8 mm Hg. In 91.5% of the eyes, the IOP increased in the lateral decubitus position. The average change in the RE was an increment of 4.22 +/- 2.67 mm Hg (P < 0.001) and in the LE an increment of 3.51 +/- 3.11 (P < 0.001). This increment was significantly higher in the dependent eye (ie, lower eye) (P = 0.049). Sixty-seven percent of eyes had a positional elevation of IOP between 2 and 5 mm Hg and 23.2% of eyes had IOP elevation between 6 and 12 mm Hg. In the great majority of the eyes (80.5% RE and 78% LE) the lateral decubitus IOP was greater than maximal diurnal sitting IOP. Conclusions: The IOP in the lateral decubitus position was significantly higher than the mean maximal diurnal sitting IOP. Over 20% of the patients had an IOP increase of >= 6 mm Hg when lying down. Timely identification of patients with excessive postural elevation of IOP could affect their management and prevent visual fields loss.