J Korean Ophthalmol Soc.  2015 Dec;56(12):1913-1920. 10.3341/jkos.2015.56.12.1913.

Diurnal Variation in Intraocular Pressure Measured by Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

  • 1Department of Ophthalmology and The Institute of Ophthalmology and Optometry, Ewha Womans University School of Medicine, Seoul, Korea. Ckrey02@ewha.ac.kr


To analyze the diurnal change in intraocular pressure (IOP) and corneal biomechanical properties measured using the Ocular Response Analyzer (ORA; Reichert Inc., Depew, NY, USA) in Korean patients with normal tension glaucoma (NTG) patients.
Intraocular pressure (Goldmann applanation tonometer IOP [GAT IOP], Goldmann-correlated IOP [IOPg], corneal-compensated IOP [IOPcc]) and corneal hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT) were measured in 21 eye of NTG patients (12 males, 9 female) at 3 hour intervals for 48 hours using ORA. We recorded the time of each parameter that showed the lowest and the highest values of during the 48 hour testing period (Day 1 and Day 2) and evaluated the change of diurnal variation using Repeated measures analysis of variance (Re-ANOVA).
Peak IOP measured with GAT and ORA occurred at 6 AM-9 AM, 3 PM-6 PM and the trough IOP at 9 PM-12 AM during the 48 hour period. CCT, GAT IOP, IOPcc and IOPg measurements showed statistically significant variations (p<0.05). CH and CRF variations were not statistically significant (p>0.05).
In Korean NTG patients, IOP exhibits significant diurnal variation, with higher values during the dawn and afternoon and lower values before retiring. Clinically, measurements of IOP performed in the afternoon could aid in the detection of relatively elevated IOP.


Biomechanical properties; Diurnal variation; Intraocular pressure; Ocular response analyzer

MeSH Terms

Intraocular Pressure*
Low Tension Glaucoma*


  • Figure 1. Diurnal measurements of GAT IOP, IOPcc, IOPg and CCT in normal tension glaucoma patients during 1st 24-hr period. IOP (GAT IOP, IOPcc, IOPg) reaches its peak at 6 AM on the 1st day and the time of the peak IOP measurements matched the time of peak CCT measurements. CCT = central corneal thickness; NTG = normal tension glaucoma; IOP = in-traocular pressure; GAT = Goldman applanation tonometer; IOPg = Goldman-correlated intraocular pressure; IOPcc = corneal-compensated intraocular pressure factor.

  • Figure 2. Diurnal measurements of GAT IOP, IOPcc, IOPg and CCT in normal tension glaucoma patients during 2nd 24-hr period. IOP (GAT IOP, IOPcc, IOPg) reached its peak at 6 AM and 6 PM on 2nd day. But the time of the peak IOP measurements are not matched with the time of peak CCT measurements thoroughly. CCT = central corneal thickness; NTG = normal tension glaucoma; IOP = intraocular pressure; GAT = Goldman applanation tonometer; IOPg = Goldman-cor-related intraocular pressure; IOPcc = corneal-compensated in-traocular pressure factor.

  • Figure 3. Diurnal measurements of CH and CRF in normal tension glaucoma patients during 48-hr period (Day 1 and Day 2). Diurnal fluctuation of CH and CRF show no significantly dif-ference on Day 1 and Day 2 (Day 1 CH: p = 0.183; Day 2 CH: p = 0.139; Day 1 CRF: p = 0.514; Day 2 CRF: p = 0.706). IOP = intraocular pressure; CH = corneal hysteresis; NTG = normal tension glaucoma; CRF = corneal resistant factor.



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