HTML
1.
Razeghinejad R, Hossein Nowroozzadeh M. Water-drinking Test and Pharmacologic Mydriasis as Provocative Tests in Primary Angle Closure Suspects. JOVR [Internet]. 2019Jul.18 [cited 2024Jul.17];14(3):267–274. Available from: https://knepublishing.com/index.php/JOVR/article/view/4782

https://doi.org/10.18502/jovr.v14i3.4782

statistics

  • 928 Abstract Views
  • 0 HTML Views
  • Cited by 2 articles

authors

  • Reza Razeghinejad

    Reza Razeghinejad

    Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
  • M. Hossein Nowroozzadeh

    M. Hossein Nowroozzadeh

    Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Published Date

  • Jul 18, 2019
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Water-drinking Test and Pharmacologic Mydriasis as Provocative Tests in Primary Angle Closure Suspects

Journal of Ophthalmic and Vision Research (JOVR) / July–September 2019, Volume 14, Issue 3 / Pages 267–274

Abstract

Purpose: To compare the water-drinking test (WDT) and pharmacologic mydriasis as provocative tests in patients with primary angle closure suspect (PACS).


Methods: This observational non-randomized comparative study evaluated changes in intraocular pressure (IOP) in 21 patients with PACS who underwent pharmacologic mydriasis and compared it with IOP changes in 26 patients given the WDT. Ocular biometric and anterior chamber parameters were also assessed. Tests were repeated on the same patient two weeks after performing laser peripheral iridotomy (LPI).


Results: The mean age ± standard deviation was 60 ± 7 and 57 ± 9 years in the mydriasis and WDT groups, respectively (P = 0.201). Before LPI, both provocative tests were associated with a significant increase in IOP (mydriasis: 15.1 ± 3.1 to 16.6 ± 3.5 mmHg, P = 0.025; WDT: 16.2 ± 2.8 to 18.5 ± 3.3 mmHg, P < 0.001). However, the IOP changes were not statistically different between groups (P = 0.102). After LPI, only the WDT group showed a continued significant IOP elevation after the test (mydriasis: 16.4 ± 3.3 to 16.7 ± 3.5 mmHg, P = 0.569; WDT: 14.9 ± 3.0 to 17.8 ± 4.1 mmHg, P < 0.001). The post-test IOP change was significantly greater in the WDT than in the mydriasis group (3.0 versus 0.3 mmHg, respectively; P = 0.002). Step-wise multiple regression analysis verified the type of provocative test as the only independent factor affecting the post-test IOP change after LPI (regression coefficient: 2.664; P = 0.002).


Conclusion: Pharmacologic mydriasis and the WDT had similar IOP elevation before LPI, but after LPI, IOP elevation was much greater in the WDT group.

Keywords:

Intraocular Pressure; Pharmacologic Mydriasis; Primary Angle Closure Suspect; Water-drinking Test

References
1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol
2006;90:262–267.

2. Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, et al. The prevalence of glaucoma in Chinese residents of Singapore: A cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol
2000;118:1105–1111.

3. Quigley HA. Glaucoma. Lancet 2011;377:1367–1377.

4. Sihota R. Classification of primary angle closure disease. Curr Opin Ophthalmol 2011;22:87–95.

5. Tornquist R. Dark-room test on eyes with a shallow anterior chamber. Acta Ophthalmol (Copenh) 1958;36:664–671.

6. Kondo T, Miyazawa D, Unigame K, Kurimoto Y. Ultrasound biomicroscopic findings in humans with shallow anterior chamber and increased intraocular pressure after the prone provocation test. Am J Ophthalmol 1997;124:632–640.

7. Wilensky JT, Kaufman PL, Frohlichstein D, Gieser DK, Kass MA, Ritch R, et al. Follow-up of angle-closure glaucoma suspects. Am J Ophthalmol 1993;115:338–346.

8. Arora KS, Jefferys JL, Maul EA, Quigley HA. Choroidal thickness change after water drinking is greater in angle
closure than in open angle eyes. Invest Ophthalmol Vis sci 2012;53:6393–6402.

9. De Moraes CG, Reis AS, Cavalcante AF, Sano ME, Susanna R Jr. Choroidal expansion during the water drinking test. Graefes Arch Clin Exp Ophthalmol 2009;247:385–389.

10. Quigley HA. What’s the choroid got to do with angle closure? Arch Ophthalmol 2009;127:693–694.

11. Quigley HA. Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol 2009;148:657–669.

12. Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018;63:754–768.

13. Leydhecker W. The water-drinking test. Br J Ophthalmol 1950;34:457–479.

14. Leighton DA, Phillips CI, Gibbs AC. Provocative outflow test. Combining water drinking and homatropine. Br J
Ophthalmol 1970;54:19–26.

15. Kumar RS, de Guzman MH, Ong PY, Goldberg I. Does peak intraocular pressure measured by water drinking
test reflect peak circadian levels? A pilot study. Clin Exp Ophthalmol 2008;36:312–315.

16. Vasconcelos-Moraes CG, Susanna R Jr. Correlation between the water drinking test and modified diurnal
tension curve in untreated glaucomatous eyes. Clinics (Sao Paulo) 2008;63:433–436.

17. Esmaeili A, Barazandeh B, Ahmadi S, Haghi A, Ahmadi Hosseini SM, Abolbashari F. Assessment of the anterior
chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy. Int J
Ophthalmol 2013;6:680–684.

18. Sihota R, Rishi K, Srinivasan G, Gupta V, Dada T, Singh K. Functional evaluation of an iridotomy in primary
angle closure eyes. Graefes Arch Clin Exp Ophthalmol 2016;254:1141–1149.

19. Waisbourd M, Savant SV, Sun Y, Martinez P, Myers JS. Water-drinking test in primary angle-closure suspect
before and after laser peripheral iridotomy. Clin Exp Ophthalmol 2016;44:89–94.

20. Karmon G, Vender T, Savir H. Evaluation of laser iridectomy in angle-closure glaucoma: provocative tests. Br J
Ophthalmol 1982;66:471–473.

21. Danesh-Meyer HV, Papchenko T, Tan YW, Gamble GD. Medically controlled glaucoma patients show greater
increase in intraocular pressure than surgically controlled patients with the water drinking test. Ophthalmology
2008;115:1566–1570.

22. Medeiros FA, Pinheiro A, Moura FC, Leal BC, Susanna R Jr. Intraocular pressure fluctuations in medical versus surgically treated glaucomatous patients. J Ocul Pharmacol Ther 2002;18:489–498.

23. Venugopal N. Water drinking test and angle closure glaucoma. Indian J Ophthalmol 2015;63:172.

24. Razeghinejad MR, Lashkarizadeh H, Nowroozzadeh MH, Yazdanmehr M. Changes in ocular biometry and anterior chamber parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects. J Optom 2016;9:189–195.

25. Poon YC, Teng MC, Lin PW, Tsai JC, Lai IC. Intraocular pressure fluctuation after water drinking test in primary
angle-closure glaucoma and primary open-angle glaucoma. Indian J Ophthalmol 2016;64:919–923.

26. Nongpiur ME, Foo VH, de Leon JM, Baskaran M, Tun TA, Husain R, et al. Evaluation of choroidal thickness,
intraocular pressure, and serum osmolality after the water drinking test in eyes with primary angle closure. Invest Ophthalmol Vis Sci 2015;56:2135–2143.

27. Yamada R, Hirose F, Matsuki T, Kameda T, Kurimoto Y. Comparison of mydriatic provocative and dark room prone provocative tests for anterior chamber angle configuration. J Glaucoma 2016;25:482–486.

28. Wang N, Wu H, Fan Z. Primary angle closure glaucoma in Chinese and Western populations. Chin Med J (Engl)
2002;115:1706–1715.

29. Yeung BY, Ng PW, Chiu TY, Tsang CW, Li FC, Chi CC, et al. Prevalence and mechanism of appositional angle closure in acute primary angle closure after iridotomy. Clin Exp Ophthalmol 2005;33:478–482.

30. Wolfs RC, Grobbee DE, Hofman A, de Jong PT. Risk of acute angle-closure glaucoma after diagnostic mydriasis
in nonselected subjects: the Rotterdam Study. Invest Ophthalmol Vis Sci 1997;38:2683–2687.
31. Patel KH, Javitt JC, Tielsch JM, Street DA, Katz J, Quigley HA, et al. Incidence of acute angle-closure glaucoma after pharmacologic mydriasis. Am J Ophthalmol 1995;120:709–717.

32. Sheth HG, Goel R, Jain S. UK national survey of prophylactic YAG iridotomy. Eye (Lond) 2005;19:981–984.