Association between genetic polymorphisms of adrenergic receptor and diurnal intraocular pressure in Japanese normal-tension glaucoma

Using 24-hr ocular dimensional profile recorded with a sensing contact lens to identify primary open-angle glaucoma patients with intraocular pressure constantly below the diagnostic threshold

PURPOSE

To evaluate the use of a 24-hr ocular dimensional profile recorded with a contact lens sensor (CLS) combined with a single tonometric intraocular pressure (IOP) reading to indicate the potential for exceeding the diagnostic threshold for normal tension glaucoma (NTG) in Japanese patients.

METHODS

Intraocular pressure (IOP) of untreated Japanese NTG patients was measured with tonometry every 3 hr from 9:00 to 24:00. The subsequent day a 24-hr CLS (SENSIMED Triggerfish, Sensimed AG, Lausanne, Switzerland) profile was recorded on the same eye. Patients initially diagnosed as NTG were reclassified as NTG when the measured IOP values were consistently <20 mmHg or as primary open-angle glaucoma (POAG) when IOP was ≥20 mmHg in at least 1 measurement. For each patient and each IOP time-point, IOP values were combined with information provided by the CLS profile ('classifier') to indicate the potential for exceeding the diagnostic threshold value. Statistical analyses were performed for each classifier.

RESULTS

A total of 65 patients, 28 males and 37 females (mean ages: 50.8 ± 14.6 years and 52.6 ± 10.2 years, respectively), were analysed. Following IOP diurnal measurement, five patients (7.7%) were reclassified as POAG. Two classifiers (15:00 CLS and 18:00 CLS) showed high sensitivity and negative predictive value (100%), identifying all the POAG patients.

CONCLUSION

Contact lens sensor information can be used in conjunction with a single tonometric reading to determine patients' potential of having IOP levels exceeding the diagnostic threshold within a 24-hr period, without the need to perform a 24-hr tonometric curve. This would allow clinicians to identify POAG patients who may otherwise be eventually misclassified as NTG.

Association between Genetic Polymorphisms of the Beta Adrenergic Receptor and Diurnal Intraocular Pressure in Chinese Volunteers and Glaucoma Patients

PURPOSE

To evaluate the relationship between genetic polymorphisms of the beta adrenergic receptor (ADR) and diurnal intraocular pressure (IOP) in Chinese healthy volunteers, normal tension glaucoma (NTG) patients, and primary open-angle glaucoma (POAG) patients.

METHODS

Fifty healthy volunteers (control group), 55 untreated NTG patients, and 55 untreated POAG patients were recruited. IOP of both eyes was measured at 3-hour intervals from 0600 to 2400 hours. For control group, IOP data from the eye with better mean deviation (MD) of visual field was used for statistical analysis. For glaucoma patients, IOP data from the eye with a greater visual field defect was used for statistical analysis. Genetic polymorphisms of ADR were determined by direct DNA sequencing. The relationship between IOP and genetic polymorphisms was statistically analyzed.

RESULTS

R16G (A/G), L84L (G/A), and R175R (C/A) in β2-ADR showed significantly different allele in the three groups (p = 0.005, p = 0.045, and p = 0.045, respectively). For the POAG group, C/C of R389G (C/G) in β1-ADR had a significantly lower diurnal mean IOP (p < 0.001), peak IOP (p = 0.010), trough IOP (p < 0.001), and larger IOP range (p = 0.047) than G carriers; C/C of R389G (C/G) in β1-ADR and G carriers had parallel diurnal IOP curves but significantly different diurnal IOP levels (p = 0.001); C/C of Q27E (C/G) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.045) than G carriers; G/G of L84L (G/A) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.044) than A carriers; C/C of R175R (C/A) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.044) than A carriers; T/T of W64R (T/C) in β3-ADR had a significantly smaller IOP range (p = 0.001) than C carriers.

CONCLUSION

Certain polymorphisms of β2-ADR showed significantly different genotype frequencies in healthy volunteers untreated NTG patients, and POAG patients. Polymorphisms of the β-ADR gene may alter the untreated IOP level of POAG patients.