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Original article
Day-to-day variability in intraocular pressure in glaucoma and ocular hypertension
  1. Alan P Rotchford1,
  2. Samreen Uppal2,
  3. Arun Lakshmanan2,
  4. Anthony J King2
  1. 1Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, UK
  2. 2Department of Ophthalmology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
  1. Correspondence to Dr Alan P Rotchford, Tennent Institute of Ophthalmology, Gartnavel Hospital, Great Western Road, Glasgow G12 0YN, UK; rotchford{at}


Aims To investigate the day-to-day repeatability of intraocular pressure (IOP) measurements.

Methods A prospective cohort study of untreated patients presenting with primary open-angle glaucoma or ocular hypertension presenting with IOP>21 mm Hg. IOP was measured by masked Goldmann tonometry at 08:00, 11:00 and 16:00 at each of the three weekly visits. After starting travaprost (0.004%) to both eyes, the measurements were repeated for a further three weekly visits. Day-to-day repeatability was estimated before and after commencing medication and reported as the coefficient of repeatability and coefficient of variability.

Results At the 8:00 time point, mean IOPs were 26.1 and 17.9 mm Hg in the eye with higher pressure before and after starting treatment, respectively. Coefficient of repeatability and coefficient of variability were 6.8 mm Hg and 10.0%, respectively, before treatment, and 4.6 mm Hg and 10.5% on treatment. Therefore, before treatment and after starting medication the IOP lay within a range of ±20% of the mean IOP with 95% confidence.

Conclusions The non-therapeutic variability from day to day significantly undermines the precision of IOP estimation and of the estimation of medication effectiveness even when the time of day is standardised in patients with primary open-angle glaucoma/ocular hypertension.

  • Glaucoma
  • intraocular pressure
  • measurement error
  • intraobserver variability
  • diurnal rhythm
  • treatment medical
  • epidemiology
  • clinical trial
  • treatment surgery

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  • Funding AJK has received support from Alcon to travel to scientific meetings and is a member of an Alcon advisory board.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Nottingham Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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