Topical Corticosteroid in Normal Patients and Glaucoma Suspects R. Levene, MD; A. Wigdor, MD; A.
Edelstein, MD; and J. Baum, MD, New York
Several normal and glaucoma suspect populations were studied during four weeks of topical 0.1% dexamethasone prescribed four times daily in either one or both eyes. The difference in tension before and after steroid (\g=D\Ta) is independent of the initial tension. In 24 glaucoma suspects there was a 79% response (\g=D\ Ta xxx 6 mm Hg) and in 75 normal white patients there was a 60% response. The difference between these two groups is not significant. There was a lesser response in Negroes than in whites. An important uncontrolled factor was patient motivation in using the drops as prescribed. We suggest that the steroid hypertensive response is a genetic marker that relates to normal and glaucoma patients in a similar manner.
examinations, Bellevue private patients.
eye
clinic patients, and
The ocular status was either normal or glau¬ suspect with an arbitrary upper limit of 20 mm Hg for normals. There was no sig¬ nificant ocular disease, cupping, field loss, treatment or known family history of glauco¬ ma. Table 1 summarizes the study populations. All patients were given a complete baseline ocular exam, except that tonography was not performed on the hospital employees. All base¬ line and subsequent Goldmann applanation tensions were done at the same time of day for coma
a
given patient.
lHE REVERSIBLE elevation of intra¬ ocular pressure by corticosteroid has been demonstrated by Armaly15 and Becker.68 The steroid response is reported to be great¬ er in primary open angle glaucoma patients, family members, and glaucoma suspects than in normals. On this basis Becker8 has proposed a relationship between the magni¬ tude of the steroid response and primary open angle glaucoma, and has more recently suggested a relationship between this mag¬ nitude and diabetic retinopathy.9 This in¬ vestigation is a further study of the intra¬ ocular pressure response.
Patients were placed on a regimen of 0.1% dexamethasone sodium phosphate, one drop four times a day in either the right eye or both eyes and were examined after two and four weeks; some again after six weeks. Treatment with steroids was discontinued before four weeks if either the tension rise was greater than 15 mm Hg or the absolute tension greater than 34 mm Hg. On each return visit patients were carefully questioned about their use of the drops. Most patients admitted that they had occasionally missed a drop. Those who admitted having missed more than an occasional drop were not included in the study. For statistical analysis the Kolmogrov-Smirnov test was used for deviations from a single Gaussian distribution. Chi-square tested the significance between different frequencies of re¬ sponse. The Student's "t" test compared means.
Method
Results
patients were Universi¬ ty Hospital employees wanting free glaucoma
Comparison between eyes of patients tak¬ ing drops in both eyes determines the rela¬ tionship of the final tension after steroid to
The three
sources
of
Submitted for publication Aug 4, 1966. From the Department of Ophthalmology, New York University Medical Center, New York. Dr. Wigdor is a postdoctoral fellow at the US Public Health Service. Reprint requests to 560 First Ave, New York 10016 (Dr. Levene).
the initial tension. This method eliminates the variable of different levels of response between patients. Figure 1 demonstrates that the right minus left tension difference before steroid is equal to that after steroid
(regression slope of 1). By transposition,
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Table
1.—Study Populations Initial Tension
No.
Source
Ocular
of
White*
Men
Type
Patients
(%)
(%)
Age
OD
S40 (%)
Eye for Steroid
44
OD
36
OD
Normal
99
76
40
suspect
11
73
55
95
0D
100
OU
Mean
+
SD
(Range)
Initial Facility OD Mean + SD
(Range)
1f'7, *^;1
Hospital_(11—20) 23.0 ± 1.1 Glaucoma
employees Bellevue
Normal
19
10Q
U
eye
Glaucoma
41
85
32
C
Private
(21-25)
suspect Glaucoma
24
92
33
96
OU 19 OD 5
suspect
15·8 ± 2.7
0.24 ± 0.06
(10-19)
(0.13-0.38)
21.3 ± 3.6
0.19 ± 0.08
(18-27)
(0.05-0.42)
22.3 ± 2.8
0.22 ± 0.06
(18—26)
(0.15 0.42) —
*
Includes
one
to three Puerto Ricans in most groups; remainder
are
Negro.
Fig 1.—Effect of four weeks of bilateral topical dexamethasone on the tension differences between eyes of 56 glaucoma suspects.
the tension difference in a given eye before and after steroid ( Ta) is equal to that in the fellow eye. Be¬ cause the initial tensions of the two eyes are not equal, Ta is independent of the initial tension for a maxi¬ mum initial difference of 7 mm Hg. However, the fi¬ nal tensions are dependent on the initial tensions. We have adopted the Armaly3 notation of tension differ¬ ences for expressing the steroid results: Ta < 6 mm Hg is a low responder, 6 is an intermedi¬ Ta ate or high responder, Ta > 15 is a high responder. Figure 2 illustrates the cumulative and noncumula¬
CORRELATION COEFFICIENT =0.63
(p
