Intraocular pressure (IOP) varies with body position, with a significant increase occurring
from the seated to the supine position. Previous research has indicated that the IOP
increase cannot be explained by changes in episcleral venous pressure(blood flow leading
away from the eye) alone. As well, previous research has indicated that aqueous flow rate is
independent of body position. The purpose of this project was to determine if aqueous humor
outflow facility varied with changes in posture.
On the day of the experiment, patients will be asked to maintain a regular schedule and
normal activities. This will include avoiding excess caffeine intake, large deviations from
normal sleep cycle, or exposure to pharmacologic IOP modifying agents.
Subjects will be seated in standard ophthalmologic examining chairs and reclined into the
supine position in a quiet room with subdued lighting for approximately 5 minutes.
Anesthesia will be achieved by instilling 3-4 drops of 0.5% proparacaine. The contralateral
eye will be patched in an air-tight fashion with an adhesive eye patch to reduce evaporative
losses and drying of the cornea. The patient will be asked to keep eyes closed prior to
start of measurements. When ready, the patient will be asked to open their eyes and to
observe a dim fixation target that will be placed on the ceiling of the room, roughly 6 feet
from the patient's eyes. Baseline IOP (Po) will be measured using a pneumatonometer (Model
30 Classic Mentor). Tonography will then be performed using the electronic Schiotz
tonometer with a 10g weight in order to obtain a four minute tracing. The procedure will
then be repeated on the contralateral eye, with patching of the already tested eye. After
this, the patient's chair will the be raised 70 degrees and patient will be asked to
hyperextend their neck until their cornea is parallel to the floor. A minimum of 30 minutes
will be allowed to elapse, allowing for autonomic, postural and hormonal changes to
stabilize. Then a repeat baseline IOP for the sitting position will be taken and another 4
minute tracing will be collected successively in each eye as described above.
Data from the tonometer tracing will be collected electronically and will be exported to a
standard Excel file. A smooth curve of best fit will be established through each tonogram
once graphed, correcting for oscillations and drift. This curve will help determine the
adequacy of the collected sample. Tracings that have a poorly fitted curve might occur for
a variety of reasons including patient tenseness and anxiety, uncontrollable tendency to
fall asleep and incidental interruptions such as a sudden wave of intestinal peristalsis.
Corresponding "Po" values for the initial steady-state IOP and the "C" value for facility of
aqueous outflow will be gathered by referring to standard tables and normograms.
The main potential risk of participating in the study is the possibility of corneal
abrasion. Previous studies at the Mayo Clinic using the same techniques did not result in
any corneal abrasions in over 300 eyes of more than 150 patients. Based on this result, we
estimate the risk of a corneal abrasion to be minimal. If a corneal abrasion occurs, the
patient will be removed from the study. The patient will be treated with antibiotic drops or
ointment and followed until the abrasion has completely healed.
Other minor risks include possible allergic reaction to the anesthetic drops or the adhesive
glue. As with any medication, allergic reactions are a possibility. However, these will be
the same drops used in routine clinical practice, and allergic reaction is extremely
- Healthy, aged 18-45.
- Subjects will be given a complete dilated eye exam and an updated medical history
will be performed
- IOP greater than 22mmHg
- Evidence of glaucomatous optic neuropathy
- Poor fixation
- Recent infection
- Corneal scarring preventing reliable tonometry
- Evidence of pigment dispersion
- Narrow angles
- History of trauma or surgery
- Systemic use of beta blockers or steroids
- Diabetic eye disease, uveitis, high (>6D) myopia or high(>4D) hyperopia.
- Patients with chronic medical conditions(eg: hypertension) will be allowed to
participate as long as their medical condition has been under good control over the
preceding 12 months.
- Subjects will also need to have good cervical neck malleability and be able to meet
the physical needs of the protocol which call for 4 minutes of neck extension.