Sleeping position influences glaucoma visual loss

Researchers from South Korea suggest that patients with glaucoma should avoid sleeping on one side, after showing that it may be associated with greater visual field (VF) loss in the lower-positioned eye.

The research team, led by Ki Ho Park (Seoul National University Hospital), says the findings are likely due to the effects of intraocular pressure (IOP), which increases in the supine position, especially in patients with glaucoma. Previous studies have shown that sleeping in a sideways, or lateral decubitus, position consistently leads to greater IOP in the lower-positioned eye.

Park et al studied 692 patients with primary open-angle glaucoma aged a mean of 60.6 years, of whom 510 had normal-tension glaucoma and 182 had high-tension glaucoma.

The team identified 430 (62.1%) patients with asymmetric VF loss (defined as mean deviation ≥2 dB between eyes), at a mean of –11.3 dB in the worse eye and –4.8 dB in the better eye. The mean baseline IOP was also significantly different between the worse and better eye, at 16.7 mmHg and 16.0 mmHg, respectively.

Among patients with asymmetric VF loss, 132 (30.7%) said that they preferred to sleep on their side. And among these patients, significantly more – 89 (67.4%) – preferred to sleep on the worse-eye-dependent side than preferred to sleep on the better-eye-dependent side.

Writing in the American Journal of Ophthalmology, Park and colleagues say that their findings could explain why VF loss continues to progress in glaucoma patients despite well-controlled IOP in the sitting position.

They say that the “results of the present study strongly suggest that the sleep position habitually preferred by [open-angle glaucoma] patients may be associated with greater VF loss.”

The team concludes: “In order to confirm our speculation, a prospective, long-term follow-up study will be necessary.”

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