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Assessing the value of the water drinking test in glaucoma—a systematic review and meta-analysis

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Abstract

This systematic review and meta-analysis examines the relationship between intraocular pressure (IOP) parameters derived from the water drinking test (WDT) and diurnal IOP monitoring, and evaluates the reproducibility of the WDT and its association with future glaucomatous visual field (VF) loss. A literature search was performed on PubMed, EMBASE, and Cochrane Library from inception to 31 March 2023. Cohort, cross-sectional and observational studies reporting WDT results in glaucoma patients were included. Meta analysis with random-effect model was performed using “metafor” package in R version 3.2.1. 641 studies were identified on initial literature search. 38 studies (2479 subjects) were included in final analysis. Meta-analytic estimates of 5 studies (310 subjects) found strong positive correlation in peak IOP between the WDT and diurnal IOP monitoring (r = 0.92, 95% CI = 0.75, 1.08, p < 0.0001). However, there was only weak positive correlation for IOP fluctuation between both methods (r = 0.26, 95% CI = 0.06,0.47, p < 0.0001). Meta-analytic estimates of 3 studies (189 subjects) suggested a trend of the diurnal peak IOP being lower than that derived from the WDT (MD = −2.37 mmHg, 95% Limit of Agreement (LOA) =−5.58,0.84, p = 0.147). Two studies found that a higher WDT peak IOP was associated with greater future VF progression. Two studies demonstrated good reproducibility in peak IOP measurements for WDTs conducted across different days. In conclusion, there was a strong positive correlation between IOP peak measurements from the WDT and diurnal IOP monitoring in glaucoma patients. The WDT peak IOP demonstrated good reproducibility and may be associated with greater future VF progression.

摘要

本系统综述和荟萃分析了饮水实验 (WDT) 和昼夜眼内压 (IOP) 参数之间的关系, 并且评估了饮水实验的可重复性及其与未来青光眼视野 (VF) 缺损的联系。我们对截止至2023年3月31日, 在PubMed、EMBASE和Cochrane等数据库进行了文献检索。研究纳入了报告青光眼患者WDT结果的队列、横断面和观察性研究。使用R版本3.2.1中的“meta for”软件包进行随机效应模型的荟萃分析。初步文献检索共641项研究。研究最终纳入了38项研究 (2479例受试者) 。5项研究 (310例受试者) 的荟萃分析发现, WDT和昼夜IOP监测之间的峰值IOP存在很强的正相关性 (r = 0.92, 95%CI = 0.75, 1.08, p < 0.0001) 。然而, 两种方法测量的眼压波动仅呈微弱的正相关 (r = 0.26, 95% CI = 0.06, 0.47, p < 0.0001) 。3项研究 (189例受试者) 的Meta分析表明, 昼夜峰值IOP有低于WDT得出的值的趋势 (MD = −2.37 mmHg, 95%一致性限值 (LOA) =−5.58, 0.84, p = 0.147) 。两项研究发现, 更高的WDT峰值IOP与更严重的未来视野缺损进展有关。两项研究证明, 在不同日期进行的WDT的峰值IOP 测量具有良好的可重复性。总之, 在青光眼患者中, WDT的IOP峰值测量值与昼夜IOP监测值之间存在强正相关性。WDT峰值IOP表现出良好的重现性, 可能与未来更大的VF进展相关。

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Fig. 1
Fig. 2: Forest Plot for correlation of IOP peaks of the WDT and Diurnal IOP curve.
Fig. 3
Fig. 4

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Eric Jin, Claire Xin Yi Goh & Bjorn Kaijun Betzler

  2. Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    Bjorn Kaijun Betzler

  3. Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore

    Choon Pooh Heng

  4. Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore

    Bryan Chin Hou Ang

  5. Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, Singapore, Singapore

    Bryan Chin Hou Ang

  6. Mayo Clinic, Department of Ophthalmology, Jacksonville, FL, USA

    Bryan Chin Hou Ang

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Methodology, article search and screenings were done by EJ and CXYG. Data Analysis was done by EJ and CPH. Writing of the paper was done by EJ, CXYG and BKB. Review of the manuscript was done by BKB and BCHA.

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Jin, E., Goh, C.X.Y., Betzler, B.K. et al. Assessing the value of the water drinking test in glaucoma—a systematic review and meta-analysis. Eye (2024). https://doi.org/10.1038/s41433-024-03107-z

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  • DOI: https://doi.org/10.1038/s41433-024-03107-z

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