J Korean Ophthalmol Soc.  2015 Jan;56(1):70-79. 10.3341/jkos.2015.56.1.70.

The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression

• Kim NY
• Seo HR
• Rho SH

• KMID: 2216156
• DOI: http://doi.org/10.3341/jkos.2015.56.1.70

Abstract

PURPOSE
To investigate the effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure.
METHODS
30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glaucoma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects.
RESULTS
The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger temperature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients.
CONCLUSIONS
When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma.

Keyword

Autonomic dysregulation; Hand cold provocation test; Nocturnal dip; Vascular dysregulation

MeSH Terms

Blood Pressure Monitoring, Ambulatory
Diagnosis
Fingers*
Glaucoma*
Glaucoma, Open-Angle
Hand
Humans
Immersion
Intraocular Pressure
Logistic Models
Low Tension Glaucoma
Retrospective Studies
Visual Fields
Water
Water

Figure

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  Figure 1. (A) TONOPORT V.™, (B) 24 hrsambulatory blood pressure monitoring performed.

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  Figure 2. Hand Cold Provocation Tester (Rose HCPT™). (A) Rose HCPT™, (B) hand cold provocation test performed, (C) information about date, time and temperature is displayed on screen, (D) temperature date printed every 20 second (preset time).

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  Figure 3. Ear Thermometer (Anytem™ MS Tec-Vision, Korea).

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  Figure 4. The measurement process of hand cold provocation test. (A) Sensor of finger thermometer placed at proximal portion of middle finger, (B) baseline finger temperature is measured for about 5 minutes, (C) immersion process for 5 minutes in 10℃ cold water, (D) after immersion process, finger temperature recovery for 20 minutes.

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  Figure 5. ROC curve of finger temperature recovery rate in normal controls. Cut off value of delayed recovery rate of finger temperature: over 15%, sensitivity: 0.667, AUC: 0.732. ROC = receiver operating characteristic; AUC = area under the ROC curve.

Reference

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