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Tip of the Month
Tip of the month - Use corneal hysteresis to identify high-risk glaucoma patients
Use corneal hysteresis to identify high-risk glaucoma patients

Publishing date: March 2023

Identifying those patients at greater risk of disease progression is a key step in glaucoma management algorithms. Several variables have been identified as risk factors, such as intraocular pressure, age, cup-disc ratio, disc hemorrhages and corneal thickness (1). Biomechanical properties of the cornea may also play a role in glaucoma pathophysiology.

Corneal hysteresis (CH) is a tissue viscosity measurement available with a commercially available device. CH is lowered in glaucoma patients, in both high- and normal-tension disease. A low CH is a strong predictor of visual field progression in open-angle glaucoma patients, although a causal relationship is yet to be determined (2,3). Thus, CH measurement may be a helpful tool in identifying patients at a higher risk of progression and disability (4).

Contributor: Rafael Correia Barão MD - Hospital Santa Maria, CHULN, Lisbon, Portugal


1) Rivera JL, Bell NP, Feldman RM. Risk factors for primary open angle glaucoma progression: What we know and what we need to know. Curr Opin Ophthalmol. 2008;19(2):102-106. doi:10.1097/ICU.0b013e3282f493b3

2) Medeiros FA, Meira-Freitas D, Lisboa R, Kuang TM, Zangwill LM, Weinreb RN. Corneal hysteresis as a risk factor for glaucoma progression: A prospective longitudinal study. Ophthalmology. 2013;120(8):1533-1540. doi:10.1016/j.ophtha.2013.01.032

3) Susanna BN, Ogata NG, Jammal AA, Susanna CN, Berchuck SI, Medeiros FA. Corneal Biomechanics and Visual Field Progression in Eyes with Seemingly Well-Controlled Intraocular Pressure. Ophthalmology. 2019;126(12):1640-1646. doi:10.1016/j.ophtha.2019.07.023

4) Sit AJ, Chen TC, Takusagawa HL, et al. Corneal Hysteresis for the Diagnosis of Glaucoma and Assessment of Progression Risk: A Report by the American Academy of Ophthalmology. Ophthalmology. Published online 2022:1-10. doi:10.1016/j.ophtha.2022.11.009

Tip of the Month manager: Frances Meier-Gibbons
Tip of the Month editorial board: Francisco Goni, Karl Mercieca, Humma Shahid
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone

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