Could White Coat Ocular Hypertension Affect to the Accuracy of the Diagnosis of Glaucoma? Relationships Between Anxiety and Intraocular Pressure in a Simulated Clinical Setting

Sixty-one healthy subjects participated in a laboratory study carried out in a simulated clinical setting. Anticipatory anxiety-state was assessed at the arrival and immediately after, with no brief phase of adaptation, measurements of intraocular pressure, heart rate, systolic and diastolic blood pressure were collected. At the end of the procedure, anxiety-trait was also assessed. Results suggest that high levels of both anxiety-state and anxiety-trait significantly predicted a clinically relevant increase of intraocular pressure. Anxiety-state mediated the relationship between anxiety-trait and intraocular pressure, which also was found to be related with heart rate but not related to both systolic and diastolic blood pressure. These results suggest a common mechanism of regulation underlying anxiogenic variability found on both intraocular pressure and heart rate. A reduction in parasympathetic activity appears as a possible mechanism underlying to this phenomenon. This anxiety-enhanced intraocular pressure could be considered a phenomenon analogous to white coat hypertension found in the measurement of blood pressure; therefore, it probably should be taken into account in the clinical context to prevent errors in the diagnosis of glaucoma. Further research on cognitive and emotional regulation of intraocular pressure is needed to best characterize this hypothetical phenomenon.