Short-Term Repeatability of Diurnal Intraocular Pressure Patterns in Glaucomatous Individuals

doi:10.1016/j.ophtha.2010.04.027

Ophthalmology

Volume 118, Issue 1, January 2011, Pages 47-51

https://doi.org/10.1016/j.ophtha.2010.04.027 Get rights and content

Purpose

To evaluate the short-term repeatability of diurnal intraocular pressure (IOP) patterns in eyes with primary open-angle glaucoma (POAG).

Design

Observational cohort study.

Participants

Forty-seven subjects with treated POAG.

Methods

Subjects underwent assessment of IOP using Goldmann tonometry every 2 hours from 0800 to 2000 on 2 visits 1 week apart. Intervisit agreement of IOP by time point and of IOP change between time points was assessed using intraclass correlation coefficients (ICCs).

Main Outcome Measures

Diurnal IOP patterns.

Results

Between-visit agreement of IOP values at each time point was generally fair to good, with ICCs ranging from 0.45 to 0.71 in right eyes and from 0.51 to 0.71 in left eyes. Between-visit agreement of IOP change over time periods between time points was uniformly poor, with ICCs ranging from −0.08 to 0.38 in right eyes and from −0.11 to 0.36 in left eyes.

Conclusions

Treated POAG patients do not manifest a repeatable diurnal IOP pattern from day to day when measured by Goldmann tonometry. Measurement of single-day IOP variation poorly characterized short-term IOP variation.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Methods

This prospective study was approved by the West Virginia University institutional review board and was conducted in compliance with the tenets of the Declaration of Helsinki and the Health Insurance Portability and Accountability Act. All participating subjects provided written informed consent. Subjects were recruited between April 3, 2006, and April 16, 2007, were ≥18 years old, and had POAG. All participants had open angles, glaucomatous optic discs (excavation, diffuse or focal thinning or

Results

Overall, 47 subjects with POAG were included in this analysis. Demographics and medication use of subjects are given in Table 1. Subjects were predominantly Caucasian (43/47; 91.5%), 63.8% (30/47) were female, and their mean age was 66.3±12.4 years; most (43/47, 91.5%) were on ≥1 topical IOP-lowering medication.

Mean IOP values by eye, time point and visit are given in Table 2. The IOP tended to be lower at visit 2 than visit 1, and this difference reached significance at 1000 and 1200 in right

Discussion

Intraocular pressure does not follow a repeatable diurnal pattern in treated glaucoma patients. This finding is consistent with a prior report, but in conflict with another. Notably, both of these earlier studies used devices other than Goldmann applanation tonometry, the clinical standard for glaucoma research.6, 7 This is the first report of which we are aware to evaluate the repeatability of diurnal IOP patterns in subjects with POAG using Goldmann tonometry.

It is reasonable to question

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Cited by (74)

IOP and glaucoma damage: The essential role of optic nerve head and retinal mechanosensors
2024, Progress in Retinal and Eye Research
There are many unanswered questions on the relation of intraocular pressure to glaucoma development and progression. IOP itself cannot be distilled to a single, unifying value, because IOP level varies over time, differs depending on ocular location, and can be affected by method of measurement. Ultimately, IOP level creates mechanical strain that affects axonal function at the optic nerve head which causes local extracellular matrix remodeling and retinal ganglion cell death – hallmarks of glaucoma and the cause of glaucomatous vision loss. Extracellular tissue strain at the ONH and lamina cribrosa is regionally variable and differs in magnitude and location between healthy and glaucomatous eyes. The ultimate targets of IOP-induced tissue strain in glaucoma are retinal ganglion cell axons at the optic nerve head and the cells that support axonal function (astrocytes, the neurovascular unit, microglia, and fibroblasts). These cells sense tissue strain through a series of signals that originate at the cell membrane and alter cytoskeletal organization, migration, differentiation, gene transcription, and proliferation. The proteins that translate mechanical stimuli into molecular signals act as band-pass filters – sensing some stimuli while ignoring others – and cellular responses to stimuli can differ based on cell type and differentiation state. Therefore, to fully understand the IOP signals that are relevant to glaucoma, it is necessary to understand the ultimate cellular targets of IOP-induced mechanical stimuli and their ability to sense, ignore, and translate these signals into cellular actions.
Relationship between Intraocular Pressure Fluctuation and Visual Field Progression Rates in the United Kingdom Glaucoma Treatment Study
2024, Ophthalmology
To investigate whether intraocular pressure (IOP) fluctuation is associated independently with the rate of visual field (VF) progression in the United Kingdom Glaucoma Treatment Study.
Randomized, double-masked, placebo-controlled multicenter trial.
Participants with ≥5 VFs (213 placebo, 217 treatment).
Associations between IOP metrics and VF progression rates (mean deviation [MD] and five fastest locations) were assessed with linear mixed models. Fluctuation variables were mean Pascal ocular pulse amplitude (OPA), standard deviation (SD) of diurnal Goldmann IOP (diurnal fluctuation), and SD of Goldmann IOP at all visits (long-term fluctuation). Fluctuation values were normalized for mean IOP to make them independent from the mean IOP. Correlated nonfluctuation IOP metrics (baseline, peak, mean, supine, and peak phasing IOP) were combined with principal component analysis, and principal component 1 (PC1) was included as a covariate. Interactions between covariates and time from baseline modeled the effect of the variables on VF rates. Analyses were conducted separately in the two treatment arms.
Associations between IOP fluctuation metrics and rates of MD and the five fastest test locations.
In the placebo arm, only PC1 was associated significantly with the MD rate (estimate, –0.19 dB/year [standard error (SE), 0.04 dB/year]; P < 0.001), whereas normalized IOP fluctuation metrics were not. No variable was associated significantly with MD rates in the treatment arm. For the fastest five locations in the placebo group, PC1 (estimate, –0.58 dB/year [SE, 0.16 dB/year]; P < 0.001), central corneal thickness (estimate, 0.26 dB/year [SE, 0.10 dB/year] for 10 μm thicker; P = 0.01) and normalized OPA (estimate, –3.50 dB/year [SE, 1.04 dB/year]; P = 0.001) were associated with rates of progression; normalized diurnal and long-term IOP fluctuations were not. In the treatment group, only PC1 (estimate, –0.27 dB/year [SE, 0.12 dB/year]; P = 0.028) was associated with the rates of progression.
No evidence supports that either diurnal or long-term IOP fluctuation, as measured in clinical practice, are independent factors for glaucoma progression; other aspects of IOP, including mean IOP and peak IOP, may be more informative. Ocular pulse amplitude may be an independent factor for faster glaucoma progression.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure
2023, Ophthalmology
Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS).
Prospective, multicenter, open-label, single-arm, interventional clinical trial.
Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy).
An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors’ IOP measurements at all postoperative visits through 12 months.
Device position and adverse events.
Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], –5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was –0.2 mmHg (95% CI of LoA, –4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT.
The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring.
Proprietary or commercial disclosure may be found after the references.
Wearable electronic devices for glaucoma monitoring and therapy
2021, Materials and Design
Citation Excerpt :
The accuracy of measurements is affected by the central corneal thickness, corneal edema, excessive or insufficient fluorescein dye in the tear film, high astigmatism, irregular or scarred cornea, Valsava maneuver or excessive external pressure on the eyelid. The IOP measured with Goldmann applanation tonometry represents a single time point during office hours, and this does not reliably represent a complete view of IOP due to the variability of IOP throughout the day and among days [56]. It is known that 24-hour IOP pattern in ∼ two thirds of individuals has a nocturnal peak during sleep and gradually decreases during the day [7–9].
Glaucoma is a leading cause of irreversible blindness worldwide, which is estimated to affect approximately 112 million people by 2040. Elevated intraocular pressure (IOP) is the most important risk factor for glaucoma, as well as the primary target for the treatment. Current therapies aim at IOP reduction to prevent the disease progression. The accurate and real-time measurement of IOP is therefore critical to evaluate treatment response and guide medical decisions. However, IOP fluctuates throughout the 24-hour cycle with different patterns from day to day in the same individual and also different patterns among individuals. The current clinical practice typically captures a single IOP measurement during “in-office hours”, and this is insufficient for disease monitoring. With the development of wearable electronic devices, a variety of IOP monitoring devices provide a unique potential for continuous IOP monitoring. In addition to IOP monitoring for glaucoma management, this mini-review also summarizes novel drug delivery devices for treating glaucoma. Because certain types of glaucoma do not show elevated IOP, we also discuss the potential to incorporate biomarker detection with IOP measurement for more accurate and reliable glaucoma diagnostics and therapies.
Short-Term and Long-Term Variability of Intraocular Pressure Measured with an Intraocular Telemetry Sensor in Patients with Glaucoma
2021, Ophthalmology
To evaluate the short-term and long-term variability of intraocular pressure (IOP) in eyes with primary open-angle glaucoma.
Prospective study.
Twenty-two patients previously implanted with a sulcus-based IOP sensor (EyeMate, Implandata GmbH, Germany).
Twenty-two patients previously implanted with the EyeMate were requested to obtain at least 4 IOP measurements daily. Data were grouped according to the eye and the medication so that an eye treated with a particular medication was considered as one group, and the same eye treated with a different medication during the observation period was considered as a different group. A day was divided into 7 periods: night, midnight to 5:59 am; early, 6 am to 7:59 am; morning, 8 am to 10:59 am; noon, 11 am to 1:59 pm; afternoon, 2 pm to 5:59 pm; evening, 6 pm to 8:59 pm; and late, 9 pm to 11:59 pm. Short-term variability during a particular period was defined as the variability in IOP measurements obtained during that period on different days within 3 months of each other. Long-term variability was defined as the variability in IOP measurements obtained during a particular period on different days over a period of 1 year or more. Variability was assessed using intraclass correlation coefficients (ICCs).
The mean age of study participants was 67.8 ± 6.8 years and 36.4% were women. The mean follow-up duration of patients was 19.2 ± 21.3 months (median, 9 months; range, 1–58 months). Overall, 92 860 IOP measurements over 15 811 measurement days were obtained and analyzed during the study period. The number of measurements obtained from each eye ranged from 1 daily to 277 daily. Intraclass correlation coefficients for short-term variability among the 7 periods during the day ranged from 0.52 (morning) to 0.66 (early). Long-term ICCs ranged from 0.29 (night) to 0.51 (late).
Continual IOP monitoring showed that IOP has moderate short-term and high long-term variability in glaucoma patients. These findings demonstrate that single IOP measurements do not characterize day-to-day variations in IOP. Moreover, they show the importance of continual IOP monitoring in glaucoma patients.
Prospective randomized clinical trial on the effects of latanoprost, travoprost and bimatoprost on latanoprost non-responders
2019, Journal Francais d'Ophtalmologie
To determine whether a patient who is non-responder to latanoprost after one month of use should continue using latanoprost or switch to either bimatoprost or travoprost.
Prospective randomized clinical trial. We recruited new patients who were felt to require intraocular pressure reduction. Patients who had ≤ 20% intraocular pressure reduction after one month of latanoprost treatment were randomly assigned to another month of treatment with latanoprost or a switch to bimatoprost or travoprost for an additional month.
Overall, 83 non-responders to latanoprost after one month of treatment were included in the study. Before latanoprost treatment, the mean intraocular pressure was 23.7 ± 4.7 mmHg. At randomization on latanoprost, mean intraocular pressure was 21.5 ± 4.5 mmHg. One month after the switch of medication, the mean reduction in intraocular pressure was not significantly different between the groups (P = 0.148) and was −0.9 mmHg, −2.10 mmHg and −2.5 mmHg, for latanoprost, bimatoprost and travoprost respectively. One month after randomization, 32 (38.5%) of the patients had become responders, with IOP reduction > 20%. Of those patients, 9 (31%) were using latanoprost, 13 (41.9%) bimatoprost and 10 (43.5%) travoprost. The number of new responders was similar between the three groups (P = 0.584).
There is no added benefit of switching latanoprost to another topical prostaglandin for patients who are initially non-responders. Regression towards the mean and the Hawthorne effect are probably important factors explaining the additional IOP reduction obtained after randomization and explain the result of most switch studies.
Nous voulions vérifier si les patients qui ne répondent pas au latanoprost après un mois d’utilisation, devraient continuer le latanoprost ou changer pour le bimatoprost ou le travoprost.
Étude randomisée et prospective. On a recruté des nouveaux patients qui nécessitaient une réduction de la pression intraoculaire. Ceux qui avaient une réduction de ≤ 20 % après un mois sur latanoprost ont été randomisés à continuer le latanoprost ou changer pour le bimatoprost ou le travoprost pour un autre mois.
Nous avons recruté 83 patients qui ne répondaient pas au latanoprost. Sans traitement, la pression intraoculaire moyenne était de 23,7 ± 4,7 mmHg. Avec le latanoprost, elle était 21,5 ± 4,5 mmHg. Un mois après le changement de molécules, on notait une baisse additionnelle de 0,9 mmHg pour le latanoprost, 2,1 mmHg pour le bimatoprost et 2,5 mmHg pour le travoprost. Il n’y avait pas de différence entre les groupes (p = 0,148). Un mois après la randomisation, 32 (38,5 %) patients avaient une réponse > 20 % dont 9 (31 %) pour le latanoprost, 13 (41,9 %) pour le bimatoprost et 10 (43,5 %) pour le travoprost. Il n’y avait pas de différence entre les groupes (p = 0,584).
Nous n’avons pas trouvé de bénéfice à changer de prostaglandine si la réponse initiale au latanoprost est insatisfaisante. La régression vers la moyenne et l’effet Hawthorne sont des facteurs importants pour expliquer la baisse additionnelle après la randomisation et expliquent en grande partie, les résultats des nombreuses études de changement de molécules.

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: Manuscript no. 2010-121.

: Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

: Supported by National Institutes of Health Grants EY015682 (TR) and EY018859 (TR) and by an unrestricted grant from Research to Prevent Blindness (WVU).

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Original articleShort-Term Repeatability of Diurnal Intraocular Pressure Patterns in Glaucomatous Individuals

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Circadian variations in intraocular pressure

Nocturnal elevation of intraocular pressure is detectable in the sitting position

Invest Ophthalmol Vis Sci

Original article
Short-Term Repeatability of Diurnal Intraocular Pressure Patterns in Glaucomatous Individuals