What’s the Frequency?
The promise of round-the-clock IOP monitoring in glaucoma care: a Pandora’s box?
L. Jay Katz |
At the present time, IOP remains the only clinically proven modifiable risk factor for glaucoma, and IOP measurements are vital for diagnosis and for judging the adequacy of therapy by reaching a target IOP. Daily diurnal IOP fluctuations are well-recognized – with particularly large ‘swings’ occurring in glaucomatous eyes. Although peak IOP has been definitively correlated with disease progression, and IOP fluctuation may be a separate risk factor for glaucoma, practicality has limited tonometry to a ‘split second’ in-office determination with patients in an upright position. Is this really an adequate sampling of IOP to drive clinical decisions?
An additional concern is the revelation that supine, nocturnal IOP is generally higher then upright, daytime IOP readings. Studies have also raised questions about activities that may lead to large IOP elevations, such as yoga, playing wind musical instruments, and sleeping on one side. There are also concerns about medical therapy inducing troughs and spikes in IOP as drug effects wane; consistent adherence with drug therapy; and the ineffectiveness of certain drugs at night. In other diseases, such as systemic hypertension and diabetes mellitus, there have been welcome advances in providing 24-hour measurements for advanced care, and it is great to see that those models have spurred a potential restructuring of glaucoma management.
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