Diurnal IOP monitoring helps predict glaucomatous progression

WAILEA, Hawaii — Large diurnal fluctuations in intraocular pressure are an independent risk factor for disease progression in patients with glaucoma, said Sanjay Asrani, MD, speaking here. Fluctuations in IOP must be considered even in patients who appear to have well-controlled IOP during office visits, he said.

Dr. Asrani, affiliated with the Duke University Eye Center, noted that many studies of patients with glaucoma do not take into account the effects of diurnal IOP variation separately from the effect of mean IOP.

“The relative risk of progression if a patient has a diurnal IOP fluctuation of 5.4 mm Hg is six times greater than if a patient has a diurnal fluctuation of 3.1 mm Hg,” Dr. Asrani said.

He described a study in which patients with open-angle glaucoma self-monitored their IOP with a self-tonometer. IOP was measured each day for 5 days at waking, noon, mid-afternoon, dinner time and bedtime.

There was “virtually no difference” in the levels of office-measured IOP for eyes in the highest 25th percentile of visual field loss vs. the lowest 25th percentile. However, significant variation was found in the home IOP measurements

“We saw that only 12% of those eyes in the highest 25th percentile had retained visual fields vs. 57% in the lowest 25th percentile,” Dr. Asrani said.

For more details, see the May 1 issue of Ocular Surgery News.