Questions remain regarding continuous IOP monitoring

DENVER – A number of technologies to continuously measure intraocular pressure are being developed. Here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry, Steve Mansberger, MD, MPH, asked what clinicians will do with the data collected.

Steve Mansberger

“Current IOP measurements are just snapshots,” Mansberger said. “IOP telemetry is coming back, and the technology is getting better.

“Once we get all this data, however, we’ll have to figure out what to do with it, and do it in a way that’s efficient,” he said. “Reimbursement is going down, and we need to increase efficiency. We can’t go through pages and pages of information in a reliable fashion.

“Will we look at peak IOPs?” Mansberger asked. “Will we do cosine regression? Will we look at IOP variants? Or will we use a combination of IOP, ocular perfusion pressure and intracranial pressure?”

Mansberger said we have learned that IOP varies widely with sleep position, blinking and physical activity. He asked which pressure needs to be treated.

The potential for home IOP monitoring may allow patients to use the data to change the way they behave, Mansberger said. The potential exists for patients to keep a diary of what they have done, correlate that with their pressure at the time and adjust their activities.

They could change their sleep positions and exercise schedule depending on IOP, he said.

“In one study, patients were able to drop pressure by 2 mm Hg to 3 mm Hg just by raising the position of their head when they sleep,” he said. “It allows patients to be empowered to control their outcomes.”

Home monitoring may also help clinicians and researchers better diagnose and treat glaucoma. Their doctors could test structure and function depending on IOP, he added.

“In the epidemiology literature, self-monitoring devices have been around for a long time,” Mansberger said, including blood pressure and Holter monitors.

Some studies have shown improved outcomes and reduced costs with home monitoring, and others show that patients will not stick with it, he said.

Mansberger acknowledged the need for a better IOP monitor. Challenges exist, such as calibration, signal drift, duration of measurement and device location.

Disclosure: Mansberger has no relevant financial disclosures.