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Large fluctuation of IOP seen in patients with PE glaucoma
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Patients with pseudoexfoliation syndrome had a greater fluctuation of intraocular pressure as measured by a contact lens sensor, according to recent research published in the Journal of Glaucoma.
“High maximum IOP levels and a greater IOP fluctuation range may be contributory factors in [pseudoexfoliation syndrome] PE glaucoma,” Naoki Tojo, MD, and colleagues wrote in their study. “In this regard, treatment for glaucoma is needed not only to reduce a temporary IOP, but also to lower the peak IOP and IOP fluctuation.”
Tojo and colleagues evaluated the diurnal and nocturnal IOP levels of 22 patients using the Triggerfish (Sensimed, Lausanne, Switzerland) contact lens sensor (CLS) over a 24-hour period, according to the study. They measured corneal thickness and curvature changes before the CLS was inserted and just after it was removed.
The researchers found the mean IOP in patients with PE was 20.3 ± 3.9 mm Hg compared with 13.1 ± 2.1 mm Hg in patients with healthy eyes. Tojo and colleagues noted that IOP fluctuations over a 24-hour period were significantly larger in the PE group compared with patients with healthy eyes. Seven patients had maximum value during the nocturnal period, whereas all patients in the healthy eyes group had maximum value during the nocturnal period, according to the study.
“This larger fluctuation might be one of the reasons underlying the aggravation of the visual field by PE,” they added. – by Jeffrey Craven
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma was once considered a disease characterized exclusively by elevated intraocular pressure. Although our understanding has deepened over the years, IOP remains the most important glaucoma risk factor, and lowering IOP is still our only proven glaucoma treatment. Recent technological advances, such as the ability to continuously monitor IOP, may shed light on the pathophysiology of glaucoma in general and the differences between types of glaucoma in particular.
Tojo and colleagues use the Sensimed Triggerfish contact lens to compare IOP fluctuations in patients with psuedoexfoliative syndrome (PE) and normals. They found that PE patients were more likely to have their peak IOP during the daytime hours than normals, who invariably experienced their high IOP night. Not unexpectedly, PE patients ran higher IOPs in general and had greater IOP fluctuation than normals.
These findings are not particularly surprising, since previous investigations have yielded similar results. However, as a proof of concept, this paper helps establish the Triggerfish device as an accurate and promising research tool. Beyond that, it is easy to imagine such devices eventually being employed in clinic. With as complex and varied a condition as glaucoma, we can use all the help we can get.
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