Report can predict risk for visual field progression in glaucoma
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A progression report provided comparable predictions for the risk of fast visual field progression in patients with open-angle glaucoma, according to a retrospective multicenter study published in the Journal of Glaucoma.
“[Progression report] computes 24-hour IOP-related parameters that have been associated with visual field progression in glaucoma to provide clinicians with an evaluation of the progression risk,” Kevin Gillmann, MBBS, FEBOphth, MArch, of the Glaucoma Research Center at Montchoisi Clinic in the Swiss Visio Network in Lausanne, Switzerland, and colleagues wrote.
Researchers enrolled 30 patients with primary or secondary open-angle glaucoma who underwent Triggerfish contact lens sensor monitoring between December 2012 and November 2017. They recorded IOP-related 24-hour variations with the Triggerfish contact lens sensor and used those recordings to generate the progression report.
The Triggerfish contact lens sensor consists of an oxygen-permeable soft contact lens embedded with two strain gauges capable of recording ocular dimensional changes in the corneoscleral junction related to IOP. Essential pre-recording clinical data and the Triggerfish output of each patient was coded and sent to Sensimed, and the resulting algorithm was used to produce the progression report.
For comparisons, two masked assessors estimated fast visual field progression.
On average, patients had performed 4.8 visual field tests before Triggerfish recording and 4.9 after recording. The risk for fast progression increased by an average of 0.9 dB per year. Of the 30 analyzed eyes, investigators assessed eight (26.7%) as fast progressors with a decrease of an average 2.9 dB per year. Slow progressors had an increase of an average of 0.1 dB per year.
The average risk score attributed by the progression report was 42%, and the two assessors attributed average scores of 39%. Correlation between the two assessors (r = 0.59) was identical to that between the progression report and the assessors’ average gradings.
“Our study shows fair to good agreement between the assessors and the [progression report],” the researchers wrote. “This further suggests that detailed analysis of 24-hour IOP profile parameters could play a role in glaucoma assessment and management.” – by Erin T. Welsh
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
Applanation tonometry is the eye pressure equivalent of predicting the weather by looking outside your window. It merely gives you a snapshot of a dynamic and potentially volatile situation. We know that IOP fluctuation throughout the day and the extent of that fluctuation is a risk factor for glaucoma progression. With the emergence of a contact lens sensor (CLS), 24-hour IOP measurement studies are beginning to confirm those risks and attempting to predict visual field progression. This study describes one such predictive technique that shows promise.
While remote IOP measurement was inevitably going to become mainstream, the current COVID-19 situation highlights how vital such an at-home system can be. Nothing is more frustrating than knowing some of my patients may be progressing but not being able to monitor and treat them as I would like to.
Aside from the obvious advantage of predicting visual field progression, a CLS might help correlate and confirm OCT, visual field and funduscopy. Going forward, we will likely depend more on remote monitoring as we establish a new normal. Such innovations can serve our patients and practices well, particularly if there is a second round of the current pandemic.
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Gillmann K, et al. J Glaucoma. 2020;doi:10.1097/IJG.0000000000001502.
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