IOP monitoring with contact lens sensors can help assess risk for glaucoma progression
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Contact lens sensors that recorded ocular dimensional changes among patients with primary open-angle glaucoma are useful to identify risk for progression, according to research published in the Journal of Glaucoma.
“Clinical assessment of IOP is usually performed as a single measurement with Goldmann applanation tonometry (GAT) during office-hour visits,” Zhiyong Yang, MD, PhD, and colleagues wrote. “A major limitation of GAT-based IOP assessment is that IOP-related information that describes its dynamic nature is missing and not utilized in glaucoma management.
“The purpose of the current study was to determine whether 24-hour [contact lens sensor (CLS)] recording of changes in IOP-related ocular dimensions correlated with the rate of visual field progression and whether associations found in previous studies could be confirmed.”
Yang and colleagues conducted a retrospective, observational cohort study. They analyzed data from 32 patients (mean age, 69.8 years; mean IOP, 17.8 mmHg) with primary open-angle glaucoma who participated in the Glaucoma Clinic and Diagnostic Innovations in Glaucoma study conducted by researchers at the Hamilton Glaucoma Center. The mean follow-up time was 9.9 years.
Mean deviation progression was –0.2 dB per year, with 26 eyes progressing less than 0.5 dB per year, and six eyes progressing greater than 0.5 dB per year. A 10-unit nocturnal variability of ocular dimension changes related to IOP correlated with faster visual field loss by –0.25 dB (P = .035).
“In conclusion, we found that some CLS parameters related to larger nocturnal variability of IOP-related ocular dimensional changes may correlate with faster glaucoma progression,” Yang and colleagues wrote. “Our findings suggest that ambulatory CLS monitoring may enhance risk stratification in clinical decision-making for glaucoma management.”
Perspective
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There are many impediments to truly understanding our patients’ IOP. Traditional GAT may miss IOP peaks in up to 60% patients, and nighttime fluctuations may be more damaging to ganglion cell axons and the lamina cribrosa. Conventional nocturnal IOP measurement requires sleep interruption, which interferes with the intended measurement. CLSs overcome these barriers by giving continuous 24-hour readings.
This study confirms what others have found before it: nighttime IOP variability is associated with visual field loss.
The future of IOP measurement is continuous monitoring devices. For the time being, iCare Home (Centervue) is an option to take additional snapshots of IOP measurements beyond office visits. However, CLSs or an improved variant will eventually move from the lab to our clinics. While much of the current research has focused on primary open angle glaucoma, continuous IOP measurement may have the greatest impact on secondary glaucoma where IOP is less stable.
Additionally, continuous IOP monitoring will allow us to tailor recommendations on higher risk activity such as playing wind instruments, yoga and basketball. This will help prevent IOP spikes in sensitive individuals while allowing unaffected patients to enjoy the benefits of these activities.
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