Association Between 24-Hour Intraocular Pressure Monitored With Contact Lens Sensor and Visual Field Progression in Older Adults With Glaucoma

Key Points

Question

Does a single 24-hour curve with a contact lens sensor that measures intraocular pressure–related patterns correlate with the rates of visual field progression in patients with treated glaucoma?

Findings

In a cohort study including 445 patients (445 eyes) with glaucoma, a combination of contact lens sensor–derived variables was associated with prior rates of visual field progression of glaucoma. These variables performed better than Goldmann intraocular pressure measurements taken over follow-up.

Meaning

These findings suggest that a single 24-hour contact lens sensor session can help in risk stratification of patients with treated glaucoma.

Abstract

Importance

Twenty-four–hour intraocular pressure (IOP) patterns may provide more information regarding rates of visual field progression than office-hour measurements. However, little is known about the added value of 24-hour monitoring when stratifying glaucoma risk based on rates of progression.

Objective

To test the hypothesis that 24-hour IOP-related patterns recorded with a contact lens sensor (CLS) correlate with prior rates of visual field progression.

Design, Setting, and Participants

A multicenter, retrospective cohort study was conducted at 50 ophthalmology care centers in 13 countries. Participants included 445 patients (445 eyes) with treated, manifest open-angle glaucoma. The study was conducted from November 8, 1999, to September 17, 2016.

Interventions

Twenty-four–hour recordings of IOP-related patterns were prospectively collected with a CLS system. Retrospective visual field data of patients who underwent at least 3 prior reliable visual field tests were examined.

Main Outcomes and Measures

Association between CLS variables and rates of visual field mean deviation (MD) change.

Results

Of the 445 patients included, 238 (53.5%) were women and 394 (88.5%) were white. The mean (SD) age and MD values at the time of CLS recording were 68.9 (11.2) years and −9.0 (7.0) dB. The mean rate of MD change was −0.46 (0.5) dB/y in 5.2 (3) years of follow-up. After adjusting for baseline MD severity, age, and treatment, the following CLS variables were associated with fast visual field progression: mean peak ratio while awake (β = −0.021; 95% CI, −0.04 to −0.003), number of long peaks during sleep (β = 0.036; 95% CI, 0.005 to 0.067), night bursts ocular pulse frequency SD (β = 0.027; 95% CI, 0.004 to 0.051), and night bursts ocular pulse amplitude SD (β = 19.739; 95% CI, 1.333 to 38.145). Regression models including CLS variables had better fit than Goldmann IOP when testing the association with rates of progression.

Conclusions and Relevance

Results of this study indicate that 24-hour CLS recordings may be associated with prior rates of visual field progression of glaucoma. This association appears to be better than Goldmann mean IOP measured multiple times during office hours. Therefore, the CLS may be useful to assess the risk of future functional loss, even in situations when insufficient historical visual field information is available.

Abstract

This cohort study examines the use of 24-hour monitoring of intraocular pressure with a contact lens sensor in assessing risk for change in the visual field of older adult patients with glaucoma.