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      Systematic Review of Current Devices for 24-h Intraocular Pressure Monitoring

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          Abstract

          Glaucoma is a common optic neuropathy that can lead to irreversible vision loss, and intraocular pressure (IOP) is the only known modifiable risk factor. The primary method of treating glaucoma involves lowering IOP using medications, laser and/or invasive surgery. Currently, we rely on in-office measurements of IOP to assess diurnal variation and to define successful management of disease. These measurements only convey a fraction of a patient’s circadian IOP pattern and may frequently miss peak IOP levels. There is an unmet need for a reliable and accurate device for 24-h IOP monitoring. The 24-h IOP monitoring devices that are currently available and in development fall into three main categories: self-monitoring, temporary continuous monitoring, and permanent continuous monitoring. This article is a systematic review of current and future technologies for measuring IOP over a 24-h period.

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          Wireless contact lens sensor for intraocular pressure monitoring: assessment on enucleated pig eyes.

          H Pitchon, Philippe Renaud, Arnaud Bertsch … (2009)
          Assessment on enucleated pig eyes of a novel and minimally invasive method for the continuous monitoring of intraocular pressure (IOP), based on a novel wireless contact lens sensor (CLS). The wireless CLS is a disposable silicone soft contact lens with a sensor embedded in it, allowing the wireless measurement of changes in corneal curvature induced by IOP variations. A CLS was adapted and tested on enucleated pig eyes. To demonstrate the measurement principle of the device, the enucleated pig eye was cannulated, allowing precise control of IOP. The CLS signal was then compared to the imposed IOP. First, the IOP of enucleated pig eyes was changed between 11 and 14 mmHg, simulating ocular pulsation. Then, IOP was changed with static steps of 1 mmHg between 20 and 30 mmHg to assess the reproducibility and linearity of the CLS. In both cases, measurements from the CLS and IOP showed very good correlation. A calibration graph shows that the CLS is capable of monitoring the IOP of each individual eye with a reproducibility of +/- 0.2 mmHg (95% confidence interval). The wireless CLS shows a good functionality to monitor the IOP on enucleated pig eyes. The device is placed in the same way as a soft disposable contact lens. This device would allow a minimally invasive and continuous monitoring of IOP over prolonged periods of up to 24 hr, regardless of patient activity, thus opening up new diagnostic and therapeutic methods to manage glaucoma.
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            Clinical utility of intraocular pressure monitoring outside of normal office hours in patients with glaucoma.

            Sarah Anis, Yaniv Barkana, Jeffrey M. Liebmann … (2006)
            To determine whether intraocular pressure (IOP) monitoring outside of normal office hours adds clinically useful information. We reviewed the records of all patients with glaucoma who were admitted for 24-hour IOP monitoring during 3 years. Applanation IOP was recorded in the sitting position from 7 am until midnight and in the supine position at 6 am. Thirty-two patients (22 women and 10 men) were enrolled (mean +/- SD age, 67.3 +/- 12.1 years). Mean +/- SD 24-hour IOP was 13.0 +/- 2.2 mm Hg. Mean +/- SD peak 24-hour IOP (16.8 +/- 3.2 mm Hg) was significantly higher than peak office IOP (14.7 +/- 3.2 mm Hg) (P<.001). Peak IOP was recorded outside of office hours in at least 1 eye in 22 patients (69%). Mean IOP fluctuation during 24-hour monitoring (6.9 +/- 2.9 mm Hg) was significantly greater than that during office hours (3.8 +/- 2.3 mm Hg) (P<.001). Peak 24-hour IOP was higher than the peak IOP noted during previous office visits in 40 eyes (62%). Results of 24-hour IOP monitoring led to immediate treatment change in 23 eyes (36%). In glaucoma patients with advanced disease or progression that are disproportionate to known IOP measurements, 24-hour monitoring of IOP may reveal a greater role for pressure-related risk for glaucoma progression than previously suspected and may alter treatment strategies.
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              Continuous 24-hour monitoring of intraocular pressure patterns with a contact lens sensor: safety, tolerability, and reproducibility in patients with glaucoma.

              Kaweh Mansouri, Felipe Medeiros, Ali Tafreshi … (2012)
              OBJECTIVE To examine the safety, tolerability, and reproducibility of intraocular pressure (IOP) patterns during repeated continuous 24-hour IOP monitoring with a contact lens sensor. METHODS Forty patients suspected of having glaucoma (n = 21) or with established glaucoma (n = 19) were studied. Patients participated in two 24-hour IOP monitoring sessions (S1 and S2) at a 1-week interval (SENSIMED Triggerfish CLS; Sensimed AG). Patients pursued daily activities, and sleep behavior was not controlled. Incidence of adverse events and tolerability (visual analog scale score) were assessed. Reproducibility of signal patterns was assessed using Pearson correlations. RESULTS The mean (SD) age of the patients was 55.5 (15.7) years, and 60% were male. Main adverse events were blurred vision (82%), conjunctival hyperemia (80%), and superficial punctate keratitis (15%). The mean (SD) visual analog scale score was 27.2 (18.5) mm in S1 and 23.8 (18.7) mm in S2 (P = .22). Overall correlation between the 2 sessions was 0.59 (0.51 for no glaucoma medication and 0.63 for glaucoma medication) (P = .12). Mean (SD) positive linear slopes of the sensor signal from wake to 2 hours into sleep were detected in both sessions for the no glaucoma medication group (S1: 0.40 [0.34], P < .001; S2: 0.33 [0.30], P < .01) but not for the glaucoma medication group (S1: 0.24 [0.60], P = .06; S2: 0.40 [0.40], P < .001). CONCLUSIONS Repeated use of the contact lens sensor demonstrated good safety and tolerability. The recorded IOP patterns showed fair to good reproducibility, suggesting that data from continuous 24-hour IOP monitoring may be useful in the management of patients with glaucoma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01319617.
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                Author and article information

                Contributors
                Sabita M. Ittoop: adisrapidplus@springer.com
                Journal
                Journal ID (nlm-ta): Adv Ther
                Journal ID (iso-abbrev): Adv Ther
                Title: Advances in Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 0741-238X
                ISSN (Electronic): 1865-8652
                Publication date (Electronic): 16 August 2016
                Publication date PMC-release: 16 August 2016
                Publication date (Print): 2016
                Volume: 33
                Issue: 10
                Pages: 1679-1690
                Affiliations
                [1 ]Vienna, VA USA
                [2 ]Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO USA
                [3 ]Glaucoma Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland
                Article
                Publisher ID: 388
                DOI: 10.1007/s12325-016-0388-4
                PMC ID: 5055550
                PubMed ID: 27531519
                SO-VID: 4c4d70ff-9beb-4824-acac-d77487d3891d
                Copyright © © The Author(s) 2016
                History
                Date received : 13 April 2016
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer Healthcare 2016

                Keywords: 24-h,contact lens sensor,eyecare® (implandata ophthalmic products gmbh),glaucoma,icare® tonometer (icare finland oy),intraocular pressure,phosphene tonometer,self-tonometry,triggerfish® (sensimed ag),wireless intraocular transducer
                Data availability:
                Keywords: 24-h, contact lens sensor, eyecare® (implandata ophthalmic products gmbh), glaucoma, icare® tonometer (icare finland oy), intraocular pressure, phosphene tonometer, self-tonometry, triggerfish® (sensimed ag), wireless intraocular transducer

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