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

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Abstract

<div class="section"> <a class="named-anchor" id="ab-eoi180035-1">  </a> <h5 class="section-title" id="d3626471e293">Question</h5> <p id="d3626471e295">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? </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-2">  </a> <h5 class="section-title" id="d3626471e298">Findings</h5> <p id="d3626471e300">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-3">  </a> <h5 class="section-title" id="d3626471e303">Meaning</h5> <p id="d3626471e305">These findings suggest that a single 24-hour contact lens sensor session can help in risk stratification of patients with treated glaucoma. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-4">  </a> <h5 class="section-title" id="d3626471e309">Importance</h5> <p id="d3626471e311">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-5">  </a> <h5 class="section-title" id="d3626471e314">Objective</h5> <p id="d3626471e316">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-6">  </a> <h5 class="section-title" id="d3626471e319">Design, Setting, and Participants</h5> <p id="d3626471e321">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-7">  </a> <h5 class="section-title" id="d3626471e324">Interventions</h5> <p id="d3626471e326">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-8">  </a> <h5 class="section-title" id="d3626471e329">Main Outcomes and Measures</h5> <p id="d3626471e331">Association between CLS variables and rates of visual field mean deviation (MD) change.</p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-9">  </a> <h5 class="section-title" id="d3626471e334">Results</h5> <p id="d3626471e336">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. </p> </div><div class="section"> <a class="named-anchor" id="ab-eoi180035-10">  </a> <h5 class="section-title" id="d3626471e339">Conclusions and Relevance</h5> <p id="d3626471e341">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. </p> </div><p class="first" id="d3626471e344">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. </p>

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Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes.

Daniel F. Kripke, Xiaoyan Zhang, Robert N. Weinreb … (2003)

To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated patients with newly diagnosed early glaucomatous changes. Measurements of IOP, blood pressure, and heart rate were taken every 2 hours during a 24-hour period from a group of 24 untreated patients (ages 40-78 years) with newly diagnosed abnormal optic discs and/or abnormal visual fields. In the 16-hour diurnal awake period, IOP was measured sitting and supine, and blood pressure and heart rate were measured supine. In the 8-hour nocturnal sleep period, all measurements were taken in the supine position. Mean diurnal and nocturnal IOP, blood pressure, and heart rate in the glaucoma group were compared with data obtained from an age-matched control group of 24 individuals with healthy eyes. Mean diurnal IOP, either sitting or supine, was significantly higher in the glaucoma group than in the control group. For both subject groups, nocturnal supine IOP was higher than diurnal sitting IOP. However, this diurnal-to-nocturnal increase in IOP was significantly smaller in the glaucoma group. When compared with the diurnal supine IOP, the nocturnal supine IOP was lower in the glaucoma group but higher in the control group. Around normal awakening time, the supine IOP increased in the glaucoma group and did not change in the control group. There was a diurnal-to-nocturnal decrease in mean blood pressure only in the glaucoma group. Compared with healthy eyes, the diurnal IOP is higher, the diurnal-to-nocturnal change of habitual IOP is less, and the posture-independent IOP pattern around normal awakening time is different in eyes with early glaucomatous changes.

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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.