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    How 24-hour IOP measurements vary with glaucoma treatment


    IOP normally fluctuates throughout the day by around 4-6 mm HG, Konstas and colleagues found. In patients with ocular hypertension (OHT), the 24-hour fluctuation usually averages 6-8 mm Hg, but sometimes reaches 15 mm Hg. In glaucoma patients the 24-hour fluctuation usually ranges from 6-15 mm HG, but can reach as high as 40 mm Hg, they reported.

    In most studies, IOP in untreated glaucoma is highest between 6 a.m. and noon; the authors noted the highest IOP in their own patients at 10 a.m. This time can also vary with the patient and type of glaucoma, they noted.

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    For example, one study found that 45% of patients with exfoliation glaucoma (XFG) and 22.5% of patients with primary open-angle glaucoma (POAG), reach peak IOP outside office hours.

    The patient’s position can affect IOP as well; in general, a patient’s IOP is lower when sitting than when lying supine, the researchers reported.

    Among the findings from various medication studies they identified:

    • The combination of dorzolamide and timolol was more effective than timolol alone in lowering daytime IOP, but not nighttime IOP.

    • Latanoprost was more effective than either timolol or dorzolamide overall, and the reduction in IOP it caused seemed relatively uniform over the course of 24 hours in patients with POAG.

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    • Timolol was more effective than dorzolamide at 3 p.m., but dorzolamide surpassed the effectiveness of timolol at midnight and 3 a.m.

    • Supine IOP was lower with timolol than with latanoprost at night. Administering latanoprost, or latanoprost and timolol together, at night lowered daytime IOP more than administering the drugs in the morning.

    • Latanoprost caused a significantly better 24-hour drop in IOP while tafluprost provide a significantly lower 24-hour IOP fluctuation.

    • IOP reduction was greater with latanoprost and dorzolamide than with latanoprost at nighttime.

    • Bimatoprost was as effective as latanoprost/timolol fixed combination in maintaining 24-hour IOP in patients with glaucoma or ocular hypertension in patients who switched from the unmixed combination of latanoprost and timolol.

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