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    Round-the-clock IOP measurement becoming reality with technologic advances

    Implantable device for continuous, long-term monitoring of patients based on wireless communication systems

     

    Take-home

    The development of a device for 24-hour IOP monitoring is unique in that it can do so autonomously, without direct patient interaction, and can take measurements without external control signals.

    Dr. Moster

    Philadelphia—An ongoing conundrum for glaucoma specialists has been an inability to monitor patients throughout a 24-hour period in real-world clinical settings. About a decade ago, investigators started looking beyond the office readings and found IOP increased at night during sleep.

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    “That was quite a paradigm shift, as we used to believe that the pressure increased early in the morning when cortisol levels rose,” said Marlene Moster, MD, professor of ophthalmology, Thomas Jefferson University School of Medicine, Philadelphia. What diurnal studies on patients with glaucoma went on to find is that extrapolating IOP from one eye to the other is ineffective, as each eye operates independently.

    “When the pressure rises in one eye, it may rise in the other but not as much,” Dr. Moster said. “Even a diurnal pressure curve in patients with primary open-angle glaucoma poorly describes IOP fluctuations. Therefore, it is almost impossible to predict the IOP variability moving forward in time.“

    Glaucoma specialists and researchers alike agree there is a substantial amount that is just not yet known about IOP—how heavy exercise may affect it, how inversion positions in yoga (or any position where the head is below the heart) may affect pressure, or how the pressure varies when new drops or therapies are introduced. Therapy is determined based on a fleeting moment’s worth of data, and may not be reflective of the dynamic nature of IOP in daily life.

    Envisioning the possibilities

    What if glaucoma specialists could monitor a patient 24/7? What if physical contact with the eye was not needed to get an accurate measurement? What if all that could be accomplished without office visits?

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