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    Weighing IOP fluctuation in glaucoma progression

    Chicago—Available evidence indicates that long-term IOP fluctuation is an important factor in glaucoma progression, said Joseph Caprioli, MD.

    Based on this information he encouraged ophthalmologists to consider IOP “modulation” rather than “reduction.”

    “This relates to the quality of IOP control,” said Dr. Caprioli, professor of ophthalmology, University of California, Los Angeles. “The target for patients with progressing primary open-angle glaucoma at high risk should be a low mean IOP and fewer excursions of pressures into a range that may be damaging.”

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    Addressing the question of whether IOP fluctuation is important for glaucoma patient outcomes, Dr. Caprioli divided his review into evidence regarding the effects of instantaneous, diurnal-nocturnal (nyctohemeral), short-term, and long-term fluctuations.

    He noted there is no evidence that instantaneous fluctuations in IOP—i.e., those that are caused by such factors as saccades, blinks, or eye rubbing—have any effect on glaucoma progression.

    “These can be quite high excursions of IOP, although they are very brief, on the order of seconds or fractions of seconds,” Dr. Caprioli said. “It is interesting to speculate, however, that these high peaks can produce strain from IOP stress in susceptible eyes.”

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    Diurnal-nocturnal fluctuations, also referred to as nyctohemeral fluctuations, describe variations that occur between day and night as a result of central or humoral factors.

    Dr. Caprioli said there is also no solid evidence that nyctohemeral IOP fluctuations affect glaucoma progression, although one recent study that employed a contact lens sensor for IOP monitoring and measured visual field change in treated glaucoma patients concluded “the number of long peaks and the mean peak ratio when patients were awake were the best predictors of faster progression.”

    Defining short-term fluctuation in IOP as changes occurring over a period of days to weeks, Dr. Caprioli said there is also no evidence that it affects glaucoma progression.


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