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IOP continuous monitoring: background

IOP continuous monitoring: background. Richard P. Mills MD MPH Seattle, USA. I have no financial interests or relationships to disclose. Financial Disclosure. IOP and glaucoma. We no longer define glaucoma by IOP level Glaucoma can occur at consistently “normal” IOP

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IOP continuous monitoring: background

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  1. IOP continuous monitoring:background Richard P. Mills MD MPH Seattle, USA

  2. I have no financial interests or relationships to disclose. Financial Disclosure

  3. IOP and glaucoma • We no longer define glaucoma by IOP level • Glaucoma can occur at consistently “normal” IOP • Consistently “abnormal” IOP often isn’t glaucoma • BUT • IOP is a strong risk factor for glaucoma • IOP is all we have to treat

  4. IOP charts in glaucoma practice Each measurement is a snapshot, an instantaneous IOP reading

  5. IOP variability • AKA fluctuation • Transient: blinks, eye movements, cardiac pulse • Diurnal: morning high, afternoon low, evening low; other patterns common • Intervisit: Time of day, medication use, many unknown factors

  6. Transient IOP fluctuations Courtesy Clifford Downs, PhD

  7. Diurnal IOP Fluctuation in Glaucoma Patients 11 12 10 7.6 8 IOP Fluctuation (mm Hg) 6 3.7 4 2 0 POAG Off POAG Normal Eyes Treatment Controlled Drance SM. Arch Ophth, 1963;70: 302-311 Drance SM. Arch Ophth, 1960; 64: 494-501

  8. Rates of Visual Field Loss Diurnal Office vs Home testing • Rate of VF loss for Different Levels of Home IOP Range • (higher quartile vs lower quartile) • Home tonometry measurements provided a strong predictor of progression Rate of VF loss for Different Levels of Office IOP (higher quartile vs lower quartile) Office IOP measurements did not help predict which patients would progress Courtesy Sanjay Asrani MD Asrani S, Zeimer, R, Wilensky J, Geiser D, Lindenmuth K, Vitale S. Journal of Glaucoma ;9:134-142, 2000

  9. Sitting Sitting Supine Diurnal fluctuation From Mosaed, Liu, Weinreb 2005 Mosaed, Liu & Weinreb. Am J Ophthalmol. 2005; 139: 320-324.

  10. Predictive Factors for Visual Field Progression in AGIS study • No relationship found between mean IOP and VF progression • It is only when IOP fluctuation was excluded, did mean IOP reach statistical significance • Weak correlation found between mean IOP and IOP fluctuation “Thus IOP fluctuation is an independent and stronger predictor than mean IOP for VF progression” Nouri-Madhavi K, Hoffman D, Coleman A, Gaasterland D,, Caprioli J Ophthalmology, 2004; 111:1627-1635

  11. Worsening of visual fields (AGIS Score) in eyes with greater IOP fluctuation Loss of Visual Field (change in AGIS scoring system) Time in months Nouri-Madhavi K, Hoffman D, Coleman A, Gaasterland D,, Caprioli J Ophthalmology, 2004; 111:1627-1635

  12. Fluctuation in CIGTS study In 607 patients, visual field loss over 5 years was strongly associated with • increased IOP variation • Larger maximum IOP • Mean IOP

  13. Cox Proportional Hazards Model (N=84 eyes; 16 progressed) Variable Hazard Ratio 95% CI P-Value Mean IOP (increasing) 1.2 (1.0, 1.4) 0.03 SD of IOP (increasing) 4.2 (1.3, 12.9) 0.01 Difference between Lowest and Highest IOP (increasing) 0.4 (0.3, 0.7) 0.001 Age (increasing) 1.1 (1.0, 1.1) 0.02 Gender (Male vs. Female) 0.8 (0.2, 2.4) 0.63 Baseline glaucoma stage (Higher vs. Lower) 0.3 (0.1, 1.4) 0.12 Received Medication in Baseline Stage (Yes vs. No) 0.1 (0.03, 0.5) 0.004 Best Overall Stage of Patient (Higher vs. Lower) 4.1 (0.8, 22.6) 0.10 Intervisit IOP fluctuation and progression across 12 centers Study patients derived from Lee P, et al, Archives, 2006; 124: 12-19 Presented Lee PP, AGS Annual Meeting, Charleston, SC 2006

  14. IOP fluctuation is probably important in glaucoma, but we’re not sure how. We cannot measure it currently. It will change the face of glaucoma treatment if IOP can be continuously monitored. Conclusion

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