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Editors Selection IGR 16-4

Intraocular Pressure: 24-hour IOP measurements

Comment by Tony Realini on:

53015 Twenty-four-hour pattern of intraocular pressure in untreated patients with ocular hypertension, Grippo TM; Liu JH; Zebardast N et al., Investigative Ophthalmology and Visual Science, 2013; 54: 512-517

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Grippo and colleagues from the sleep lab at UCSD have recently reported a long-term analysis of the 24-hour IOP profiles of ocular hypertensive individuals. A group of 15 OHTN patients underwent 24-hour IOP characterization in the habitual position (sitting during the day and supine at night). The same was undertaken with a group of age-matched healthy subjects and also a group of untreated glaucoma patients. Overall, the OHTN group's 24-hour IOP patterns resembled those in the glaucoma group. Now flash forward several years. Five of the 15 OHTN patients eventually converted to glaucoma. Re-evaluating those 24-hour IOP profiles, there were notable differences between the converters and non-converters. In short, the IOP profiles of the non-converters looked like the IOP profiles of the healthy group, while the IOP profiles of the converters looked more like the IOP profiles of the glaucoma group ‐ an average of four years before they actually converted to glaucoma. The authors acknowledge limitations of the study ‐ particularly its small sample size. Much additional work is necessary to more fully explore these hypothesis-generating observations.

Perhaps the current OHTN risk calculator can be refined by replacing the random IOP values with some parameter that characterizes 24-hour IOP patterns

Nevertheless, it is irresistable to speculate a bit. It appears that within the glaucoma continuum, there is a prodromal phase in which IOP patterns shift from 'healthy' to 'glaucomatous' years before the disease is clinically evident. These data also hold out hope that we may have a new risk factor ‐ a causal one ‐ that may help us identify the OHTN patients at greatest risk for developing glaucoma. Perhaps the current OHTN risk calculator can be refined by replacing the random IOP values with some parameter that characterizes 24-hour IOP patterns. If so, the need for continuous IOP monitoring to capture 24-hour data will be more important than ever.

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