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Editors Selection IGR 16-4

Clinical Examination Methods: Intereye Symmetry of Circadian IOP Patterns

Comment by John Liu on:

90231 Intereye Symmetry of 24-Hour Intraocular Pressure-related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor, Mansouri K; Gillmann K, Journal of Glaucoma, 2020; 29: 666-670

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The authors reported the correlation of 24-hour IOP-related patterns in the paired eyes of 20 untreated glaucoma patients in an ambulatory setting. Data were collected using the wireless Triggerfish contact lens IOP sensors placed on the paired eyes at the same time. They took careful steps to manage wireless data communications from the two Triggerfish devices. Simultaneous 24-hour recordings from both eyes were successful in the majority of participants. The authors showed an overall strong correlation of 24-hour IOP-related patterns, specifically the peak timing and the amplitude of high-low IOP variation, using advanced analyses including cosinor rhythmometry modeling. Results indicate a high degree of inter-eye symmetry compared to previously reported IOP symmetry in the literature. For the present study, 288 data points from each eye were used during a 24-hour period, much more than those data points used in clinical practice and in clinical research with standard tonometers. Theoretically, more data points should decrease technical artifacts as well as the impact of transient IOP fluctuations on the 24-hour IOP-related patterns.

Results from the present study have an important implication for the monocular therapeutic IOP trial

Results from the present study have an important implication for the monocular therapeutic IOP trial that involves the treatment of one eye with a topical glaucoma medication and the use of fellow eye as a control for IOP fluctuations. As the authors pointed out, the current uncertainty of the utility of monocular therapeutic trial is in part due to the small number of IOP measurements during a patient's office visits. The Triggerfish device that can generate a large amount of 24-hour data outside the office visits has the potential to fill in this gap. Toward this goal, it is important to perform a therapeutic trial that includes baseline bilateral 24-hour recordings using the contact lens IOP sensors and follow-up 24-hour recordings after applying a topical glaucoma medication in one eye.

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