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Editors Selection IGR 12-1

Clinical Examination Methods: Daily life activities and IOP

Comment by Christopher Teng on:

92421 The effect of daily life activities on intraocular pressure related variations in open-angle glaucoma, Gillmann K; Weinreb RN; Mansouri K, Scientific reports, 2021; 11: 6598

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In this prospective observational study, Gillman et al. utilize Sensimed Triggerfish Contact Lens Sensor (TFCLS) to observe intraocular pressures (IOP) changes over a 24-hour period in glaucoma suspects and primary open angle patients. Subjects had IOP measured by Goldmann tonometry before and after wearing the TFCLS for 24 hours and the protocol was repeated for each patient at least seven days later. During the 24-hour period, subjects recorded events sorted into five categories: Walking/ Cycling, Resistance Training, Yoga/Meditation, Alcohol Consumption, and Emotional Stress. A total of 40 events (10 walking/cycling, 11 resistance training, 4 yoga/meditation, 2 alcohol consumption, and 13 emotional stress events) were recorded for 22 eyes from 14 patients. Average TFCLS measurement 30-60 minutes prior to the event were used as baseline which was then compared to average measurements during the event, 0-30 minutes, 30-60 minutes, and 90-120 minutes after the event.

The group found a small increase in IOP during walking/cycling (p = 0.018). Additionally, an elevation of IOP was found during (p = 0.005) and persisted 120 minutes (p = 0.007) after resistance training. A non-significant sustained drop in IOP was found during Yoga/ Meditation (p > 0.38). A gradual elevation of IOP was found after emotional stress events, starting 30 minutes after (p=0.038) and continuing 120 minutes later (p = 0.021). Alcohol was associated with a decrease in IOP during the event, though subsequent times were not significant.

These findings were in agreement with prior reported findings with a few exceptions. Notably, resistance training in prior studies was found to have an increase in IOP during the procedure with a prompt reduction shortly afterwards¹ while in this study IOP elevation persisted 120 minutes after exercise. This difference may be because continuous monitoring includes a higher sample of information as compared to individual tonometry readings present in prior studies. Interestingly, in this study walking/cycling was associated with elevation in IOP. Although upright position is associated with IOP reduction, thought to be from gravitational forces and dopamine release, prior studies on endurance exercise have shown mixed results.^2,3 The authors speculate that the increase found in this study could be from other neurotransmitter associations, associated with fluid intake during/ after the exercise, or could be a result of the relatively small sample size.

There are some limitations to this study, most notably, the relatively low sample size of events, particularly with yoga/meditation and alcohol consumption. Additionally, the study relied on non-standardized, subjective reports of activities by patients. Finally, the categories included were broad and included activities that may increase or reduce IOP. For example, downward facing yoga positions⁴ have been associated with elevated IOP while meditation has been associated with lowering IOP.⁵ Although these limitations exist, this study utilizes the continuous monitoring offered by TFCLS to look for fluctuations of IOP in daily activities and thus offers an excellent basis for future studies to further evaluate these findings.

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