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Moodie et al. (1141) assessed the value of daytime vs. 24-hour intraocular pressure (IOP) monitoring in patients with glaucoma. They conclude that 24-hour IOP monitoring offers little advantage over daytime phasing. The study has methodological issues that might have influenced the outcome. Most importantly, IOP measurements were taken throughout the day in the sitting position. Ideally, such an investigation should be carried out with measurements taken in the habitual body position. It has been hypothesized that postural change from sitting to supine produces a redistribution of body fluid with a probable increase of episcleral venous pressure and, possibly, the choroidal vascular volume. Liu et al.1,2 have shown repeatedly (and confirmed by others) that in a majority of glaucoma patients a significant elevation of IOP occurs during the nocturnal period when measured in the habitual body position. These observations have clinical significance. When Barkana et al.3 measured IOP over 24-hours, this led to a change of treatment in 36% of eyes that had their maximum IOP occur out - side office-hours.
Recently, trials of continuous IOP monitoring with a wireless ocular telemetry sensor have shown consistently higher nocturnal IOPs in glaucoma patients
Of note, nocturnal IOP values were available for only 54% of patients in this study, reducing sample size and introducing selection bias. Contrary to previous studies, they included a mixed cohort of glaucoma subtypes (25% of overnight patients had congenital, aphakic, or chronic narrow angle glaucoma). It is possible that glaucoma subtypes have different circadian IOP patterns, although this has not been studied yet and would be an important topic of future research. Clinicians and scientists equally recognize the need for better understanding of the dynamic nature of IOP. So far, no tool has been available to measure IOP during sleep in real-life conditions. With the introduction of newer technologies, ambulatory 24-hour IOP monitoring could become part of clinical practice. Recently, trials of continuous IOP monitoring with a wireless ocular telemetry sensor have shown consistently higher nocturnal IOPs in glaucoma patients.4