Association of Ambulatory Blood Pressure and Other Factors With Intraocular Pressure-Related 24-Hour Contact Lens Sensor Profile in Untreated Glaucoma.

Purpose: To investigate the association of diurnal blood pressure (BP) and other factors with the intraocular pressure (IOP)-related 24-hour contact lens sensor (CLS) profile of patients with untreated glaucoma. Methods: The prospective study included 82 patients with untreated normal-tension glaucoma. CLS measurements and ambulatory BP monitoring were performed simultaneously for 24 hours. The association between the mean arterial pressure (MAP) and CLS profile was examined for the daytime and nocturnal periods using linear regression analysis. The associations between other factors and the CLS profile were also examined. Results: Multivariate analysis of data from 63 eligible patients showed that higher average MAPs were significantly associated with larger average nocturnal CLS values (ß coefficient = 0.273; P = 0.023); a larger increase in the last CLS value (ß coefficient = 0.366; P = 0.003); larger standard deviations (SDs) of CLS values for the daytime, nocturnal, and 24-hour periods (ß coefficient = 0.407, 0.293, and 0.375; P < 0.001, P = 0.032 and 0.002, respectively); and higher average ocular pulse frequencies for the daytime, nocturnal, and 24-hour periods (ß coefficient = 0.268, 0.380, and 0.403; P = 0.029, 0.002, and 0.001, respectively). Thicker subfoveal choroids and shorter axial length were significantly associated with larger SDs and larger average CLS values, respectively. Smaller anterior chamber volume and lower corneal hysteresis were associated with larger SDs or larger average ocular pulse amplitude. Conclusions: Ambulatory BP and several ocular parameters were significantly associated with various parameters of the 24-hour CLS profile. Translational Relevance: Ambulatory BP and ocular parameters may be modifiers of the 24-hour IOP-related profile of CLS.

Diurnal Variation of Corneal Hysteresis in Patients With Untreated Primary Open Angle Glaucoma and Normal Individuals.

PRCIS: Corneal hysteresis in both patients with untreated open angle glaucoma and normal individuals demonstrated significant diurnal variation independent of confounding factors and was higher in the nighttime than in the daytime. PURPOSE: To investigate diurnal variations in corneal hysteresis (CH) in patients with untreated primary open angle glaucoma (POAG) and normal individuals by using an ocular response analyzer. MATERIALS AND METHODS: This prospective study included 72 eyes of 53 patients with untreated POAG and 53 eyes of 47 normal individuals. Intraocular pressure (IOP) and CH were measured using Goldmann applanation tonometry (GAT) and ocular response analyzer, respectively, every 3 hours from 9:00 to 24:00. Mixed-effects models were used to determine factors associated with CH values and CH amplitude (maximum values minus minimum values) and to examine the diurnal variations in GAT IOP and CH in each group. Significant differences between time points were defined as significant variations. RESULTS: The diurnal average GAT IOP and CH in patients with POAG were significantly higher and lower than those in normal individuals ( P =0.001, 0.002). In the multivariate analysis, the larger central corneal thickness was associated with larger CH values in POAG and normal eyes (both P <0.001). A larger amplitude of GAT IOP was significantly associated with a larger CH amplitude in POAG and normal eyes ( P =0.010, 0.013). CH, in both groups, showed similar significant diurnal variation and was higher in the nighttime than in the daytime, even after adjusting for confounding factors, while IOP showed an antiphase pattern. CONCLUSION: CH in both untreated POAG patients and normal participants demonstrated similar diurnal variations, that is, higher at night, independent of confounding factors. These findings suggest that viscoelastic properties of the cornea may fluctuate diurnally independent of IOP.

Using 24-hr ocular dimensional profile recorded with a sensing contact lens to identify primary open-angle glaucoma patients with intraocular pressure constantly below the diagnostic threshold.

PURPOSE: To evaluate the use of a 24-hr ocular dimensional profile recorded with a contact lens sensor (CLS) combined with a single tonometric intraocular pressure (IOP) reading to indicate the potential for exceeding the diagnostic threshold for normal tension glaucoma (NTG) in Japanese patients. METHODS: Intraocular pressure (IOP) of untreated Japanese NTG patients was measured with tonometry every 3 hr from 9:00 to 24:00. The subsequent day a 24-hr CLS (SENSIMED Triggerfish, Sensimed AG, Lausanne, Switzerland) profile was recorded on the same eye. Patients initially diagnosed as NTG were reclassified as NTG when the measured IOP values were consistently <20 mmHg or as primary open-angle glaucoma (POAG) when IOP was ≥20 mmHg in at least 1 measurement. For each patient and each IOP time-point, IOP values were combined with information provided by the CLS profile ('classifier') to indicate the potential for exceeding the diagnostic threshold value. Statistical analyses were performed for each classifier. RESULTS: A total of 65 patients, 28 males and 37 females (mean ages: 50.8 ± 14.6 years and 52.6 ± 10.2 years, respectively), were analysed. Following IOP diurnal measurement, five patients (7.7%) were reclassified as POAG. Two classifiers (15:00 CLS and 18:00 CLS) showed high sensitivity and negative predictive value (100%), identifying all the POAG patients. CONCLUSION: Contact lens sensor information can be used in conjunction with a single tonometric reading to determine patients' potential of having IOP levels exceeding the diagnostic threshold within a 24-hr period, without the need to perform a 24-hr tonometric curve. This would allow clinicians to identify POAG patients who may otherwise be eventually misclassified as NTG.