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Zhang Y, Wei Y, Lee CHC, Or PW, Karunaratne IK, Deng M, Yang W, Chong IT, Yang Y, Chen Z, Fan Y, Lam DCC, Yu M. Continuous 24-hour intraocular pressure monitoring in normal Chinese adults using a novel contact lens sensor system. Br J Ophthalmol 2024:bjo-2023-323361. [PMID: 38365429 DOI: 10.1136/bjo-2023-323361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
AIMS To investigate the physiological nyctohemeral intraocular pressure (IOP) rhythms of normal Chinese adults using a novel contact lens sensor system (CLS) that can output IOP in millimetres of mercury (mm Hg) continuously. METHODS Fifty-nine eyes of 59 normal Chinese adults completed 24-hour IOP monitoring using the novel CLS. A descriptive analysis was conducted on the 24-hour IOP mean, peak and acrophase, trough and bathyphase, fluctuation, and mean amplitude of intraocular pressure excursion (MAPE). The continuous data were analysed at several periods (diurnal period, 08:00-20:00 hours; nocturnal period, 22:00-06:00 hours; sleep time, 0:00-06:00 hours), and compared between right and left eyes, males and females, and different age ranges (<30, and ≥30), respectively. RESULTS Normal adults had a lower peak, higher trough, smaller fluctuation and smaller MAPE (p<0.05 for all comparisons) but non-significantly different mean (p=0.695) in the nocturnal period or sleep time compared with the diurnal period. The 24-hour IOP peak and trough showed the frequency of occurrence ranging from 1.69% to 15.25% at an interval of 2 hours. No IOP parameter showed significant difference between right and left eyes (p>0.1 for all comparisons). The male group had larger 24-hour and diurnal IOP fluctuation and MAPE (p<0.05 for all comparisons). Subjects aged 30 or over had higher 24-hour and diurnal mean, higher peak, and larger MAPE (p<0.05 for all comparisons). CONCLUSION Continuous 24-hour IOP output from the CLS in normal Chinese was stable with a comparable mean level between day and night, as well as scattered acrophase and bathyphase. The 24-hour IOP mean increased with age, and IOP variations were positively correlated to age and male sex.
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Affiliation(s)
- Yuning Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ching Hymn Christopher Lee
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Ping Wai Or
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Isuru Kaweendra Karunaratne
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Mingjie Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenxin Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Iok Tong Chong
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yanmei Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - David C C Lam
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Phan A, Truong P, Camp A, Stewart K, Suen B, Weinreb RN, Talke FE. A Wireless Handheld Pressure Measurement System for In Vivo Monitoring of Intraocular Pressure in Rabbits. IEEE Trans Biomed Eng 2019; 67:931-937. [PMID: 31247540 DOI: 10.1109/tbme.2019.2924440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Intraocular pressure (IOP) is the leading modifiable risk factor for preventing vision loss in glaucoma patients. Direct and frequent IOP measurements are highly desirable to assess adequacy of treatment and prevent further vision loss. In this study, we report on successful in vivo measurements of intraocular pressure in rabbits using an optical IOP measurement system. The sensor was implanted during cataract surgery in two New Zealand white (NZW) rabbits and tested in vivo for ten weeks. Prior to implantation, the sensors were characterized in vitro in the physiologically relevant pressure range of 0-60 mmHg. A portable wireless handheld reader consisting of an internal beam splitter, a monochromatic light source, and a digital single-lens reflex (DSLR) camera was also designed and implemented to capture interference patterns from the sensor. The sensitivity and accuracy of the sensor was 30 nm/mmHg and ±0.2 mmHg, respectively. Ten weeks post-implantation, the two NZW rabbits continued to respond well to the implant with no observable inflammation, signs of infection, or biofouling. All IOP measurements were obtained using the portable DSLR handheld reader. Successful in vivo studies demonstrate biocompatibility of the IOP sensor and prove feasibility of the IOP measurement system. The system has the potential to be used in both clinical and patient point-of-care (home) settings to frequently and accurately measure pressure.
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Twenty-Four-Hour Contact Lens Sensor Monitoring of Aqueous Humor Dynamics in Surgically or Medically Treated Glaucoma Patients. J Ophthalmol 2019; 2019:9890831. [PMID: 30809389 PMCID: PMC6369465 DOI: 10.1155/2019/9890831] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
Aim This study assessed the 24 h circadian rhythm of intraocular pressure (IOP) using a contact lens sensor in three groups of patients with open-angle glaucoma. Methods This study was a monocentric, cross-sectional, nonrandomized, prospective, pilot study. Eighty-nine patients were enrolled: 29 patients previously underwent an Ex-PRESS mini glaucoma device procedure (Group 1), 28 patients previously underwent Hydrus microstent implantation (Group 2), and 32 patients were currently being treated medically for primary open-angle glaucoma (Group 3). Circadian rhythm patterns were considered with five circadian indicators: fluctuation ranges, maximum, minimum, acrophase (time of peak value), and bathyphase (time of trough value). A two-tailed Mann–Whitney U-test was used to evaluate differences between groups. Results All subjects exhibited a circadian rhythm and a nocturnal pattern. The signal fluctuation range was significantly smaller in the surgical groups than in the medically treated group (Group 1 vs. Group 3, p=0.003; Group 2 vs. Group 3, p=0.010). Subjects who underwent the Ex-PRESS procedure (Group 1) exhibited significant differences compared with the drug therapy group (Group 3) with regard to the minimum value (p=0.015), acrophase (p=0.009), and bathyphase (p=0.002). The other circadian indicators were not significantly different among groups. Conclusions Patients who underwent IOP-lowering surgery had an intrinsic nyctohemeral rhythm. Both surgical procedures, Ex-PRESS and Hydrus, were associated with smaller signal fluctuations compared with medical treatment.
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Zhang LF, Hargens AR. Spaceflight-Induced Intracranial Hypertension and Visual Impairment: Pathophysiology and Countermeasures. Physiol Rev 2017; 98:59-87. [PMID: 29167331 DOI: 10.1152/physrev.00017.2016] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 12/21/2022] Open
Abstract
Visual impairment intracranial pressure (VIIP) syndrome is considered an unexplained major risk for future long-duration spaceflight. NASA recently redefined this syndrome as Spaceflight-Associated Neuro-ocular Syndrome (SANS). Evidence thus reviewed supports that chronic, mildly elevated intracranial pressure (ICP) in space (as opposed to more variable ICP with posture and activity on Earth) is largely accounted for by loss of hydrostatic pressures and altered hemodynamics in the intracranial circulation and the cerebrospinal fluid system. In space, an elevated pressure gradient across the lamina cribrosa, caused by a chronic but mildly elevated ICP, likely elicits adaptations of multiple structures and fluid systems in the eye which manifest themselves as the VIIP syndrome. A chronic mismatch between ICP and intraocular pressure (IOP) in space may acclimate the optic nerve head, lamina cribrosa, and optic nerve subarachnoid space to a condition that is maladaptive to Earth, all contributing to the pathogenesis of space VIIP syndrome. Relevant findings help to evaluate whether artificial gravity is an appropriate countermeasure to prevent this seemingly adverse effect of long-duration spaceflight.
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Affiliation(s)
- Li-Fan Zhang
- Department of Aerospace Physiology, Fourth Military Medical University, Xi'an, China; and Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Alan R Hargens
- Department of Aerospace Physiology, Fourth Military Medical University, Xi'an, China; and Department of Orthopaedic Surgery, University of California, San Diego, California
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Nuzzi R, Tridico F. Glaucoma: Biological Trabecular and Neuroretinal Pathology with Perspectives of Therapy Innovation and Preventive Diagnosis. Front Neurosci 2017; 11:494. [PMID: 28928631 PMCID: PMC5591842 DOI: 10.3389/fnins.2017.00494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Glaucoma is a common degenerative disease affecting retinal ganglion cells (RGC) and optic nerve axons, with progressive and chronic course. It is one of the most important reasons of social blindness in industrialized countries. Glaucoma can lead to the development of irreversible visual field loss, if not treated. Diagnosis may be difficult due to lack of symptoms in early stages of disease. In many cases, when patients arrive at clinical evaluation, a severe neuronal damage may have already occurred. In recent years, newer perspective in glaucoma treatment have emerged. The current research is focusing on finding newer drugs and associations or better delivery systems in order to improve the pharmacological treatment and patient compliance. Moreover, the application of various stem cell types with restorative and neuroprotective intent may be found appealing (intravitreal autologous cellular therapy). Advances are made also in terms of parasurgical treatment, characterized by various laser types and techniques. Moreover, recent research has led to the development of central and peripheral retinal rehabilitation (featuring residing cells reactivation and replacement of defective elements), as well as innovations in diagnosis through more specific and refined methods and inexpensive tests.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Ophthalmic HospitalTurin, Italy
| | - Federico Tridico
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Ophthalmic HospitalTurin, Italy
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Butt NH, Ayub MH, Ali MH. Challenges in the management of glaucoma in developing countries. Taiwan J Ophthalmol 2016; 6:119-122. [PMID: 29018725 PMCID: PMC5525615 DOI: 10.1016/j.tjo.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 01/05/2023] Open
Abstract
Glaucoma is the most common optic neuropathy characterized by normal to raised intraocular pressure (IOP), visual field defects, loss of retinal nerve fiber layer, thinning of the neuroretinal rim, and cupping of the optic disc. IOP reduction by medical, laser, or surgical therapies remains the only clinically proven treatment of glaucoma. The challenges in glaucoma management are diverse. They include early detection and diagnosis, setting of appropriate target IOP, choice of treatment, monitoring of quality of life and sight, and compliance with the treatment. Early diagnosis can be made by assessing optic nerve structure using imaging devices and optic nerve function through perimetry. Reducing IOP and controlling its fluctuations are considered to be the most important factors in limiting progression of glaucoma. Selection of the best suitable therapy out of medical, surgical, or laser treatment options is yet another management challenge. Patients suffering from glaucoma experience poor quality of life owing to the diagnosis itself, functional visual loss, inconvenience and cost of treatment, and side effects of treatment. All these factors lead to poor compliance, adherence, and persistence to treatment, and further progression of the disease. It is, therefore, important that ophthalmologists keep all the aforementioned factors in mind when managing patients with glaucoma.
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Affiliation(s)
- Nadeem Hafeez Butt
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hammad Ayub
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
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Mansouri K, Medeiros FA, Weinreb RN. Effect of glaucoma medications on 24-hour intraocular pressure-related patterns using a contact lens sensor. Clin Exp Ophthalmol 2015; 43:787-95. [PMID: 26152693 DOI: 10.1111/ceo.12567] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this article was to study the circadian intraocular pressure (IOP)-related effects of ocular hypotensive medications using a contact lens sensor (CLS). DESIGN This is a university-based prospective, randomized, crossover trial. PARTICIPANTS A total of 23 patients with primary open-angle glaucoma participated. METHODS Patients underwent ambulatory recording of IOP-related patterns for 24 h in one eye during 3 monthly sessions using a CLS. Patients were untreated in session 1 (S1), were randomized to one of four classes of glaucoma drops for S2 and had a prostaglandin analogue add-on for S3. MAIN OUTCOME MEASURES Changes in IOP-related patterns were defined using (i) slopes from wake/sitting to sleep/supine; (ii) cosinor rhythmometry modelling; and (iii) area under receiver operating curve (AUC) of sleep period. RESULTS Mean patient age was 63.8 ± 11.8 years. Positive linear slopes were seen from wake/sitting to sleep/supine at S1 (17.1 ± 14.2 mVeq/h) and S2 (5.5 ± 23.9 mVeq/h) and negative slopes at S3 (-1.9 ± 29.4 mVeq/h) (S1-S2, P = 0.01; S1-S3, P = 0.02). In the prostaglandin group, slopes changed significantly with introduction of drops (S1-S2, P < 0.024), whereas they did not in a mixed group combining the three other classes (S1-S2, P = 0.060). Overall, cosinor amplitudes were 98.4 ± 46.5 mVeq (S1), 113.0 ± 35.6 mVeq (S2) and 109.6 ± 58.3 mVeq (S3) (S1-S2, P = 0.23; S1-S3, P = 0.66; S2-S3, P = 0.93). AUC were 91.8 ± 63.0 mVeq (S1), 76.3 ± 102.7 mVeq (S2) and 19.9 ± 135.8 mVeq (S3). Differences between sessions were not statistically significant (S1-S2, P = 0.541; S1-S3, P = 0.083; S2-S3, P = 0.092). CONCLUSIONS Prostaglandin analogues, but not other medications, seem to flatten the IOP-related increase at transition of the wake/sitting to the sleep/supine period, but do not seem to have an effect on acrophase and amplitude.
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Affiliation(s)
- Kaweh Mansouri
- Hamilton Glaucoma Center and Shiley Eye Center, Department of Ophthalmology, University of California, San Diego, California, USA.,Glaucoma Center, Montchoisi Clinic, Genolier Swiss Vision Network, Lausanne, Switzerland
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Shiley Eye Center, Department of Ophthalmology, University of California, San Diego, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Shiley Eye Center, Department of Ophthalmology, University of California, San Diego, California, USA
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Mansouri K, Weinreb RN, Liu JHK. Efficacy of a contact lens sensor for monitoring 24-h intraocular pressure related patterns. PLoS One 2015; 10:e0125530. [PMID: 25942434 PMCID: PMC4420265 DOI: 10.1371/journal.pone.0125530] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/15/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To study performance of a contact lens sensor (CLS) for 24-hour monitoring of IOP-related short-term patterns and compare with IOP obtained by pneumatonometry. Methods Prospective clinical trial. Thirty-one healthy volunteers and 2 glaucoma patients were housed for 24 hours in a sleep laboratory. One randomly selected eye was fitted with a CLS (Triggerfish, Sensimed, Switzerland), which measures changes in ocular circumference. In the contralateral eye, IOP measurements were taken using a pneumatonometer every two hours with subjects in the habitual body positions. Heart rate (HR) was measured 3 times during the night for periods of 6 minutes separated by 2 hours. Performance of CLS was defined in two ways: 1) recording the known pattern of IOP increase going from awake (sitting position) to sleep (recumbent), defined as the wake/sleep (W/S) slope and 2) accuracy of the ocular pulse frequency (OPF) concurrent to that of the HR interval. Strength of association between overall CLS and pneumatonometer curves was assessed using coefficients of determination (R2). Results The W/S slope was statistically significantly positive in both eyes of each subject (CLS, 57.0 ± 40.5 mVeq/h, p<0.001 and 1.6 ± 0.9 mmHg/h, p<0.05 in the contralateral eye). In all, 87 CLS plots concurrent to the HR interval were evaluated. Graders agreed on evaluability for OPF in 83.9% of CLS plots. Accuracy of the CLS to detect the OPF was 86.5%. Coefficient of correlation between CLS and pneumatonometer for the mean 24-h curve was R2 = 0.914. Conclusions CLS measurements compare well to the pneumatonometer and may be of practical use for detection of sleep-induced IOP changes. The CLS also is able to detect ocular pulsations with good accuracy in a majority of eyes. Trial Registration ClinicalTrials.gov NCT01390779
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Affiliation(s)
- Kaweh Mansouri
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
- Glaucoma Sector, Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Robert N. Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
| | - John H. K. Liu
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
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Gisler C, Ridi A, Hennebert J, Weinreb RN, Mansouri K. Automated Detection and Quantification of Circadian Eye Blinks Using a Contact Lens Sensor. Transl Vis Sci Technol 2015; 4:4. [PMID: 25635236 PMCID: PMC4306263 DOI: 10.1167/tvst.4.1.4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/28/2014] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To detect and quantify eye blinks during 24-hour intraocular pressure (IOP) monitoring with a contact lens sensor (CLS). METHODS A total of 249 recordings of 24-hour IOP patterns from 202 participants using a CLS were included. Software was developed to automatically detect eye blinks, and wake and sleep periods. The blink detection method was based on detection of CLS signal peaks greater than a threshold proportional to the signal amplitude. Three methods for automated detection of the sleep and wake periods were evaluated. These relied on blink detection and subsequent comparison of the local signal amplitude with a threshold proportional to the mean signal amplitude. These methods were compared to manual sleep/wake verification. In a pilot, simultaneous video recording of 10 subjects was performed to compare the software to observer-measured blink rates. RESULTS Mean (SD) age of participants was 57.4 ± 16.5 years (males, 49.5%). There was excellent agreement between software-detected number of blinks and visually measured blinks for both observers (intraclass correlation coefficient [ICC], 0.97 for observer 1; ICC, 0.98 for observer 2). The CLS measured a mean blink frequency of 29.8 ± 15.4 blinks/min, a blink duration of 0.26 ± 0.21 seconds and an interblink interval of 1.91 ± 2.03 seconds. The best method for identifying sleep periods had an accuracy of 95.2 ± 0.5%. CONCLUSIONS Automated analysis of CLS 24-hour IOP recordings can accurately quantify eye blinks, and identify sleep and wake periods. TRANSLATIONAL RELEVANCE This study sheds new light on the potential importance of eye blinks in glaucoma and may contribute to improved understanding of circadian IOP characteristics.
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Affiliation(s)
- Christophe Gisler
- ICT Institute, University of Applied Sciences Western Switzerland, Fribourg, Switzerland
| | - Antonio Ridi
- ICT Institute, University of Applied Sciences Western Switzerland, Fribourg, Switzerland
| | - Jean Hennebert
- ICT Institute, University of Applied Sciences Western Switzerland, Fribourg, Switzerland
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, USA
| | - Kaweh Mansouri
- Glaucoma sector, Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, USA
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Wentz SM, Kim NJ, Wang J, Amireskandari A, Siesky B, Harris A. Novel therapies for open-angle glaucoma. F1000PRIME REPORTS 2014; 6:102. [PMID: 25580256 PMCID: PMC4229725 DOI: 10.12703/p6-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Open-angle glaucoma is a multifactorial optic neuropathy characterized by progressive loss of retinal ganglion cells and their axons. It is an irreversible disease with no established cure. The only currently approved treatment is aimed at lowering intraocular pressure, the most significant risk factor known to date. However, it is now clear that there are other risk factors involved in glaucoma's pathophysiology. To achieve future improvements in glaucoma management, new approaches to therapies and novel targets must be developed. Such therapies may include new tissue targets for lowering intraocular pressure, molecules influencing ocular hemodynamics, and treatments providing neuroprotection of retinal ganglion cells. Furthermore, novel drug delivery systems are in development that may improve patient compliance, increase bioavailability, and decrease adverse side effects.
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Huchzermeyer C, Reulbach U, Horn F, Lämmer R, Mardin CY, Jünemann AGM. Longitudinal stability of the diurnal rhythm of intraocular pressure in subjects with healthy eyes, ocular hypertension and pigment dispersion syndrome. BMC Ophthalmol 2014; 14:122. [PMID: 25316067 PMCID: PMC4210493 DOI: 10.1186/1471-2415-14-122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/24/2014] [Indexed: 11/25/2022] Open
Abstract
Background The diurnal fluctuation of intraocular pressure may be relevant in glaucoma. The aim of this study was to find out whether the timing of diurnal fluctuation is stable over the years. Methods Long-term IOP data from the Erlangen Glaucoma Registry, consisting of several annual extended diurnal IOP profiles for each patient, was retrospectively analyzed. Normal subjects, patients with ocular hypertension and with pigment dispersion syndrome were included because these subjects had not been treated with antiglaucomatous medications at the time of data acquisition. A cosine curve was fitted to the IOP data and the stability of individual rhythms over the years was tested using the Rayleigh test. To compare the peak times among groups, means were calculated only from subjects with a significant Rayleigh test. Results Of the fifty-two eligible subjects, a total of 364 extended diurnal IOP profiles measured in a sitting position had been collected over a period of 114 ± 39 months. The Rayleigh test indicated intraindividual stability of phase timing only in 19 subjects (36%). In subjects with pigment dispersions syndrome, peak IOP occurred on average two hours and seven minutes later during the day compared with subjects without this condition (p = 0.05). Conclusions Fitting of cosine curves to the clinical IOP profiles was generally feasible, although careful interpretation is warranted due to lack of measurements in supine position and between midnight and 7 am. The interesting observation of a phase lag in eyes with pigment dispersion syndrome warrants confirmation and exploration in future prospective studies. The analysis of the IOP data showed no stable individual rhythm in the long term in a majority of patients.
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Affiliation(s)
- Cord Huchzermeyer
- Department of Ophthalmology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Paschalis EI, Cade F, Melki S, Pasquale LR, Dohlman CH, Ciolino JB. Reliable intraocular pressure measurement using automated radio-wave telemetry. Clin Ophthalmol 2014; 8:177-85. [PMID: 24531415 PMCID: PMC3891580 DOI: 10.2147/opth.s54753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present an autonomous intraocular pressure (IOP) measurement technique using a wireless implantable transducer (WIT) and a motion sensor. METHODS The WIT optical aid was implanted within the ciliary sulcus of a normotensive rabbit eye after extracapsular clear lens extraction. An autonomous wireless data system (AWDS) comprising of a WIT and an external antenna aided by a motion sensor provided continuous IOP readings. The sensitivity of the technique was determined by the ability to detect IOP changes resulting from the administration of latanoprost 0.005% or dorzolamide 2%, while the reliability was determined by the agreement between baseline and vehicle (saline) IOP. RESULTS On average, 12 diurnal and 205 nocturnal IOP measurements were performed with latanoprost, and 26 diurnal and 205 nocturnal measurements with dorzolamide. No difference was found between mean baseline IOP (13.08±2.2 mmHg) and mean vehicle IOP (13.27±2.1 mmHg) (P=0.45), suggesting good measurement reliability. Both antiglaucoma medications caused significant IOP reduction compared to baseline; latanoprost reduced mean IOP by 10% (1.3±3.54 mmHg; P<0.001), and dorzolamide by 5% (0.62±2.22 mmHg; P<0.001). Use of latanoprost resulted in an overall twofold higher IOP reduction compared to dorzolamide (P<0.001). Repeatability was ±1.8 mmHg, assessed by the variability of consecutive IOP measurements performed in a short period of time (≤1 minute), during which the IOP is not expected to change. CONCLUSION IOP measurements in conscious rabbits obtained without the need for human interactions using the AWDS are feasible and provide reproducible results.
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Affiliation(s)
| | - Fabiano Cade
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Samir Melki
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Claes H Dohlman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Joseph B Ciolino
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Abstract
Although intraocular pressure (IOP) is the only treatable risk factor for glaucoma, its 24-hour behavior is poorly understood. Conflicting information is available in the literature with regard to the importance and predictive value of IOP peaks and fluctuations on the risk of glaucoma development and progression. This may be secondary to lack of prospective studies designed to address this issue. This article critically reviews the current evidence for the importance of 24-h IOP measurements in glaucoma and discusses shortcomings of current methods to assess 24-h IOP data, drawing attention to new developments in this field.
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Affiliation(s)
- Kaweh Mansouri
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093-0946, USA
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Grippo TM, Liu JHK, Zebardast N, Arnold TB, Moore GH, Weinreb RN. Twenty-four-hour pattern of intraocular pressure in untreated patients with ocular hypertension. Invest Ophthalmol Vis Sci 2013; 54:512-7. [PMID: 23211815 DOI: 10.1167/iovs.12-10709] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated ocular hypertensive (OHTN) patients. METHODS IOP measurements were taken every 2 hours during a 24-hour period from 15 untreated OHTN patients (ages 41-77 years). Measurements were both sitting and supine (diurnal) and supine only (nocturnal). Mean diurnal and nocturnal IOPs in the OHTN group were compared to previously reported values in age-matched healthy and glaucomatous eyes. Post hoc analysis compared the 24-hour IOP pattern of the OHTN patients who converted to glaucoma and those who did not with that in the same healthy and glaucomatous eyes. RESULTS Mean sitting and supine IOPs were significantly higher in the OHTN group than in the healthy control but not the glaucoma group. Similar to the glaucoma group, the OHTN group demonstrated significant differences from healthy controls in diurnal IOP variation and IOP changes upon awakening in habitual and supine positions. The 24-hour IOP curve acrophases and amplitudes for OHTNs were closer to those of the glaucoma than the healthy control group in the habitual position. Thirty-three percent of OHTNs developed glaucoma during a mean follow-up period of 4.3 ± 3.8 years. Similar to findings in the glaucoma group, habitual IOP curve phase delay, habitual IOP variation, diurnal-to-nocturnal IOP changes, and IOP changes upon awakening of the converters were significantly different from those in healthy controls. There were no differences between nonconverters and other groups. CONCLUSIONS Baseline 24-hour IOP pattern in OHTN patients is similar to that in glaucomatous patients. In contrast to nonconverters, OHTN patients who converted to glaucoma are significantly different from healthy controls.
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Affiliation(s)
- Tomas M Grippo
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California at San Diego, La Jolla, California, USA.
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Luna C, Li G, Huang J, Qiu J, Wu J, Yuan F, Epstein DL, Gonzalez P. Regulation of trabecular meshwork cell contraction and intraocular pressure by miR-200c. PLoS One 2012; 7:e51688. [PMID: 23272142 PMCID: PMC3522713 DOI: 10.1371/journal.pone.0051688] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/05/2012] [Indexed: 01/20/2023] Open
Abstract
Lowering intraocular pressure (IOP) delays or prevents the loss of vision in primary open-angle glaucoma (POAG) patients with high IOP and in those with normal tension glaucoma showing progression. Abundant evidence demonstrates that inhibition of contractile machinery of the trabecular meshwork cells is an effective method to lower IOP. However, the mechanisms involved in the regulation of trabecular contraction are not well understood. Although microRNAs have been shown to play important roles in the regulation of multiple cellular functions, little is known about their potential involvement in the regulation of IOP. Here, we showed that miR-200c is a direct postranscriptional inhibitor of genes relevant to the physiologic regulation of TM cell contraction including the validated targets Zinc finger E-box binding homeobox 1 and 2 (ZEB1 and ZEB2), and formin homology 2 domain containing 1 (FHOD1), as well as three novel targets: lysophosphatidic acid receptor 1 (LPAR1/EDG2), endothelin A receptor (ETAR), and RhoA kinase (RHOA). Consistently, transfection of TM cells with miR-200c resulted in strong inhibition of contraction in collagen populated gels as well as decreased cell traction forces exerted by individual TM cells. Finally, delivery of miR-200c to the anterior chamber of living rat eyes resulted in a significant decrease in IOP, while inhibition of miR-200c using an adenoviral vector expressing a molecular sponge led to a significant increase in IOP. These results demonstrate for the first time the ability of a miRNA to regulate trabecular contraction and modulate IOP in vivo, making miR-200c a worthy candidate for exploring ways to alter trabecular contractility with therapeutic purposes in glaucoma.
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Affiliation(s)
- Coralia Luna
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
| | - Guorong Li
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
| | - Jianyong Huang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Jianming Qiu
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
| | - Jing Wu
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
| | - Fan Yuan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - David L. Epstein
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
| | - Pedro Gonzalez
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
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Mansouri K, Liu JHK, Weinreb RN, Tafreshi A, Medeiros FA. Analysis of continuous 24-hour intraocular pressure patterns in glaucoma. Invest Ophthalmol Vis Sci 2012; 53:8050-6. [PMID: 23139273 DOI: 10.1167/iovs.12-10569] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To present a method to analyze circadian intraocular pressure (IOP) patterns in glaucoma patients and suspects undergoing repeated continuous 24-hour IOP monitoring. METHODS Forty patients with established (n = 19) or suspected glaucoma (n = 21) underwent ambulatory 24-hour IOP monitoring on two sessions 1 week apart using a contact lens sensor (CLS). The CLS provides its output in arbitrary units (a.u.). A modified cosinor rhythmometry method was adapted to the CLS output to analyze 24-hour IOP patterns and their reproducibility. Nonparametric tests were used to study differences between sessions 1 and 2 (S1 and S2). Patients pursued their routine daily activities and their sleep was uncontrolled. CLS data were used to assess sleep times. RESULTS Complete 24-hour data from both sessions were available for 35 patients. Mean (SD) age of the patients was 55.8 ± 15.5 years. The correlation of the cosinor fitting and measured CLS values was r = 0.38 (Spearman r; P < 0.001) for S1, r = 0.50 (P < 0.001) for S2, whereas the correlation between S1 and S2 cosinor fittings was r = 0.76 (P < 0.001). Repeated nocturnal acrophase was seen in 62.9% of patients; 17.1% of patients had no repeatable acrophase. The average amplitude of the 24-hour curve was 143.6 ± 108.1 a.u. (S1) and 130.8 ± 68.2 a.u. (S2) (P = 0.936). CONCLUSIONS Adapting the cosinor method to CLS data is a useful way for modeling the rhythmic nature of 24-hour IOP patterns and evaluating their reproducibility. Repeatable nocturnal acrophase was seen in 62.9% of patients. (ClinicalTrials.gov number, NCT01319617.).
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Affiliation(s)
- Kaweh Mansouri
- Hamilton Glaucoma Center and Shiley Eye Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
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