The Fluctuation of Intraocular Pressure Measured by a Contact Lens Sensor in Normal-Tension Glaucoma Patients and Nonglaucoma Subjects

Tojo, Naoki; Abe, Shinya; Ishida, M.; Yagou, Takaaki; Hayashi, Atsushi

doi:10.1097/ijg.0000000000000517

Cited by 56 publications

(59 citation statements)

References 26 publications

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“…The results suggested a trend towards a higher-amplitude IOP-related profile and faster rates of change in the visual field, although using an α level of 0.05, this was not statistically significant ( p = 0.053). We did, however, find that 13 of 22 eyes (59.1%) had a peak IOP-related profile during nocturnal hours, in agreement with previous studies showing that the majority of patients have a peak IOP at night [2,23,24] , and very similar to a previous study that found 57.1% of patients with NTG to have nocturnal IOP peaks [25] . Although aqueous production decreases during sleep, the nocturnal rise in IOP has been attributed to reduced aqueous outflow, partly due to a recumbent position during sleep, coupled with increased episcleral venous pressure [13,19,24,26] .…”

Section: Discussionsupporting

confidence: 81%

24-Hour Contact Lens Sensor Monitoring of Intraocular Pressure-Related Profiles in Normal-Tension Glaucoma and Rates of Disease Progression

et al. 2017

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Purpose: To determine the relationship between the rate of glaucomatous visual field loss and the amplitude of a 24-h intraocular pressure (IOP)-related profile measured using a contact lens sensor (CLS). Methods: This observational study included 22 patients with glaucoma and an IOP of consistently ≤21 mm Hg during office hours. All subjects underwent Goldmann tonometry, standard automated perimetry (SAP), dilated fundus examination, and had a CLS recording. A cosine function was used to obtain peak (acrophase), trough (bathyphase), and amplitude measurements. Prior rates of change in SAP mean deviation were calculated and compared to CLS parameters. Results: The patients had a mean (± SD) age of 66.6 ± 8.2 years (range 54-89 years). Mean follow-up was 6.6 ± 5.0 years with 8.3 ± 3.2 reliable SAP tests. The mean rate of change in SAP was -0.86 ± 1.0 dB per year (range -0.11 to -2.12 dB). Regression analysis suggested faster rates of prior visual field loss in eyes with higher-amplitude CLS curves, but this did not reach statistical significance (R² = 0.174, p = 0.053). The CLS accurately identified waking and sleeping periods.59.1% of eyes had a nocturnal acrophase (peaking between 23:00 and 07:00). There was no significant difference in rates of visual field change between patients with nocturnal or diurnal acrophase (-0.71 ± 1.17 and -1.07 ± 0.84 dB/year, respectively, p = 0.437). Conclusion: CLS recordings in patients with normal-tension glaucoma (defined by office hours IOP) indicated that 60% of patients had peak IOP during nocturnal hours, which may not be captured using conventional methods of IOP measurement. Novel parameters obtained using the CLS may provide information for predicting the risk of visual field changes for patients with glaucoma.

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Section: Discussionsupporting

confidence: 81%

24-Hour Contact Lens Sensor Monitoring of Intraocular Pressure-Related Profiles in Normal-Tension Glaucoma and Rates of Disease Progression

et al. 2017

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“…Most importantly, the magnitude of change in IOP, rather than absolute IOP, appears to be of greater import for disease etiology in both animal models and human patients. In humans, IOP fluctuations, defined as the difference between the highest and lowest IOP, is greater in glaucoma patients than non-glaucoma patients (Nouri-Mahdavi et al, 2004; Sihota et al, 2005; De Moraes et al, 2011; Tan et al, 2017; Tojo et al, 2017) and is predictive of glaucoma progression (Nouri-Mahdavi et al, 2004; Sihota et al, 2005). Likewise, the magnitude of peak IOP measurement predicts progression in glaucoma patients, even for those with IOP successfully lowered by conventional treatments (Nouri-Mahdavi et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Interleukin-6 Deficiency Attenuates Retinal Ganglion Cell Axonopathy and Glaucoma-Related Vision Loss

2017

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The pleotropic cytokine interleukin-6 (IL-6) is implicated in retinal ganglion cell (RGC) survival and degeneration, including that associated with glaucoma. IL-6 protects RGCs from pressure-induced apoptosis in vitro. However, it is unknown how IL-6 impacts glaucomatous degeneration in vivo. To study how IL-6 influences glaucomatous RGC axonopathy, accompanying glial reactivity, and resultant deficits in visual function, we performed neural tracing, histological, and neurobehavioral assessments in wildtype (B6;129SF2/J; WT) and IL-6 knock-out mice (B6;129S2-IL6tm1kopf/J; IL-6-/-) after 8 weeks of unilateral or bilateral microbead-induced glaucoma (microbead occlusion model). IOP increased by 20% following microbead injection in both genotypes (p < 0.05). However, deficits in wound healing at the site of corneal injection were noted. In WT mice, elevated IOP produced degenerating axon profiles and decreased axon density in the optic nerve by 15% (p < 0.01). In IL-6-/- mice, axon density in the optic nerve did not differ between microbead- and saline-injected mice (p > 0.05) and degenerating axon profiles were minimal. Preservation of RGC axons was reflected in visual function, where visual acuity decreased significantly in a time-dependent manner with microbead-induced IOP elevation in WT (p < 0.001), but not IL-6-/- mice (p > 0.05). Despite this preservation of RGC axons and visual acuity, both microbead-injected WT and IL-6-/- mice exhibited a 50% decrease in anterograde CTB transport to the superior colliculus, as compared to saline-injected controls (p < 0.01). Assessment of glial reactivity revealed no genotype- or IOP-dependent changes in retinal astrocytes. IOP elevation decreased microglia density and percent retinal area covered in WT mice (p < 0.05), while IL-6-/- mice exhibited only a decrease in density (p < 0.05). Together, our findings indicate that two defining features of RGC axonopathy—axon transport deficits and structural degeneration of axons—likely occur via independent mechanisms. Our data suggest that IL-6 is part of a mechanism that specifically leads to structural degeneration of axons. Furthermore, its absence is sufficient to prevent both structural degeneration of the optic nerve and vision loss. Overall, our work supports the proposition that functional deficits in axon transport represent a therapeutic window for RGC axonopathy and identify IL-6 signaling as a strong target for such a therapeutic.

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“…Transient blurred vision, conjunctival hyperemia, and superficial punctate keratitis are the most frequent complications associated with Triggerfish CLS wear, as demonstrated by a number of clinical studies 8–12. Although no serious adverse events have been reported to be associated with the wear of the Triggerfish CLS, mild adverse effects are common.…”

Section: Introductionmentioning

confidence: 99%

“…A study by Tojo et al performed 24-hour CLS monitoring in 14 NTG subjects and 12 healthy individuals 12. Significantly higher ranges of CLS output were observed in NTG patients compared to controls over the entire 24-hour observation period, as well as during diurnal and nocturnal periods when analyzed individually.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives

Dunbar¹,

Shen²,

Aref³

2017

OPTH

100

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Intraocular pressure, a major modifiable risk factor for glaucoma, has been shown to fluctuate throughout the day in patients with glaucoma. The detection and measurement of this fluctuation may help guide the clinical management of glaucomatous individuals. The Sensimed Triggerfish contact lens sensor (CLS), which has recently gained approval for marketing in the USA, is designed to detect intraocular pressure-related changes in an eye over a 24-hour period. This review will provide an overview of the Triggerfish CLS, as well as summarize current clinical data pertaining to the device. Overall, the current evidence suggests that the Triggerfish CLS is safe and well tolerated, and provides reproducible results. One challenge of using the Triggerfish CLS is that it may only provide data on relative changes in intraocular pressure rather than absolute intraocular pressure. In addition, its validity at estimating intraocular pressure compared to other methods is still controversial. Despite these limitations, recent studies suggest a myriad of potential indications for the Triggerfish CLS, including predicting glaucomatous progression and predicting efficacy of glaucoma treatment. With further research, the Triggerfish CLS may become a useful tool for eye care practitioners.

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The Fluctuation of Intraocular Pressure Measured by a Contact Lens Sensor in Normal-Tension Glaucoma Patients and Nonglaucoma Subjects

Cited by 56 publications

References 26 publications

24-Hour Contact Lens Sensor Monitoring of Intraocular Pressure-Related Profiles in Normal-Tension Glaucoma and Rates of Disease Progression

24-Hour Contact Lens Sensor Monitoring of Intraocular Pressure-Related Profiles in Normal-Tension Glaucoma and Rates of Disease Progression

Interleukin-6 Deficiency Attenuates Retinal Ganglion Cell Axonopathy and Glaucoma-Related Vision Loss

The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives

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