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Twenty-Four–Hour Intraocular Pressure Monitoring It’s About Time

Ahmad A. Aref, MD1; Ingrid U. Scott, MD, MPH2
[+] Author Affiliations
1Illinois Eye and Ear Infirmary, University of Illinois at Chicago School of Medicine
2Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey
JAMA Ophthalmol. 2013;131(11):1403-1404. doi:10.1001/jamaophthalmol.2013.4700.
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The lowering of intraocular pressure (IOP) remains the only proven method to prevent the development, or slow the progression, of glaucomatous optic neuropathy.1 Unfortunately, patients with seemingly well-controlled, office-measured IOP may still go on to develop glaucomatous visual field progression.

Several explanations exist for glaucomatous progression in the setting of well-controlled office-measured IOP. However, one must also consider the possibility that office-measured IOP may not accurately represent a given patient’s 24-hour IOP profile and that glaucomatous damage may occur during times of undetected increases in IOP. Mosaed et al2 evaluated the correlations between office-hour IOP and peak nocturnal IOP in 68 nonglaucomatous eyes and 35 glaucomatous eyes. The correlation between a single office-hour sitting IOP and peak nocturnal IOP measurements was moderate in glaucomatous eyes (r = 0.557, P < .001) and even less in age-matched nonglaucomatous eyes (r = 0.351, P < .001). The majority of peak 24-hour IOP values (67.2%) in habitual body positions in glaucomatous patients occurred at night. Results of this study suggest that a single office-measured IOP may not be a sufficient indicator of a given individual’s 24-hour IOP profile. The finding that peak IOP occurs at night in the majority of glaucomatous patients is of clinical importance because peak IOP has been shown to be a strong predictor of glaucomatous progression.3

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