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Original Investigation | Clinical Sciences

24-Hour Intraocular Pressure Rhythm in Young Healthy Subjects Evaluated With Continuous Monitoring Using a Contact Lens Sensor

Benjamin Mottet, MSc1,2,3; Florent Aptel, MD, PhD1,2,3; Jean-Paul Romanet, MD1,2; Ralitsa Hubanova, MD, MSc1,2; Jean-Louis Pépin, MD, PhD3; Christophe Chiquet, MD, PhD1,2,3
[+] Author Affiliations
1Joseph Fourier University–Grenoble 1, Grenoble, France
2Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble, France
3INSERM U1042, Lab Hypoxia and Physiopathology, Joseph Fourier University, Grenoble, France
JAMA Ophthalmol. 2013;131(12):1507-1516. doi:10.1001/jamaophthalmol.2013.5297.
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Importance  This study evaluates a new device that has been proposed to continuously monitor intraocular pressure (IOP) over 24 hours.

Objective  To evaluate 24-hour IOP rhythm reproducibility during repeated continuous 24-hour IOP monitoring with noncontact tonometry (NCT) and a contact lens sensor (CLS) in healthy participants.

Design, Setting, and Participants  Cross-sectional study of 12 young healthy volunteers at a referral center of chronobiology.

Interventions  Participants were housed in a sleep laboratory and underwent four 24-hour sessions of IOP measurements over a 6-month period. After initial randomized attribution, the IOP of the first eye was continuously monitored using a CLS and the IOP of the fellow eye was measured hourly using NCT. Two sessions with NCT measurements in 1 eye and CLS measurements in the fellow eye, 1 session with CLS measurements in only 1 eye, and 1 session with NCT measurements in both eyes were performed.

Main Outcomes and Measures  A nonlinear least squares, dual-harmonic regression analysis was used to model the 24-hour IOP rhythm. Comparison of acrophase, bathyphase, amplitude, midline estimating statistic of rhythm, IOP values, IOP changes, and agreement were evaluated in the 3 tonometry methods.

Results  A significant nyctohemeral IOP rhythm was found in 31 of 36 sessions (86%) using NCT and in all sessions (100%) using CLS. Hourly awakening during NCT IOP measurements did not significantly change the mean phases of the 24-hour IOP pattern evaluated using CLS in the contralateral eye. Throughout the sessions, intraclass correlation coefficients of the CLS acrophase (0.6 [95% CI, 0.0 to 0.9]; P = .03), CLS bathyphase (0.7 [95% CI, 0.1 to 0.9]; P = .01), NCT amplitude (0.7 [95% CI, 0.1 to 0.9]; P = .01), and NCT midline estimating statistic of rhythm (0.9 [95% CI, 0.9 to 1.0]; P < .01) were significant. When performing NCT measurements in 1 eye and CLS measurements in the contralateral eye, the IOP change at each point normalized from the first measurement (9 am) was not symmetric individually or within the population.

Conclusions and Relevance  The CLS is an accurate and reproducible method to characterize the nyctohemeral IOP rhythm in healthy participants but does not allow for estimating the IOP value in millimeters of mercury corresponding to the relative variation of the electrical signal measured.

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Figures

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Figure 1.
Examples of 24-Hour Raw and Modeled Individual Intraocular Pressure (IOP) Curves of 1 Participant

CLS indicates contact lens sensor; eqVm, electric arbitrary unit; M0, first visit; M4, third visit (4-month); and NCT, noncontact tonometry.

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Figure 2.
Reproducibility and Symmetry of 24-Hour Average Change in Intraocular Pressure (∆IOP) of All Individuals

A-D, Reproducibility of 24-hour ∆IOP. E-G, Symmetry of 24-hour ∆IOP. For each individual, 1 randomly chosen eye was randomized to the eyes 1 group and the fellow eye was included in the eyes 2 group. CLS indicates contact lens sensor; M0, first visit; M2, second visit (2-month); M4, third visit (4-month); M6, fourth visit (6-month); NCT, noncontact tonometry; and SD, standard deviation.

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Figure 3.
Linear Regression of Simultaneous Hourly Mean Intraocular Pressure Values Between the Eyes 1 and Eyes 2 Groups

A, At the fourth visit (6-month) (M6) using noncontact tonometry (NCT). B and C, At the first visit (M0) and third visit (4-month) (M4) using a contact lens sensor (CLS) in the eyes 1 group and NCT in the eyes 2 group in all participants. For each individual, 1 eye was randomized to the eyes 1 group and the fellow eye was included in the eyes 2 group. eqVm indicates electric arbitrary unit.

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Figure 4.
Bland-Altman Graphs of Intraocular Pressure Changes Agreement in the Eyes 1 Group

Changes were calculated between day 0 at 9 am and day 1 at 9 am. A, Agreement between the contact lens sensor (CLS) and noncontact tonometry (NCT). B, Agreement between CLS and Goldmann applanation tonometry (GAT). C, Agreement between NCT and GAT. For each individual, 1 eye was randomized to the eyes 1 group. 95% CI, 95% modeling confidence interval; LCB, global lower 95% confidence bound; M0, first visit; M2, second visit (2-month); M4, third visit (4-month); UCB, global upper 95% confidence bound; and Δ, change in.

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