Eyeworld

35 EW GLAUCOMA December 2018 Contact information Kahook: malik.kahook@gmail.com Mosaed: smosaed@uci.edu to be adequate therapy, 24-hour IOP data might lead to some clues that could help dramatically improve outcomes. "Perhaps the patient is not always taking his or her drops, and continuous monitoring will reveal non-adherence that is difficult to gauge from clinic visit interac- tions," Dr. Kahook said. "Perhaps the patient has a large spike in IOP at night when sleeping, and chang- ing the medical or surgical approach to care could lead to stabilizing these spikes over time. These are a couple of scenarios where I can see continuous monitoring leading to an enhancement of outcomes in a subgroup of patients." Dr. Mosaed agreed. "I think 24-hour IOP monitoring makes sense if a patient's glaucoma seems to be getting worse despite what is considered controlled intraocular pressure in the office setting. This makes you wonder if he or she is having IOP spikes outside of office hours. Are patients having noctur- nal IOP elevation? Do they have decreased perfusion pressure during the nocturnal period or some other explanation for why they would be getting worse? These are patients in whom it would make sense to do a sleep study," she said. She added that perfusion pressure is an important concept in these patients as well. "A lot of the information that we're getting from 24-hour IOP studies relates not just to IOP but also to what happens to systemic blood pressure during the nocturnal period as it relates to IOP. Are some of these patients progress- ing because they have decreased per- fusion pressure during the nocturnal or even diurnal periods? So, 24-hour IOP by itself as an isolated measure may not be as relevant as 24-hour perfusion pressure," Dr. Mosaed said. With regard to the future, Dr. Kahook thinks we are in the mid- dle of a revolution in the surgical management of glaucoma utilizing microinvasive techniques with a fa- vorable risk-benefit profile. "This has pushed surgical intervention into an earlier treatment modality for glau- coma patients, and obtaining more reliable data on adherence problems or lack of therapeutic efficacy from medications might help drive deci- sion-making to earlier surgery with enhanced outcomes," Dr. Kahook said. EW Editors' note: The physicians have no financial interests related to their comments. 840 Walnut St., Philadelphia, PA 19107 | willseye.org | 877.289.4557 Allen C. Ho, MD, FACS Director, Retina Research *Based on a Doximity clinical reputation survey for 2018-2019. When conquering eye disease demands resolve, we embrace the long and difficult road. That's part of the reason so many residents want to come to Wills Eye Hospital to train. We teach perseverance. Voted #1 ophthalmology residency program in the United States.* Where no challenge is too great.

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