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EW GLAUCOMA
December 2015
Medeiros: fmedeiros@glaucoma.ucsd.edu
Quaranta: luciano.quaranta@unibs.it
Sit: sit.arthur@mayo.edu
Germany). "This is a small implant-
able device placed in the ciliary
sulcus during cataract or glaucoma
surgery that directly measures IOP
over the long term," Dr. Mansouri
said. In clinical studies, issues such
as inflammation and long-term
drift of IOP measurements have
been identified, and further study is
warranted.
Provocative testing
If measuring IOP at night to charac-
terize IOP peaks is impractical, there
are a few shortcuts that can approx-
imate peak nocturnal IOP. One is
simply to lay the patient back in
the examination chair and measure
IOP after 3–5 minutes. The rise seen
in the office is correlated to peak
nocturnal IOP.
Another interesting option is
the water-drinking test: Measure a
patient's IOP before and every 15
minutes for an hour after consum-
ing 800–1,000 mL of water.
Remo Susanna, MD, Brazil,
has studied this test extensively and
said, "The water-drinking test is a
tool to estimate IOP peaks. It can re-
veal peaks we don't see during office
hours. Moreover, these peaks during
office hours have been shown to
be related to both the severity and
asymmetry of glaucoma."
Clinical implications
Data suggest that many aspects of
IOP behavior may be associated with
progression risk, and new tools are
emerging to help us better character-
ize IOP in our patients. This may be
of little value in stable patients, but
may benefit others.
"Patient selection for com-
prehensive IOP assessment will be
important," Dr. de Moraes said. "It
will be particularly useful if there is
progression despite apparently good
IOP control, to assess the risk of pro-
gression, to assess treatment efficacy,
and in cases when the accuracy of
IOP measurement is in doubt."
Similarly, we need more research
to better identify the aspects of IOP
behavior that are associated with
glaucoma progression risk. Among
these, Dr. Medeiros said, "We need
to better evaluate the prognostic
significance of IOP fluctuations." EW
Editors' note: Dr. Mansouri has
financial interests with Sensimed.
Drs. de Moraes, Hatanaka, Medeiros,
Quaranta, and Sit have no financial
interests related to this article.
Contact information
de Moraes: cvd2109@cumc.columbia.edu
Hatanaka: marcelohatanaka@gmail.com
Mansouri: kawehm@yahoo.com
