Huang Jessie, Katalinic Paula, Kalloniatis Michael, Hennessy Michael P, Zangerl Barbara
Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia.
Optom Vis Sci. 2018 Feb;95(2):88-95. doi: 10.1097/OPX.0000000000001172.
This article shows that self-tonometry can provide robust measures of diurnal intraocular pressure (IOP) and also detect changes to IOP in response to treatment within a short period of monitoring. These advances in IOP monitoring may contribute to improved management of glaucoma patients and suspects.
The aim of this study was to prospectively investigate the utility of rebound self-tonometry performed over several weeks for detecting diurnal IOP fluctuations in glaucoma patients and suspects and also initial response to topical treatment in glaucoma patients.
Forty patients were recruited following glaucoma-specific examination. Subsequent to successful training with the iCare HOME tonometer, patients were instructed to measure IOP, in a sitting position, four times a day over 4 to 6 weeks. Date, time, laterality, and IOP downloaded from the tonometer and clinical examination data, including applanation IOP and corneal thickness, were analyzed. A user satisfaction survey was also administered at study completion. t Test and analysis of variance were used to compare groups and IOP across days. Pearson correlation was used to compare measurements to Goldmann applanation tonometry and IOP measurements from the first day/s to the overall mean IOP.
Twenty-seven patients (18 suspects and 9 glaucoma patients) completed data collection. Patients self-measured IOP on 118 (±29) occasions for 40 (±7.4) days. Two dominant patterns of fluctuation were revealed: peak IOP upon awakening (n = 11) and at midday (n = 13). Diurnal IOP measured in the first 7 days showed strong correlation to diurnal IOP across the entire study period (r = 0.82, P < .0001). Within 24 hours of treatment commencement (latanoprost 0.005% ophthalmic solution), IOP reduced from 23.9 (±5.2) to 16.1 (±2.6) mmHg. Overall, patients rated the instrument as easy to use, although difficulties with correct alignment were expressed.
Rebound self-tonometry demonstrated utility for measuring diurnal IOP fluctuations in most patients, hence enhancing management of patient with or at risk of developing glaucoma.
本文表明，自我眼压测量法能够可靠地测量昼夜眼压（IOP），并在短时间监测内检测出眼压对治疗的反应变化。眼压监测方面的这些进展可能有助于改善青光眼患者及疑似患者的管理。
本研究的目的是前瞻性地调查在数周内进行的回弹式自我眼压测量法在检测青光眼患者及疑似患者的昼夜眼压波动以及青光眼患者对局部治疗的初始反应方面的效用。
在进行青光眼专项检查后招募了40名患者。在用iCare HOME眼压计成功培训后，指导患者在4至6周内每天4次坐着测量眼压。分析从眼压计下载的日期、时间、患侧和眼压以及临床检查数据，包括压平眼压和角膜厚度。在研究结束时还进行了用户满意度调查。采用t检验和方差分析比较各组和各天的眼压。使用Pearson相关性分析将测量结果与Goldmann压平眼压测量法以及第一天至总体平均眼压的眼压测量结果进行比较。
27名患者（18名疑似患者和9名青光眼患者）完成了数据收集。患者在40（±7.4）天内进行了118（±29）次自我眼压测量。揭示了两种主要的波动模式：醒来时眼压峰值（n = 11）和中午时眼压峰值（n = 13）。在研究的前7天测量的昼夜眼压与整个研究期间的昼夜眼压显示出强烈的相关性（r = 0.82，P <.0001）。在开始治疗（0.005%拉坦前列素滴眼液）后的24小时内，眼压从23.9（±5.2）降至16.1（±2.6）mmHg。总体而言，患者认为该仪器易于使用，不过也表示在正确对准方面存在困难。
回弹式自我眼压测量法在大多数患者中显示出测量昼夜眼压波动的效用，从而加强了对患有青光眼或有患青光眼风险患者的管理。
