EyeWorld Asia-Pacific June 2019 Issue

EWAP JUNE 2019 65 DEVICES Imagining the future of IOP monitoring by Liz Hillman EyeWorld Senior Staff Writer Editors’ note: Dr. Sit has ƂPCPEKCN KPVGTGUVU YKVJ +PLGEVUGPUG 'OGT[XKNNG %CNKHQTPKC &T /QUVGT JCU ƂPCPEKCN KPVGTGUVU YKVJ 3WTC &T /CPUQWTK JCU ƂPCPEKCN KPVGTGUVU YKVJ Sensimed and Implandata. Contact information Mansouri: kwmansouri@gmail.com Moster: marlenemoster@gmail.com Sit: Sit.Arthur@mayo.edu I ntraocular pressure and its association with glaucoma dates back to the 10th century, with more widespread recognition and understanding of this association becoming established in the 19th century. 1 Since then, measuring intraocular pressure to detect risk of progression has become standard of care for glaucoma patients and suspects. Despite its long history, there are still many unknowns about IOP, said Arthur Sit, MD , professor of ophthalmology, vice chair of clinical practice, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. But a better understanding might not be far off with advances in the development and testing of continuous IOP-monitoring devices. “Right now, we only measure IOP a few times a year for a few seconds when a patient is in ̅i Vˆ˜ˆV `ÕÀˆ˜} œvwVi…œÕÀÃ]» Dr. Sit said, acknowledging that research has provided insight on what happens, generally, with IOP and circadian patterns. “But this still doesn’t tell us what happens to an individual patient’s IOP during activities of living.” Marlene Moster, MD , professor of ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, said one of the remaining mysteries in understanding glaucoma is IOP over time. What happens at night? What happens during exercise? Is it the same in every patient? What is the patient’s response to a medication change or surgery? These are all questions that continuous IOP monitoring could provide. And, according to Dr. Moster, a device that could truly provide this information is not far off. "˜Þ œ˜i `iۈVip/Àˆ}}iÀwÅ (Sensimed, Lausanne, Switzerland) —is currently approved by the U.S. FDA to provide some of these insights. The 24-hour contact lens monitoring device, however, does not measure IOP directly, rather ocular volume change. Dr. Moster also said Åi ̅ˆ˜ŽÃ /Àˆ}}iÀwňà Ì>ˆœÀi` more toward research situations rather than practical, clinical situations. “But it has been tremendously helpful in our understanding of what happens at night,” she acknowledged. There is also Icare Home (Icare, Raleigh, North Carolina), an FDA-approved, externally applied, at-home tonometer operated by the patient with data retrieved by the healthcare provider. This device, though not continuous, allows patients to collect several IOP measurements throughout a time period as directed by their physician. The ideal continuous IOP monitoring device would come in two iterations, Dr. Sit said. He said a non-invasive, well- tolerated monitoring device, like a contact lens, could be useful to learn more over a short time frame (days) about IOP patterns in glaucoma suspects or those in early stages of the disease who are not surgical candidates. For patients with established glaucoma, Devices for continuous IOP monitoring might not be that far off ICare Home is a portable tonometer that allows patients to measure their IOP at home during several parts of the day/night as prescribed by their ophthalmologist. Source: ICare USA 6JKU CTVKENG QTKIKPCNN[ CRRGCTGF KP VJG /CTEJ KUUWG QH EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ RGTOKUUKQP HTQO VJG #5%45 1RJVJCNOKE 5GTXKEGU %QTR