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Duan Z, Yuan M, Liu Z, Pei W, Jiang K, Li L, Shen G. An Ultrasensitive Ti 3C 2T x MXene-based Soft Contact Lens for Continuous and Nondestructive Intraocular Pressure Monitoring. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309785. [PMID: 38377279 DOI: 10.1002/smll.202309785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Indexed: 02/22/2024]
Abstract
Wearable soft contact lens sensors for continuous and nondestructive intraocular pressure (IOP) monitoring are highly desired as glaucoma and postoperative myopia patients grow, especially as the eyestrain crowd increases. Herein, a smart closed-loop system is presented that combines a Ti3C2Tx MXene-based soft contact lens (MX-CLS) sensor, wireless data transmission units, display, and warning components to realize continuous and nondestructive IOP monitoring/real-time display. The fabricated MX-CLS device exhibits an extremely high sensitivity of 7.483 mV mmHg-1, good linearity on silicone eyeballs, excellent stability under long-term pressure-release measurement, sufficient transparency with 67.8% transmittance under visible illumination, and superior biocompatibility with no discomfort when putting the MX-CLS sensor onto the Rabbit eyes. After integrating with the wireless module, users can realize real-time monitoring and warning of IOP via smartphones, the demonstrated MX-CLS device together with the IOP monitoring/display system opens up promising platforms for Ti3C2Tx materials as the base for multifunctional contact lens-based sensors and continuous and nondestructive IOP measurement system.
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Affiliation(s)
- Zhongyi Duan
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, 100081, P. R. China
| | - Miao Yuan
- State Key Laboratory of Integrated Optoelectronics Institute of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, P. R. China
| | - Zhiduo Liu
- School of Physics, Beijing Institute of Technology, Beijing, 100081, P. R. China
| | - Weihua Pei
- State Key Laboratory of Integrated Optoelectronics Institute of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, P. R. China
| | - Kai Jiang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA & Key Laboratory of Digital Hepatobiliary Surgery, Beijing, 100853, P. R. China
| | - La Li
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, 100081, P. R. China
| | - Guozhen Shen
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, 100081, P. R. China
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2
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Mcmonnies CW. The importance of and potential for continuous monitoring of intraocular pressure. Clin Exp Optom 2021; 100:203-207. [DOI: 10.1111/cxo.12497] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Charles W Mcmonnies
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia,
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Yang C, Huang X, Li X, Yang C, Zhang T, Wu Q, liu D, Lin H, Chen W, Hu N, Xie X. Wearable and Implantable Intraocular Pressure Biosensors: Recent Progress and Future Prospects. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002971. [PMID: 33747725 PMCID: PMC7967055 DOI: 10.1002/advs.202002971] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Indexed: 05/09/2023]
Abstract
Biosensors worn on or implanted in eyes have been garnering substantial attention since being proven to be an effective means to acquire critical biomarkers for monitoring the states of ophthalmic disease, diabetes. Among these disorders, glaucoma, the second leading cause of blindness globally, usually results in irreversible blindness. Continuous intraocular pressure (IOP) monitoring is considered as an effective measure, which provides a comprehensive view of IOP changes that is beyond reach for the "snapshots" measurements by clinical tonometry. However, to satisfy the applications in ophthalmology, the development of IOP sensors are required to be prepared with biocompatible, miniature, transparent, wireless and battery-free features, which are still challenging with many current fabrication processes. In this work, the recent advances in this field are reviewed by categorizing these devices into wearable and implantable IOP sensors. The materials and structures exploited for engineering these IOP devices are presented. Additionally, their working principle, performance, and the potential risk that materials and device architectures may pose to ocular tissue are discussed. This review should be valuable for preferable structure design, device fabrication, performance optimization, and reducing potential risk of these devices. It is significant for the development of future practical IOP sensors.
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Affiliation(s)
- Cheng Yang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xiangling Li
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- School of Biomedical EngineeringSun Yat‐Sen UniversityGuangzhou510006China
| | - Chengduan Yang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Tao Zhang
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- School of Biomedical EngineeringSun Yat‐Sen UniversityGuangzhou510006China
| | - Qianni Wu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Dong liu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Haotian Lin
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Weirong Chen
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
| | - Ning Hu
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and TechnologiesGuangdong Province Key Laboratory of Display Material and TechnologySchool of Electronics and Information TechnologyThe First Affiliated Hospital of Sun Yat‐Sen UniversitySun Yat‐Sen UniversityGuangzhou510006China
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhou510060China
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Dou Z, Tang J, Liu Z, Sun Q, Wang Y, Li Y, Yuan M, Wu H, Wang Y, Pei W, Chen H. Wearable Contact Lens Sensor for Non-invasive Continuous Monitoring of Intraocular Pressure. MICROMACHINES 2021; 12:108. [PMID: 33499080 PMCID: PMC7910926 DOI: 10.3390/mi12020108] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Intraocular pressure (IOP) is an essential indicator of the diagnosis and treatment of glaucoma. IOP has an apparent physiological rhythm, and it often reaches its peak value at night. To avoid missing the peak value at night and sample the entire rhythm cycle, the continuous monitoring of IOP is urgently needed. A wearable contact lens IOP sensor based on a platinum (Pt) strain gauge is fabricated by the micro-electro-mechanical (MEMS) process. The structure and parameters of the strain gauge are optimized to improve the sensitivity and temperature stability. Tests on an eyeball model indicate that the IOP sensor has a high sensitivity of 289.5 μV/mmHg and excellent dynamic cycling performance at different speeds of IOP variation. The temperature drift coefficient of the sensor is 33.4 μV/°C. The non-invasive IOP sensor proposed in this report exhibits high sensitivity and satisfactory stability, promising a potential in continuous IOP monitoring.
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Affiliation(s)
- Zhiqiang Dou
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jun Tang
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhiduo Liu
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qigong Sun
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yang Wang
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
| | - Yamin Li
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Miao Yuan
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China;
| | - Yijun Wang
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Weihua Pei
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hongda Chen
- The State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; (Z.D.); (J.T.); (Z.L.); (Q.S.); (Y.W.); (Y.L.); (M.Y.); (Y.W.); (H.C.)
- University of Chinese Academy of Sciences, Beijing 100049, China
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Enders P, Cursiefen C. Device profile of the EYEMATE-IO™ system for intraocular pressure monitoring: overview of its safety and efficacy. Expert Rev Med Devices 2020; 17:491-497. [DOI: 10.1080/17434440.2020.1761788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Philip Enders
- Department of Ophthalmology, University Hospital of Cologne , Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University Hospital of Cologne , Cologne, Germany
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Analysis of peripapillary vessel density and Bruch's membrane opening-based neuroretinal rim parameters in glaucoma using OCT and OCT-angiography. Eye (Lond) 2019; 34:1086-1093. [PMID: 31649346 DOI: 10.1038/s41433-019-0631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/14/2019] [Accepted: 09/25/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare peripapillary vessel density (VD) measured by spectral domain optical coherence tomography angiography (SD-OCT-A) with morphometric parameters assessing the neuroretinal rim based on Bruch's membrane opening (BMO) by spectral domain optical coherence tomography (SD-OCT) in glaucoma. METHODS In this non-interventional cohort study, 50 eyes of 25 consecutively enrolled patients with diagnosis of glaucoma underwent SD-OCT and SD-OCT-A imaging of the optic nerve head (ONH). BMO minimum rim width (BMO-MRW) and area (BMO-MRA) as well as peripapillary retinal nerve fiber layer (RNFL) thickness were compared to peripapillary VD in the RNFL layer around the ONH. RESULTS Mean BMO-MRW was 221.46 ± 81.5 µm, mean BMO-MRA was 1.05 ± 0.04 mm2, mean RNFL thickness was 72.46 ± 23.16 µm, and mean VD was 43.8 ± 11.4%. VD was significantly lower when morphometric parameters had lower thickness values (p < 0.01). Correlation coefficients and their 95%- confidence intervals (95%-CI) with VD were r = 0.53 (95%-CI: 0.21-0.77) for BMO-MRW, r = 0.55 (95%-CI: 0.21-0.77) for BMO-MRA, and r = 0.57 (95%-CI: 0.13-0.73) for RNFL thickness. Intra-individual VD in both eyes correlated with r = 0.72 (p < 0.001), mean VD was comparable (p = 0.6). Eyes with high global RNFL thickness (>90 µm) showed less VD variance (σ2 = 48.1) compared to eyes with highly reduced RNFL thickness (<65 µm; σ2 = 82.0). Best corrected visual acuity, perimetric mean defect, and PSD correlated significantly with VD (95%-CI: -0.66 to -0.10, 0.16 to 0.6, and -0.65 to -0.02, respectively). CONCLUSIONS Peripapillary vessel density measured by SD-OCT angiography correlates significantly with Bruch's membrane opening-based parameters measured by SD-OCT in glaucoma patients.
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Osmers J, Sorg M, Fischer A. Optical measurement of the corneal oscillation for the determination of the intraocular pressure. ACTA ACUST UNITED AC 2019; 64:471-480. [DOI: 10.1515/bmt-2018-0093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Motivation
Glaucoma is currently the most common irreversible cause of blindness worldwide. A significant risk factor is an individually increased intraocular pressure (IOP). A precise measurement method is needed to determine the IOP in order to support the diagnosis of the disease and to monitor the outcome of the IOP reduction as a medical intervention. A handheld device is under development with which the patient can perform self-measurements outside the clinical environment.
Method
For the measurement principle of the self-tonometer the eye is acoustically excited to oscillate, which is analyzed and attributed to the present IOP. In order to detect the corneal oscillation, an optical sensor is required which meets the demands of a compact, battery driven self-tonometer. A combination of an infrared diode and a phototransistor provides a high-resolution measurement of the corneal oscillation in the range of 10 μm–150 μm, which is compared to a reference sensor in the context of this study. By means of an angular arrangement of the emitter and the detector, the degree of reflected radiation of the cornea can be increased, allowing a measurement with a high signal-to-noise ratio.
Results
By adjusting the angle of incidence between the detector and the emitter, the signal-to-noise ratio was improved by 40 dB which now allows reasonable measurements of the corneal oscillation. For low amplitudes (10 μm) the signal-to-noise ratio is 10% higher than that of the commercial reference sensor. On the basis of amplitude variations at different IOP levels, the estimated standard uncertainty amounts to <0.5 mm Hg in the physiological pressure range with the proposed measuring approach.
Conclusion
With a compact and cost-effective approach, that suits the requirements for a handheld self-tonometer, the corneal oscillation can be detected with high temporal resolution. The cross-sensitivity of the sensor concept concerning a distance variation can be reduced by adding a distance sensor. Existing systematic influences of corneal biomechanics will be integrated in the sensor concept as a consecutive step.
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Sharif NA. iDrugs and iDevices Discovery Research: Preclinical Assays, Techniques, and Animal Model Studies for Ocular Hypotensives and Neuroprotectants. J Ocul Pharmacol Ther 2018; 34:7-39. [PMID: 29323613 DOI: 10.1089/jop.2017.0125] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Discovery ophthalmic research is centered around delineating the molecular and cellular basis of ocular diseases and finding and exploiting molecular and genetic pathways associated with them. From such studies it is possible to determine suitable intervention points to address the disease process and hopefully to discover therapeutics to treat them. An investigational new drug (IND) filing for a new small-molecule drug, peptide, antibody, genetic treatment, or a device with global health authorities requires a number of preclinical studies to provide necessary safety and efficacy data. Specific regulatory elements needed for such IND-enabling studies are beyond the scope of this article. However, to enhance the overall data packages for such entities and permit high-quality foundation-building publications for medical affairs, additional research and development studies are always desirable. This review aims to provide examples of some target localization/verification, ocular drug discovery processes, and mechanistic and portfolio-enhancing exploratory investigations for candidate drugs and devices for the treatment of ocular hypertension and glaucomatous optic neuropathy (neurodegeneration of retinal ganglion cells and their axons). Examples of compound screening assays, use of various technologies and techniques, deployment of animal models, and data obtained from such studies are also presented.
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Affiliation(s)
- Najam A Sharif
- 1 Global Alliances & External Research , Santen Incorporated, Emeryville, California.,2 Department of Pharmaceutical Sciences, Texas Southern University , Houston, Texas.,3 Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center , Fort Worth, Texas
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Mariacher S, Ebner M, Hurst J, Szurman P, Januschowski K. Implantation and testing of a novel episcleral pressure transducer: A new approach to telemetric intraocular pressure monitoring. Exp Eye Res 2017; 166:84-90. [PMID: 29066280 DOI: 10.1016/j.exer.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
Measurement of intraocular pressure (IOP) is an essential tool in monitoring glaucoma. Single IOP assessments during clinical routine examinations represent punctual values and are not able to identify IOP fluctuations and spikes. Telemetric IOP measurements are able to monitor IOP during the day and night, and are location-independent. Six telemetric episcleral IOP sensors were investigated after minimally invasive subconjunctival implantation in 6 eyes of 6 New-Zealand-White rabbits. Three of the 4 edges of the implant were fixated intrasclerally with non-absorbable sutures. The sutures were stitched into the edges of the implants' silicone rubber encasements. Telemetric IOP measurements were validated 1 week, 4 weeks, 8 weeks, 12 weeks and 30 weeks after implantation. For each validation the anterior chamber was cannulated and connected to a height-adjustable water column. Different intracameral pressure levels (10-45 mmHg) were generated by height adjustment of the water column. Measurement reliability and concordance between telemetric and intracameral IOP was validated using Bland-Altman analysis. Overall comparison (10-45 mmHg) between telemetric and intracameral pressure revealed a standard deviation of ±1.0 mmHg. A comparison of pressure values in the range between 10 and 30 mmHg revealed a standard deviation of ±0.8 mmHg. Device deficiency was related to follow-up length: 4 weeks after implantation, 3 of the 6 sensors showed malfunction, with all sensors having failed 30 weeks after implantation. The most likely reason for the sensor malfunction is the loss of hermeticity as a result of penetration of the encasement during the episcleral fixation, resulting from the lack of preformed suture holes at the implants encasement. However, no clinical signs of injury or inflammation of the conjunctiva, sclera, implantation site or any other involved structures were observed, except for an expected mild short-term irritation postoperatively. The episcleral pressure transducer for telemetric IOP monitoring is able to assess IOP without the need for invasive intraocular surgery. Episcleral implantation is an easy and safe procedure and can be undone very easily, so even temporary implantation and IOP measurements could be possible in the future. Sensor malfunction over time is a problem that needs to be addressed. Improvements in sensor encapsulation and especially preformed suture holes could significantly decrease the failure rate and increase durability.
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Affiliation(s)
- Siegfried Mariacher
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280 Sulzbach, Germany.
| | - Martina Ebner
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280 Sulzbach, Germany
| | - José Hurst
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany
| | - Peter Szurman
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280 Sulzbach, Germany; Centre for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany
| | - Kai Januschowski
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280 Sulzbach, Germany; Centre for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany
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Aptel F, Weinreb RN, Chiquet C, Mansouri K. 24-h monitoring devices and nyctohemeral rhythms of intraocular pressure. Prog Retin Eye Res 2016; 55:108-148. [PMID: 27477112 DOI: 10.1016/j.preteyeres.2016.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
Abstract
Intraocular pressure (IOP) is not a fixed value and varies over both the short term and periods lasting several months or years. In particular, IOP is known to vary throughout the 24-h period of a day, defined as a nyctohemeral rhythm in humans. In clinical practice, it is crucial to evaluate the changes in IOP over 24 h in several situations, including the diagnosis of ocular hypertension and glaucoma (IOP is often higher at night) and to optimize the therapeutic management of glaucoma. Until recently, all evaluations of 24-h IOP rhythm were performed using repeated IOP measurements, requiring individuals to be awakened for nocturnal measurements. This method may be imperfect, because it is not physiologic and disturbs the sleep architecture, and also because it provides a limited number of time point measurements not sufficient to finely asses IOP changes. These limitations may have biased previous descriptions of physiological IOP rhythm. Recently, extraocular and intraocular devices integrating a pressure sensor for continuous IOP monitoring have been developed and are available for use in humans. The objective of this article is to present the contributions of these new 24-h monitoring devices for the study of the nyctohemeral rhythms. In healthy subjects and untreated glaucoma subjects, a nyctohemeral rhythm is consistently found and frequently characterized by a mean diurnal IOP lower than the mean nocturnal IOP, with a diurnal bathyphase - usually in the middle or at the end of the afternoon - and a nocturnal acrophase, usually in the middle or at the end of the night.
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Affiliation(s)
- Florent Aptel
- Inserm U1042, Hypoxia and Physiopathology Laboratory, University Grenoble Alpes, Grenoble, France; Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble, France
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Christophe Chiquet
- Inserm U1042, Hypoxia and Physiopathology Laboratory, University Grenoble Alpes, Grenoble, France; Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble, France
| | - Kaweh Mansouri
- Glaucoma Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland; Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA.
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Nuyen B, Mansouri K. Detecting IOP Fluctuations in Glaucoma Patients. Open Ophthalmol J 2016; 10:44-55. [PMID: 27014387 PMCID: PMC4780505 DOI: 10.2174/1874364101610010044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/12/2022] Open
Abstract
Lowering intraocular pressure (IOP) remains the guiding principle of glaucoma management. Although IOP is the only treatable risk factor, its 24-hour behavior is poorly understood. Current glaucoma management usually relies on single IOP measurements during clinic hours, even though IOP is a dynamic parameter with rhythms dependent on individual patients. It has further been shown that most glaucoma patients have their highest IOP measurements outside clinic hours. The fact that these IOP peaks go largely undetected may explain why certain patients progress in their disease despite treatment. Nevertheless, single IOP measurements have determined all major clinical guidelines regarding glaucoma treatment. Other potentially informative parameters, such as fluctuations in IOP and peak IOP, have been neglected, and effects of IOP-lowering interventions on such measures are largely unknown. Continuous 24-hour IOP monitoring has been an interest for more than 50 years, but only recent technological advances have provided clinicians with a device for such an endeavor. This review discusses current uses and shortcomings of current measurement techniques, and provides an overview on current and future methods for 24-hour IOP assessment. It may be possible to incorporate continuous IOP monitoring into clinical practice, potentially to reduce glaucoma-related vision loss.
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Affiliation(s)
- Brenda Nuyen
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Kaweh Mansouri
- Glaucoma Center, Montchoisi Clinic, Genolier Swiss Vision Network, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
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