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Englisch CN, Boden KT, Szurman P, Mansouri K, Dick HB, Hoffmann EM, Mackert MJ, Schütte P, Langenbucher A, Messias A, Wakili P. Long-term astigmatism after intraocular pressure sensor implantation and nonpenetrating glaucoma surgery: EYEMATE-SC trial. J Cataract Refract Surg 2024; 50:899-905. [PMID: 38662577 PMCID: PMC11338036 DOI: 10.1097/j.jcrs.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE To investigate long-term astigmatism after combined nonpenetrating glaucoma surgery (NPGS) and implantation of the first miniaturized suprachoroidal intraocular pressure (IOP) sensor EYEMATE-SC. SETTING The study was conducted in 5 medical centers in 2 different countries. DESIGN Retrospective multicenter clinical study. METHODS Astigmatism of patients instrumented with the EYEMATE-SC IOP sensor was assessed over a follow-up period of 3 years. Refraction and corrected distance visual acuity (CDVA) were obtained preoperatively, after 6 months, 1, 2, and 3 years. A canaloplasty-operated patient cohort served as control. Astigmatism was evaluated using 3-dimensional power vector analysis involving the spherical equivalent M, and the Jackson crossed cylinder projections J 0 and J 45 . Exclusion criteria included neovascular and angle-closure glaucoma, myopia, axial length outside 22 to 26 mm, other ocular diseases, prior glaucoma surgery, other ocular surgery within 6 months (cataract surgery within 3 months) before NPGS, serious generalized conditions, and other active medical head/neck implants. RESULTS Multivariate analysis indicated no changes in astigmatism along the observation period in both the EYEMATE-SC (n = 24) and the canaloplasty (n = 24) group ( P > .05 or nonsignificant after Bonferroni correction). Astigmatism was unchanged between the EYEMATE-SC and the canaloplasty group at all timepoints ( P > .05). CDVA did not change along the observation period of 3 years in each of both groups ( P > .05). CONCLUSIONS Despite its suprachoroidal localization, this study indicated that the miniaturized EYEMATE-SC IOP sensor did not negatively affect long-term astigmatism after combined implantation with NPGS.
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Affiliation(s)
- Colya N. Englisch
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Karl T. Boden
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Peter Szurman
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Kaweh Mansouri
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - H. Burkhard Dick
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Esther M. Hoffmann
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Marc J. Mackert
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Paul Schütte
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Achim Langenbucher
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - André Messias
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
| | - Philip Wakili
- From the Sulzbach Eye Clinic, Sulzbach/Saar, Germany (Englisch, Boden, Szurman, Schütte, Messias, Wakili); Department of Experimental Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany (Englisch, Langenbucher); Swiss Visio Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland (Mansouri); Department of Ophthalmology, University of Colorado, Denver, Colorado (Mansouri); Knappschaftskrankenhaus Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany (Dick); Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (Hoffmann); Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany (Mackert)
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Kaya O, Akif Aydin M, Teymoori M, Kaan Erden O, Sadeghzadeh S, Dedeoglu UO, Demir S, Muhikanci O, Sahin A, Torun H, Dundar G, Yalcinkaya AD. A first-in-human pilot study of a novel electrically-passive metamaterial-inspired resonator-based ocular sensor embedded contact lens monitoring intraocular pressure fluctuations. Cont Lens Anterior Eye 2024; 47:102102. [PMID: 38114379 DOI: 10.1016/j.clae.2023.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Glaucoma is a leading cause of blindness with no cure, but early treatment and effective monitoring can often slow the progression of the disease. Monitoring of glaucoma is based on the measurement of intra-ocular pressure (IOP) that is a physiological parameter related to the mechanical state and parameters of the eye. Conventionally, diagnosing and assessing the progression of glaucoma is based on the method of measuring IOP discretely at clinics. Recent studies have demonstrated the importance of continuously monitoring IOP for 24 h to elucidate the effect of circadian rhythm. In this work, a metamaterial-inspired electrically-passive sensor-embedded contact lens is presented to monitor the IOP fluctuations based on a first-in-human pilot study. The sensor inside the contact lens is an electrically passive, metamaterial-based resonator that can be measured using a wearable antenna patch. The system has been tested with six healthy volunteers during an experiment to induce deliberate IOP changes via water-loading and placing the individuals in supine position using a recliner seat. The initial data compared with tonometer measurements suggest that the system can be used to assess the variation of IOP continuously.
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Affiliation(s)
- Ozgur Kaya
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - M Akif Aydin
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Morteza Teymoori
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Oguz Kaan Erden
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | | | - Ulas O Dedeoglu
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Saibe Demir
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Omer Muhikanci
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkiye
| | - Hamdi Torun
- Faculty of Engineering & Environment, University of Northumbria, Newcastle Upon Tyne, NE1 8ST, UK.
| | - Gunhan Dundar
- Department of Electrical and Electronics Engineering, Bogazici University, Bebek 34342 Istanbul, Turkiye
| | - Arda D Yalcinkaya
- Department of Electrical and Electronics Engineering, Bogazici University, Bebek 34342 Istanbul, Turkiye
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3
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van den Bosch JJON, Pennisi V, Rao HL, Mansouri K, Weinreb R, Thieme H, Hoffmann MB, Choritz L. Reproducibility of consecutive automated telemetric noctodiurnal IOP profiles as determined by an intraocular implant. Br J Ophthalmol 2024:bjo-2022-323080. [PMID: 38408856 DOI: 10.1136/bjo-2022-323080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/27/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Intraocular pressure (IOP) monitoring in glaucoma management is evolving with novel devices. We investigated the reproducibility of 24 hour profiles on two consecutive days and after 30 days of self-measurements via telemetric IOP monitoring. METHODS Seven primary patients with open-angle glaucoma previously implanted with a telemetric IOP sensor in one eye underwent automatic measurements throughout 24 hours on two consecutive days ('day 1' and 'day 2'). Patients wore an antenna adjacent to the study eye connected to a reader device to record IOP every 5 min. Also, self-measurements in six of seven patients were collected for a period of 30 days. Analysis included calculation of hourly averages to correlate time-pairs of day 1 versus day 2 and the self-measurements vers day 2. RESULTS The number of IOP measurements per patient ranged between 151 and 268 on day 1, 175 and 268 on day 2 and 19 and 1236 during 30 days of self-measurements. IOP time-pairs of automatic measurements on day 1 and day 2 were significantly correlated at the group level (R=0.83, p<0.001) and in four individual patients (1, 2, 6 and 7). IOP time-pairs of self-measurements and day 2 were significantly correlated at the group level (R=0.4, p<0.001) and in four individual patients (2, 5, 6 and 7). CONCLUSIONS Twenty-four hour automatic measurements of IOP are correlated on consecutive days and, though to a lesser degree, with self-measurements. Therefore a virtual 24-hour IOP curve might be constructed from self-measurements. Both options provide an alternative to frequent in-office IOP measurements.
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Affiliation(s)
- Jacqueline J O N van den Bosch
- Department of Ophthalmology, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Vincenzo Pennisi
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Kaweh Mansouri
- Swiss Visio, Montchoisi Clinic, Glaucoma Research Centre, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Robert Weinreb
- Hamilton Glaucoma Center and Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Hagen Thieme
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michael B Hoffmann
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lars Choritz
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
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Erb C, Erb C, Kazakov A, Umetalieva M, Weisser B. Influence of Diabetes Mellitus on Glaucoma-Relevant Examination Results in Primary Open-Angle Glaucoma. Klin Monbl Augenheilkd 2024; 241:177-185. [PMID: 37643738 DOI: 10.1055/a-2105-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Primary open-angle glaucoma (POAG) is no longer considered an isolated eye pressure-dependent optic neuropathy, but a neurodegenerative disease in which oxidative stress and neuroinflammation are prominent. These processes may be exacerbated by additional systemic diseases. The most common are arterial hypertension, dyslipidemia, and diabetes mellitus. Using diabetes mellitus as an example, it will be shown how far-reaching the influence of such a systemic disease can be on both the functional and the structural diagnostic methods for POAG. This knowledge is essential, since these interferences can lead to misinterpretations of POAG, which can also affect therapeutic decisions.
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Affiliation(s)
- Carl Erb
- Augenklinik am Wittenbergplatz, Berlin, Deutschland
| | | | - Avaz Kazakov
- Department of External Relations and Development, Salymbekov University, Bishkek, Kyrgyzstan
| | - Maana Umetalieva
- Medical Faculty of Medicine, Salymbekov University, Bishkek, Kyrgyzstan
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Fang Z, Bi S, Brown JD, Chen J, Pan T. Microfluidics in the eye: a review of glaucoma implants from an engineering perspective. LAB ON A CHIP 2023; 23:4736-4772. [PMID: 37847237 DOI: 10.1039/d3lc00407d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Glaucoma is a progressive optic neuropathy in the eye, which is a leading cause of irreversible blindness worldwide and currently affects over 70 million individuals. Clinically, intraocular pressure (IOP) reduction is the only proven treatment to halt the progression of glaucoma. Microfluidic devices such as glaucoma drainage devices (GDDs) and minimally invasive glaucoma surgery (MIGS) devices are routinely used by ophthalmologists to manage elevated IOP, by creating an artificial pathway for the over-accumulated aqueous humor (AH) in a glaucomatous eye, when the natural pathways are severely blocked. Herein, a detailed modelling and analysis of both the natural microfluidic pathways of the AH in the eye and artificial microfluidic pathways formed additionally by the various glaucoma implants are conducted to provide an insight into the causes of the IOP abnormality and the improvement schemes of current implant designs. The mechanisms of representative glaucoma implants have been critically reviewed from the perspective of microfluidics, and we have categorized the current implants into four groups according to the targeted drainage sites of the AH, namely Schlemm's canal, suprachoroidal space, subconjunctival space, and ocular surface. In addition, we propose to divide the development and evolution of glaucoma implant designs into three technological waves, which include microtube (1st), microvalve (2nd) and microsystem (3rd). With the emerging trends of minimal invasiveness and artificial intelligence in the development of medical implants, we envision that a comprehensive glaucoma treatment microsystem is on the horizon, which is featured with active and wireless control of IOP, real-time continuous monitoring of IOP and aqueous rate, etc. The current review could potentially cast light on the unmatched needs, challenges, and future directions of the microfluidic structural and functional designs of glaucoma implants, which would enable an enhanced safety profile, reduced complications, increased efficacy of lowering IOP and reduced IOP fluctuations, closed-loop and on-demand control of IOP, etc.
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Affiliation(s)
- Zecong Fang
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
| | - Shuzhen Bi
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
| | | | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Tingrui Pan
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, 230026, China
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Wu KY, Mina M, Carbonneau M, Marchand M, Tran SD. Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review. MICROMACHINES 2023; 14:1915. [PMID: 37893352 PMCID: PMC10609220 DOI: 10.3390/mi14101915] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Glaucoma, marked by its intricate association with intraocular pressure (IOP), stands as a predominant cause of non-reversible vision loss. In this review, the physiological relevance of IOP is detailed, alongside its potential pathological consequences. The review further delves into innovative engineering solutions for IOP monitoring, highlighting the latest advancements in wearable and implantable sensors and their potential in enhancing glaucoma management. These technological innovations are interwoven with clinical practice, underscoring their real-world applications, patient-centered strategies, and the prospects for future development in IOP control. By synthesizing theoretical concepts, technological innovations, and practical clinical insights, this review contributes a cohesive and comprehensive perspective on the IOP biosensor's role in glaucoma, serving as a reference for ophthalmological researchers, clinicians, and professionals.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Mina Mina
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marjorie Carbonneau
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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van den Bosch JJON, Pennisi V, Mansouri K, Weinreb RN, Thieme H, Hoffmann MB, Choritz L. Effect of eyelid muscle action and rubbing on telemetrically obtained intraocular pressure in patients with glaucoma with an IOP sensor implant. Br J Ophthalmol 2023; 107:1425-1431. [PMID: 35701079 PMCID: PMC10579178 DOI: 10.1136/bjophthalmol-2021-320508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with glaucoma on topical glaucoma medication are often affected by dry eye symptoms and thus likely to rub or squeeze their eyelids. Here, we telemetrically measure peak intraocular pressure (IOP) during eyelid manoeuvres and eyelid rubbing. METHODS Eleven patients with primary open-angle glaucoma (POAG) previously implanted with a telemetric IOP sensor (Eyemate-IO) were instructed to look straight ahead for 1 min as a baseline measurement. Next, 6 repeats of blinking on instruction with 10 s intervals in between were performed. In addition, 5 repeats of eyelid closure (n=9), eyelid squeezing and eyelid rubbing (n=7) were performed with 15 s intervals in between. IOP was recorded via an external antenna placed around the study eye. Average peak IOP increases from baseline were analysed and tested against zero (no change) with one-sample t-tests. RESULTS For eyelid rubbing, the average peak ∆ IOP increase (mean±SEM) was 59.1±9.6 mm Hg (p<0.001) from baseline. It was 42.2±5.8 mm Hg (p<0.0001) for eyelid squeezing, 3.8±0.6 mm Hg (n=9, p<0.01) for eyelid closure and 11.6±2.4 mm Hg (p<0.001) for voluntary blinking. No IOP change except for a short irregularity in the ocular pulse was observed during involuntary blinking. CONCLUSION Eyelid manoeuvres in patients with POAG elicited brief increases in IOP that were particularly large with squeezing and rubbing. Further investigation of the potential implications for glaucoma progression is warranted.
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Affiliation(s)
- Jacqueline J O N van den Bosch
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Vincenzo Pennisi
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
| | - Kaweh Mansouri
- Swiss Visio, Montchoisi Clinic, Glaucoma Research Centre, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Hagen Thieme
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
| | - Michael B Hoffmann
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
| | - Lars Choritz
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
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8
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Szurman P, Mansouri K, Dick HB, Mermoud A, Hoffmann EM, Mackert M, Weinreb RN, Rao HL, Seuthe AM. Safety and performance of a suprachoroidal sensor for telemetric measurement of intraocular pressure in the EYEMATE-SC trial. Br J Ophthalmol 2023; 107:518-524. [PMID: 34772665 PMCID: PMC10086291 DOI: 10.1136/bjophthalmol-2021-320023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
AIM To investigate the safety and performance of a telemetric suprachoroidal intraocular pressure (IOP) sensor (EYEMATE-SC) and the accuracy of its IOP measurements in open angle glaucoma (OAG) patients undergoing simultaneous non-penetrating glaucoma surgery (NPGS). METHODS Prospective, multicentre, open-label, single-arm, interventional clinical trial. Twenty-four eyes of 24 patients with OAG regularly scheduled for NPGS (canaloplasty or deep sclerectomy) were simultaneously implanted with an EYEMATE-SC sensor. Six-month follow-up on the sensor's safety and performance as well as on the level of agreement between the EYEMATE-SC measurements and IOP measurements with Goldmann applanation tonometry (GAT). RESULTS The eyes underwent canaloplasty (n=15) or deep sclerectomy (n=9) and achieved successful implantation of the sensor. No device migration, dislocation or serious device-related complications occurred. A total of 367 comparisons were included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 1.31 mm Hg (lower limit of agreement (LoA) 7.55 mm Hg; upper LoA -4.92 mm Hg). The maximum difference of 2.5 mm Hg ±3.96 (LoA 0.30-2.29) was reached on day 10 and continuously improved to an agreement of -0.15 mm Hg ±2.28 (LoA -1.24 to 0.89) after 6 months. Accordingly, the percentage of eyes within an IOP difference of ±5 mm Hg improved from 78% (day 3) to 100% (6 months). CONCLUSIONS After 6 months, the EYEMATE-SC sensor was safe and well tolerated, and allowed continual IOP monitoring. TRIAL REGISTRATION NUMBER NCT03756662.
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Affiliation(s)
- Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, 66280 Sulzbach, Germany
| | - Kaweh Mansouri
- Glaucoma Research Centre, Montchoisi Hospital, Lausanne, Switzerland
| | - H Burkhard Dick
- Eye Clinic, University Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Andre Mermoud
- Glaucoma Research Centre, Montchoisi Hospital, Lausanne, Switzerland
| | - Esther M Hoffmann
- Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marc Mackert
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munich, Germany
| | - Robert N Weinreb
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Harsha Laxmana Rao
- Glaucoma, Narayana Nethralaya, Bangalore, India
- Ophthalmology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anna-Maria Seuthe
- Eye Clinic Sulzbach, Saar Knappschaft Hospital Sulzbach, Sulzbach, Germany
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9
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EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure. Ophthalmology 2023; 130:304-312. [PMID: 36202141 DOI: 10.1016/j.ophtha.2022.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS). DESIGN Prospective, multicenter, open-label, single-arm, interventional clinical trial. PARTICIPANTS Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy). METHODS An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors' IOP measurements at all postoperative visits through 12 months. MAIN OUTCOME MEASURES Device position and adverse events. RESULTS Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], -5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was -0.2 mmHg (95% CI of LoA, -4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT. CONCLUSIONS The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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10
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Yaïci R, Geerling G. [Tonometry: Review and Perspectives]. Klin Monbl Augenheilkd 2023. [PMID: 36827998 DOI: 10.1055/a-2022-0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Reliable and repeated IOP measurement are essential in the diagnosis and treatment of glaucoma. In this second part, the other contact tonometry and non-contact tonometry are presented. The clinical value of the different methods and the value of multimodality in tonometry will be discussed based on a review of the literature, and the latest innovations with telemetric IOP sensors will be introduced.
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11
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Abstract
ZusammenfassungIn 2. Teil des Beitrags werden die sonstigen Kontakttonometer und die Nonkontakttonometrie präsentiert. Es wird anhand einer Revue der Literatur über den klinischen Wert der verschiedenen Methoden und den Wert der Multimodalität in der Tonometrie diskutiert; ferner werden die letzten Innovationen mit den telemetrischen IOD-Sensoren eingeführt.
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12
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Gassel CJ, Dzhelebov DN, Voykov B. Detailed intraocular pressure curve by telemetric tonometry with an implanted pressure sensor before and after PreserFlo ® MicroShunt implantation: a case report. Ther Adv Ophthalmol 2023; 15:25158414221149927. [PMID: 36714382 PMCID: PMC9875318 DOI: 10.1177/25158414221149927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo® MicroShunt to significantly reduce IOP fluctuations.
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Affiliation(s)
| | | | - Bogomil Voykov
- Centre for Ophthalmology, University Eye
Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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13
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Fafure AA, Edem EE, Obisesan AO, Enye LA, Adekeye AO, Adetunji AE, Nebo KE, Olusegun AA, Fafure OE. Fermented maize slurry (Ogi) and its supernatant (Omidun) mitigate elevated intraocular pressure by modulating BDNF expression and glial plasticity in the retina-gut axis of glaucomatous rats. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:887-896. [PMID: 34380184 DOI: 10.1515/jcim-2021-0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Growing interest has been reported on the health benefits of fermented foods, which includes cognition enhancement and inflammation attenuation. BDNF is a known protectant against retinal degeneration, however, therapies that target this neurotrophic factor has been limited. Therefore, we assessed the reaction of BDNF and glial cells in glaucomatous rats and their response to treatment with fermented maize products. METHODS Thirty male adult rats were either injected via the episcleral vein with hypertonic saline to elevate intraocular pressure (IOP) or treated with fermented maize slurry (Ogi) or its supernatant (Omidun). Following sacrifice, the retina and duodenum were studied by immunohistochemical analysis using antibodies directed against GFAP, AIF-1 and BDNF. RESULTS Hypertonic saline injection produced hypertrophy of the Müller cells and increased GFAP and AIF-1 expression in the retina and gut when compared to the control. Treatment with Ogi and Omidun produced varying degrees of reduction of gliosis, protection against hypertonic saline-induced retinal ganglion cell loss, and reduced intraocular pressure. BDNF expression was downregulated following the hypertonic saline assault, while Omidun and Ogi treatment abrogated its reduction following the hypertonic saline assault. CONCLUSIONS Collectively, our findings suggest that acute elevation of IOP alters crosstalk between gut and retina with consequent aberrant activation of glial cells; and that probiotic bacteria like the lactic acid bacteria rich in fermented foods including Ogi and Omidun may offer neuroprotection to the ganglionic cells by attenuating the retinal glial reaction and improving BDNF activity.
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Affiliation(s)
- Adedamola Adediran Fafure
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Edem Ekpenyong Edem
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Abiola Oluwatosin Obisesan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Linus Anderson Enye
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Adeshina Oloruntoba Adekeye
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Adedeji Enitan Adetunji
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Kate Eberechukwu Nebo
- Neuroscience Unit, Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Adebayo Adeoluwa Olusegun
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, Afe-Babalola University, Ado-Ekiti, Nigeria
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14
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Mansouri K, Gillmann K, Rao HL, Szurman P, Weinreb RN. Measurement of intraocular temperature in glaucoma: week-day and seasonal fluctuations. Br J Ophthalmol 2022:bjophthalmol-2021-320495. [PMID: 35443998 DOI: 10.1136/bjophthalmol-2021-320495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate long-term intraocular temperature (IOT) variations in eyes with primary open-angle glaucoma (POAG) using an intraocular telemetric sensor. METHODS This prospective, open-label, multicentre observational study analysed the IOT variations in 22 eyes of 22 patients with POAG. All enrolled patients underwent implantation of an intraocular pressure (IOP) sensor during cataract surgery. The telemetric system uses a built-in temperature sensor to control measured IOP for temperature. Each time a patient measures their IOP, both the IOP and IOT are recorded in the reader device. Patients were instructed to self-measure their IOP as often as desired, but at least four times daily. Recorded readings were retrieved and analysed using mixed effect models and pairwise comparisons using Bonferroni correction to assess the statistical significance of average IOT variations between each individual weekday and calendar month. RESULTS The mean age of patients was 67.8±6.8 years and 36.4% were women. A total of 132 745 readings over 21 102 measurement-days were obtained. On average, IOT was significantly higher on Sundays (34.57°C; 95% CI 34.37 to 34.78) than on any other day of the week (p<0.001). Mean IOT on other weekdays ranged from 34.48°C to 34.51°C. Over the year, IOT followed a clear seasonal pattern, reaching its maximum in July (34.8°C; 95% CI 34.56 to 34.97) and its minimum in January (34.4°C; 95% CI 34.15 to 34.56; p<0.001). CONCLUSIONS This study demonstrates the feasibility of continual and long-term measurement of IOT using intraocular sensors. The results show significant short-term and long-term fluctuations of IOT. Research is warranted to understand the impact of IOT variations on IOP, ocular perfusion and glaucoma progression.
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Affiliation(s)
- Kaweh Mansouri
- Swiss Visio, Montchoisi Clinic, Glaucoma Research Centre, Lausanne, Vaud, Switzerland .,Department of Ophthalmology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Kevin Gillmann
- Swiss Visio, Montchoisi Clinic, Glaucoma Research Centre, Lausanne, Vaud, Switzerland.,Glaucoma Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Harsha Laxmana Rao
- Glaucoma, Narayana Nethralaya, Bangalore, India.,University Eye Clinic Maastricht, University Medical Center, Maastricht, Netherlands
| | - Peter Szurman
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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15
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Schmidt I, Plange N, Walter P, Koutsonas A. Telemetric non-contact intraocular pressure monitoring with an implanted sensor in patients with glaucoma: long-term safety report and monitoring data. Br J Ophthalmol 2022:bjophthalmol-2021-319786. [PMID: 35314512 DOI: 10.1136/bjophthalmol-2021-319786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Glaucoma is a chronic disease that requires lifelong monitoring and treatment. However, its control is limited due to discontinuous intraocular pressure (IOP) monitoring related to the practitioners' office hours. Implantable telemetric IOP sensors have made self-measurements possible and provide important information regarding the IOP profiles of patients. However, limited long-term monitoring data are currently available. METHODS In the ARGOS-01 study, a telemetric IOP sensor was implanted in the ciliary sulcus of six patients with open-angle glaucoma during cataract surgery between 2011 and 2012. This study reports telemetric monitoring data collected by self-tonometry and automated measurements and during outpatient visits, including an analysis of one active patient with several years of follow-up. The long-term safety, tolerability and functionality were assessed in the remaining patients during the last visit. RESULTS The follow-up period was up to 10 years, in which almost 25 000 IOP measurements were performed. The patients had excellent tolerance of the implanted sensor and did not experience sensor-related discomfort or complications. The active patient reported easy handling of self-tonometry and did not experience long-term restrictions in activities of daily living due to the implanted sensor. Telemetric data provide an insight into patients' measurement routines and IOP fluctuations. CONCLUSION So far, our data suggest good long-term safety, tolerability and functionality of the implanted sensors up to almost ten years. Such sensors may help facilitate patients' self-measurements of IOP. This disease monitoring method should be investigated further to determine if it helps improve wider patient experience, engagement and visual prognosis for those being treated for complex glaucoma.
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Affiliation(s)
- Ilka Schmidt
- Department of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Niklas Plange
- Department of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Antonis Koutsonas
- Department of Ophthalmology, University Hospital Aachen, Aachen, Germany
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16
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Mercer GD, He B, Levin LA. Exploring Ophthalmologists' Adoption of Telemedicine during the COVID-19 Pandemic: A Mixed Methods Study. Ophthalmic Epidemiol 2021; 29:595-603. [PMID: 34821531 DOI: 10.1080/09286586.2021.2008454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The COVID-19 pandemic promoted hitherto unseen uptake of telemedicine by ophthalmologists. We performed a mixed methods study to explore patters of utilization during the pandemic and perceived future utility. METHODS Ophthalmologists practicing in Canada between March and July 2020 were invited to complete an online questionnaire assessing demographics, clinical practice characteristics and telemedicine utilization prior to and during the pandemic. Descriptive and bivariate statistics were used to analyze the data. Agglomerative hierarchical cluster analysis was used to identify groups who varied on the types of visits offered using telemedicine. Ten one-on-one interviews were conducted and analyzed using thematic content analysis to explain trends observed in the survey data. RESULTS Seventy-three ophthalmologists completed the survey. Six percent reported using telemedicine prior to the pandemic compared to 80% during the pandemic. A significant majority (81%) primarily used the telephone for telemedicine visits. Overall, visit volumes during the pandemic declined to 40% of pre-pandemic levels, with a smaller decline for ophthalmologists who used telemedicine than those who did not. Those who used telemedicine for all visit types were more likely to use telemedicine software and to anticipate a modest-to-large role for telemedicine in their future practice. DISCUSSION For many ophthalmologists, integrating telemedicine into clinical practice may have partially offset the disruption to normal clinical activities during the pandemic. While the majority saw telemedicine as a temporary solution, a sizeable minority appear to have made considerable use of the technology and see an ongoing role for it once regular clinical activities resume.
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Affiliation(s)
- Gareth D Mercer
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Canada
| | - Bonnie He
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Leonard A Levin
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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17
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Al-Nosairy KO, Hoffmann MB, Bach M. Non-invasive electrophysiology in glaucoma, structure and function-a review. Eye (Lond) 2021; 35:2374-2385. [PMID: 34117381 PMCID: PMC8376952 DOI: 10.1038/s41433-021-01603-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
Glaucoma, its early diagnosis, and monitoring of interventions remain an ongoing challenge. We here review developments in functional assessment and its relation to morphology, evaluating recent insights in electrophysiology in glaucoma and highlighting how glaucoma research and diagnostics benefit from combined approaches of OCT and electrophysiological investigations. After concise overviews of OCT and non-invasive electrophysiology in glaucoma, we evaluate commonalities and complementarities of OCT and electrophysiology for our understanding of glaucoma. As a specific topic, the dynamic range (floor effects) of the various techniques is discussed.
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Affiliation(s)
| | - Michael B Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Michael Bach
- Faculty of Medicine, Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
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18
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Brusini P, Salvetat ML, Zeppieri M. How to Measure Intraocular Pressure: An Updated Review of Various Tonometers. J Clin Med 2021; 10:3860. [PMID: 34501306 PMCID: PMC8456330 DOI: 10.3390/jcm10173860] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma.
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Affiliation(s)
- Paolo Brusini
- Department of Ophthalmology, Policlinico “Città di Udine”, 33100 Udine, Italy;
| | - Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy;
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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19
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[Telemedical applications in ophthalmology in times of COVID-19]. Ophthalmologe 2021; 118:885-892. [PMID: 34406461 PMCID: PMC8371418 DOI: 10.1007/s00347-021-01470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic access to and utilization of ophthalmologic healthcare providers was partially restricted. OBJECTIVE This article provides an overview of already available tele-ophthalmologic applications for better care during the pandemic as well as those still under development. MATERIAL AND METHODS The study included an analysis of current scientific publications, analysis of unrestricted screening applications in smart device app stores as well as telemetric medical products specifically designed for home monitoring and discussion of the requirements of an integrated ophthalmologic video consultation. RESULTS There is significant interest in tele-ophthalmologic applications and devices as evidenced by a rise in the number of relevant publications. Freely available screening tests for smart phones and tablets are as a rule currently not validated and show significant discrepancies from established standard tests. Telemetric medical devices show great potential for home monitoring in chronic ophthalmologic diseases but must first become established in the clinical routine. CONCLUSION There is an unmet need for systematic analysis, development and validation of telemedical applications and medical products for ophthalmology in order to advantageously utilize the potential of telemedicine and to incorporate this into an ophthalmologic video consultation.
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20
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Meduri E, Gillmann K, Mansouri K. Intraocular Pressure Variations After Intravitreal Injections Measured With an Implanted Suprachoroidal Telemetry Sensor. J Glaucoma 2021; 30:e360-e363. [PMID: 33979110 DOI: 10.1097/ijg.0000000000001879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Intravitreal injections (IVIs) may create transient intraocular pressure (IOP) elevation. This report describes continuous IOP fluctuations following multiple IVI measured with a permanent implantable sensor. PATIENTS AND METHODS We report the case of a 49-year-old white glaucomatous male with refractory macular edema secondary to central retinal vein occlusion in his left eye who underwent deep sclerectomy combined with the implantation of a suprachoroidal tonometry sensor. Serial IOP measurements were performed immediately before and after each IVI over a 1-year period. RESULTS During the first 7 months following deep sclerectomy, IOP remained below 10 mm Hg. During this period, mean IOP before each injection was 2.1±2.6 mm Hg, and each IVI caused a reduction of 1.2±0.8 mm Hg on average, with a maximum reduction of 2.7 mm Hg, before IOP normalized within 50 minutes to 24 hours. From 7 months postoperatively, mean IOP increased to the low teens. During this period, mean IOP before each injection was 9.9±1.8 mm Hg, and each IVI caused an increase of 15.8±11.7 mm Hg on average, with a maximum increase of 44.8 mm Hg, before IOP normalized within 20 minutes to 4 hours. CONCLUSIONS During the initial postoperative phase, IVI may cause acute reduction in IOP, either through subconjunctival leaks or increased filtration secondary to increased fluid pressure. Several months after surgery, this effect subsides and IOP spikes sharply immediately after each IVI, suggesting the resolution of the initial mechanism, most likely through scarring and fibrosis.
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Affiliation(s)
- Enrico Meduri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO
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21
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Intraocular Pressure Monitoring Using an Intraocular Sensor Before and After Glaucoma Surgery. J Glaucoma 2021; 30:941-946. [PMID: 34319931 DOI: 10.1097/ijg.0000000000001916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Intraocular pressure (IOP) is the only modifiable risk factor for glaucoma, with evidence from landmark randomized controlled trials demonstrating visual field preservation with IOP reduction. Over recent years, the use of remote sensors has formed an increasingly important component of the management of chronic diseases. During the COVID-19 pandemic, the ability to remotely monitor IOP proved particularly useful when public stay at home orders have been in place. PATIENTS AND METHODS This report describes the first case of glaucoma surgery in a patient who had previously received an eyemate-IO implant. The eyemate-IO (Implandata Ophthalmic Products) is an implant for intraocular pressure (IOP) monitoring placed in the ciliary sulcus during cataract surgery. RESULTS Remote IOP monitoring enabled the clinician to identify sustained high IOP readings and the need for glaucoma surgery. Post-operatively, response to treatment could be monitored to ensure sufficient long-term IOP control. CONCLUSIONS The eyemate-IO implanted during cataract surgery in this patient provided valuable remote continuous IOP information that guided timely glaucoma surgical interventions for poorly controlled IOP.
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22
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Xu J, Li R, Xu H, Yang Y, Zhang S, Ren T. Recent progress of continuous intraocular pressure monitoring. NANO SELECT 2021. [DOI: 10.1002/nano.202100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jiandong Xu
- Institute of Microelectronics Tsinghua University Beijing 100084 China
- Beijing National Research Center for Information Science and Technology (BNRist) Tsinghua University Beijing 100084 China
| | - Ruisong Li
- Department of Electrical Engineering and Computer Science and Department of Bioengineering College of Engineering University of California Berkeley California 94720 USA
| | - Haokai Xu
- Institute of Microelectronics Tsinghua University Beijing 100084 China
- Beijing National Research Center for Information Science and Technology (BNRist) Tsinghua University Beijing 100084 China
| | - Yi Yang
- Institute of Microelectronics Tsinghua University Beijing 100084 China
- Beijing National Research Center for Information Science and Technology (BNRist) Tsinghua University Beijing 100084 China
| | - Sheng Zhang
- Shenzhen International Graduate School Tsinghua University Shenzhen 518055 China
| | - Tian‐Ling Ren
- Institute of Microelectronics Tsinghua University Beijing 100084 China
- Beijing National Research Center for Information Science and Technology (BNRist) Tsinghua University Beijing 100084 China
- Center for Flexible Electronics Technology Tsinghua University Beijing 100084 China
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23
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van den Bosch JJON, Pennisi V, Invernizzi A, Mansouri K, Weinreb RN, Thieme H, Hoffmann MB, Choritz L. Implanted Microsensor Continuous IOP Telemetry Suggests Gaze and Eyelid Closure Effects on IOP-A Preliminary Study. Invest Ophthalmol Vis Sci 2021; 62:8. [PMID: 33956052 PMCID: PMC8107486 DOI: 10.1167/iovs.62.6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the effect of gaze direction and eyelid closure on intraocular pressure (IOP). Methods Eleven patients with primary open-angle glaucoma previously implanted with a telemetric IOP sensor were instructed to view eight equally-spaced fixation targets each at three eccentricities (10°, 20°, and 25°). Nine patients also performed eyelid closure. IOP was recorded via an external antenna placed around the study eye. Differences of mean IOP between consecutive gaze positions were calculated. Furthermore, the effect of eyelid closure on gaze-dependent IOP was assessed. Results The maximum IOP increase was observed at 25° superior gaze (mean ± SD: 4.4 ± 4.9 mm Hg) and maximum decrease at 25° inferonasal gaze (-1.6 ± 0.8 mm Hg). There was a significant interaction between gaze direction and eccentricity (P = 0.003). Post-hoc tests confirmed significant decreases inferonasally for all eccentricities (mean ± SEM: 10°: -0.7 ± 0.2, P = 0.007; 20°: -1.1 ± 0.2, P = 0.006; and 25°: -1.6 ± 0.2, P = 0.006). Eight of 11 eyes showed significant IOP differences between superior and inferonasal gaze at 25°. IOP decreased during eyelid closure, which was significantly lower than downgaze at 25° (mean ± SEM: -2.1 ± 0.3 mm Hg vs. -0.7 ± 0.2 mm Hg, P = 0.014). Conclusions Our data suggest that IOP varies reproducibly with gaze direction, albeit with patient variability. IOP generally increased in upgaze but decreased in inferonasal gaze and on eyelid closure. Future studies should investigate the patient variability and IOP dynamics.
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Affiliation(s)
| | - Vincenzo Pennisi
- Department of Ophthalmology, University Hospital Magdeburg, Germany
| | - Azzurra Invernizzi
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado, Denver, Colorado, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla, California, United States
| | - Hagen Thieme
- Department of Ophthalmology, University Hospital Magdeburg, Germany
| | - Michael B. Hoffmann
- Department of Ophthalmology, University Hospital Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Lars Choritz
- Department of Ophthalmology, University Hospital Magdeburg, Germany
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Toris CB, Gagrani M, Ghate D. Current methods and new approaches to assess aqueous humor dynamics. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Carol B. Toris
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
- Dept. Of Ophthalmology and Visual Science, Case Western Reserve University, Cleveland, OH USA
| | - Meghal Gagrani
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
| | - Deepta Ghate
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
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Gillmann K, Wasilewicz R, Hoskens K, Simon-Zoula S, Mansouri K. Continuous 24-hour measurement of intraocular pressure in millimeters of mercury (mmHg) using a novel contact lens sensor: Comparison with pneumatonometry. PLoS One 2021; 16:e0248211. [PMID: 33755676 PMCID: PMC7987168 DOI: 10.1371/journal.pone.0248211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To address the unmet need of continuous IOP monitoring, a Pressure-Measuring Contact Lens (PMCL) was developed to measure IOP in millimeters of mercury (mmHg) continuously over 24 hours. The present study assessed the reliability of the novel PMCL. METHODS In this prospective open-label clinical study, healthy and open-angle glaucoma (OAG) subjects were fitted with the PMCL, and pneumatonometry was performed on study eyes (in absence of the PMCL) and on fellow eyes before, during, and after provocative tests. The primary outcome measures were (1) mean IOP difference between same-eye measurements, and (2) percentage of timepoints at which IOP measured by the PMCL was within 5 mmHg of that measured by pneumatonometry in the fellow eye. RESULTS Eight subjects were analysed (4 healthy, 4 OAG). The average difference in successive IOP measurements made by pneumatonometry and with the PMCL was 2.0±4.3mmHg at placement-time, and 6.5±15.2mmHg at removal time. During water drinking test, a significant increase in IOP was detected both by PMCL in the study eye (2.4±2.5mmHg, p = 0.03) and by pneumatonometry in the fellow eye (1.9±1.9mmHg, p = 0.02). Over the 24-hour recording, 88.0% of IOP variations measured by the PMCL were within 5mmHg of that measured with the pneumatonometer in the fellow eye. A transient corneal erosion of severe intensity was observed following removal of the PMCL on one single eye, and may have affected measurement accuracy in that eye. CONCLUSIONS This study is a proof-of-concept for this novel PMCL, and its results are encouraging, with a fair accuracy in IOP values measurement and good sensitivity to subtle IOP variations.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | | | - Kirsten Hoskens
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | | | - Kaweh Mansouri
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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Mansouri K, Kersten-Gomez I, Hoffmann EM, Szurman P, Choritz L, Weinreb RN. Intraocular Pressure Telemetry for Managing Glaucoma during the COVID-19 Pandemic. Ophthalmol Glaucoma 2020; 4:447-453. [PMID: 33358988 PMCID: PMC7860938 DOI: 10.1016/j.ogla.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate in glaucoma patients the feasibility and use of remote monitoring of intraocular pressure (IOP) with an implanted telemetry sensor during the coronavirus disease 2019 (COVID-19) lockdown. DESIGN Cross-sectional study. PARTICIPANTS Patients previously implanted with a telemetric IOP sensor (Eyemate; Implandata GmbH) were included. METHODS Intraocular pressure measurements acquired by the patients during the lockdown were collected by physicians who were located remotely. A questionnaire was sent to 10 participating study centers to evaluate the clinical impact of remote monitoring of IOP via the IOP sensor system. MAIN OUTCOME MEASURES Number of patients who obtained home IOP measurements. RESULTS Data were available from all centers and from 37 eyes of 37 patients (16 patients with a sulcus-based sensor and 21 patients with a suprachoroidal sensor). Thirty-four patients obtained IOP measurements during the lockdown. Mean age of the patients was 69.3 ± 9.6 years, and 48.6% were women. A total of 8415 IOP measurements from 370 measurement days were obtained. Based on remote IOP measurements, treatment was changed in 5 patients. In another 5 patients, treatment change was considered when physicians received the IOP measurements after the lockdown. Nine of the 10 study centers judged remote IOP measurements to have a clinical impact. CONCLUSIONS These results show the feasibility of patient-acquired measurement of IOP in conjunction with remote IOP monitoring by physicians with an implantable sensor. The data obtained impacted clinical decision making, including adjustment of ocular hypotensive therapy and avoiding unnecessary office visits during the COVID-19 pandemic.
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Affiliation(s)
- Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland; Department of Ophthalmology, University of Colorado School of Medicine, Denver, Colorado.
| | | | - Esther M Hoffmann
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Lars Choritz
- Department of Ophthalmology, University of Magdeburg, Magdeburg, Germany
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
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27
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Dick HB, Gerste RD. Future Intraocular Lens Technologies. Ophthalmology 2020; 128:e206-e213. [PMID: 33373617 DOI: 10.1016/j.ophtha.2020.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022] Open
Abstract
The future of intraocular lens (IOL) technology has already begun with a number of recent innovations. The postoperative change of refractive power will lead to a customized fine-tuning that provides patients with the individual vision they expect and with as much spectacle independence as possible. The latest-generation (2.0) Light-Adjustable Lens (RxSight) was recently introduced into clinical practice, with the first results being very encouraging. Other methods of altering the power of an already implanted IOL are under development. The same can be said about the correction of presbyopia, the so-called last frontier in refractive surgery. Extended depth-of-focus IOLs have been introduced, as has the technology of the pinhole IOL. The latter has therapeutic potential beyond the refractive aspect and has already proven helpful in cases of iris defects and irregular corneas. Several technologies are currently being tested to achieve-finally-an accommodative IOL. One such concept uses the (remaining) strength of the ciliary muscle, whereas another is triggered by the pupil reaction when shifting focus from far to near. Not an IOL itself, but rather a high-tech innovation that so far has mostly been implanted during cataract surgery, is a microelectronic sensor that measures habitual intraocular pressure (IOP) at any given time and promises to revolutionize the management of glaucoma patients. The last generation of this device (Eyemate; Implandata Opthalmics Products GmbH) is implanted during small-incision cataract surgery; the latest development is an even smaller sensor that will be inserted suprachoroidally before, in the near future, such a device will be part of a capsular ring. These IOP sensors are a prime example that IOL technology will continue to be a driving force in ophthalmology, with a positive impact far beyond cataract surgery.
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Raber FP, Gerbutavicius R, Wolf A, Kortüm K. Smartphone-Based Data Collection in Ophthalmology. Klin Monbl Augenheilkd 2020; 237:1420-1428. [PMID: 33285587 DOI: 10.1055/a-1232-4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to their widespread use among the population and their wide range of functions and sensors, smartphones are suitable for data collection for medical purposes. App-supported input masks, patient diaries, and patient information systems, mobile access to the patient file as well as telemedical services will continue to find their way into our field of expertise in the future. In addition, the use of smartphone sensors (GPS and motion sensors, touch display, microphone) and coupling possibilities with biosensors (for example with Continuous Glucose Monitoring [CGM] systems), advanced camera technology, the possibility of regular and appointment independent checking of the visual system (visual acuity/contrast vision) as well as real-time data transfer offer interesting possibilities for patient treatment and clinical research. The present review deals with the current status and future perspectives of smartphone-based data collection and possible applications in ophthalmology.
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Affiliation(s)
| | | | - Armin Wolf
- Augenklinik, Universitätsklinikum Ulm, Deutschland
| | - Karsten Kortüm
- Augenheilkunde, Augenarztpraxis Dres. Kortüm, Ludwigsburg, Deutschland.,Augenklinik, Ludwig-Maximilians-Universität München, Medizinische Fakultät, München, Deutschland
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29
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Jasien JV, Zohner YE, Asif SK, Rhodes LA, Samuels BC, Girkin CA, Morris JS, Downs JC. Comparison of extraocular and intraocular pressure transducers for measurement of transient intraocular pressure fluctuations using continuous wireless telemetry. Sci Rep 2020; 10:20893. [PMID: 33262420 PMCID: PMC7708973 DOI: 10.1038/s41598-020-77880-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/11/2020] [Indexed: 11/08/2022] Open
Abstract
The optimal approach for continuous measurement of intraocular pressure (IOP), including pressure transducer location and measurement frequency, is currently unknown. This study assessed the capability of extraocular (EO) and intraocular (IO) pressure transducers, using different IOP sampling rates and duty cycles, to characterize IOP dynamics. Transient IOP fluctuations were measured and quantified in 7 eyes of 4 male rhesus macaques (NHPs) using the Konigsberg EO system (continuous at 500 Hz), 12 eyes of 8 NHPs with the Stellar EO system and 16 eyes of 12 NHPs with the Stellar IO system (both measure at 200 Hz for 15 s of every 150 s period). IOP transducers were calibrated bi-weekly via anterior chamber manometry. Linear mixed effects models assessed the differences in the hourly transient IOP impulse, and transient IOP fluctuation frequency and magnitude between systems and transducer placements (EO versus IO). All systems measured 8000-12,000 and 5000-6500 transient IOP fluctuations per hour > 0.6 mmHg, representing 8-16% and 4-8% of the total IOP energy the eye must withstand during waking and sleeping hours, respectively. Differences between sampling frequency/duty cycle and transducer placement were statistically significant (p < 0.05) but the effect sizes were small and clinically insignificant. IOP dynamics can be accurately captured by sampling IOP at 200 Hz on a 10% duty cycle using either IO or EO transducers.
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Affiliation(s)
- Jessica V Jasien
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, USA
| | | | - Sonia Kuhn Asif
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, VH 390B | 1670 University Blvd., Birmingham, AL, 35294, USA
| | - Lindsay A Rhodes
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, VH 390B | 1670 University Blvd., Birmingham, AL, 35294, USA
| | - Brian C Samuels
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, VH 390B | 1670 University Blvd., Birmingham, AL, 35294, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, VH 390B | 1670 University Blvd., Birmingham, AL, 35294, USA
| | - Jeffrey S Morris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, VH 390B | 1670 University Blvd., Birmingham, AL, 35294, USA.
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30
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[Dependency of intraocular pressure on body posture in glaucoma patients : New approaches to pathogenesis and treatment]. Ophthalmologe 2020; 117:730-739. [PMID: 32399617 DOI: 10.1007/s00347-020-01113-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKROUND Human intraocular pressure (IOP) depends on the position of the head in relation to the body in space. Physiologically, the IOP increases in a lying position compared to an upright posture. Microgravity in space also appears to cause an increase in intraocular pressure, accompanied by other ophthalmological changes, which are summarized under the term spaceflight associated neuro-ocular syndrome (SANS). Bed rest studies are being carried out to investigate the effects of weightlessness on the human body. So here there is an intersection between research into SANS and glaucoma. Increased intraocular pressure remains the most important risk factor for glaucoma development and progression that can be influenced by treatment. The influence of position-dependent IOP fluctuations on glaucoma is still not sufficiently understood. MATERIALS AND METHODS A literature search was carried in PubMed on the subject of IOP fluctuations related to posture. Analysis and evaluation of the published study results and a summary of available clinical data. RESULTS The increase in IOP when changing from a seated to a lying body position is greater in glaucoma patients with an increase of up to 8.6 mm Hg compared to healthy subjects with an increase up to 5 mm Hg. In small pilot studies the increase in lying IOP in some glaucoma patients and healthy volunteers could be attenuated by elevation of the head by 30%. A lower compartmental pressure in the subarachnoid space has been associated with glaucoma and may represent a risk factor for glaucoma development. Not only the level of IOP but also IOP fluctuations were associated with an increased risk of disease progression. CONCLUSION The clinical significance of IOP peaks during sleep on glaucoma is still not sufficiently understood. New methods for continuous IOP measurement offer promising opportunities for further research into the importance of IOP fluctuations related to changes of body and head posture.
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Invernizzi A, Haykal S, Lo Faro V, Pennisi V, Choritz L. Influence of electromagnetic radiation emitted by daily-use electronic devices on the Eyemate® system in-vitro: a feasibility study. BMC Ophthalmol 2020; 20:357. [PMID: 32867712 PMCID: PMC7461327 DOI: 10.1186/s12886-020-01623-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eyemate® is a system for the continual monitoring of intraocular pressure (IOP), composed of an intraocular sensor, and a hand-held reader device. As the eyemate®-IO sensor communicates with the hand-held reader telemetrically, some patients might fear that the electronic devices that they use on a daily basis might somehow interfere with this communication, leading to unreliable measurements of IOP. In this study, we investigated the effect of electromagnetic radiation produced by a number of everyday electronic devices on the measurements made by an eyemate®-IO sensor in-vitro, in an artificial and controlled environment. METHODS The eyemate®-IO sensor was suspended in a sterile 0.9% sodium chloride solution and placed in a water bath at 37 °C. The antenna, connected to a laptop for recording the data, was positioned at a fixed distance of 1 cm from the sensor. Approximately 2 hrs of "quasi-continuous" measurements were recorded for the baseline and for a cordless phone, a smart-phone and a laptop. Repeated measures ANOVA was used to compare any possible differences between the baseline and the tested devices. RESULTS For baseline measurements, the sensor maintained a steady-state, resulting in a flat profile at a mean pressure reading of 0.795 ± 0.45 hPa, with no apparent drift. No statistically significant difference (p = 0.332) was found between the fluctuations in the baseline and the tested devices (phone: 0.76 ± 0.41 hPa; cordless: 0.787 ± 0.26 hPa; laptop: 0.775 ± 0.39 hPa). CONCLUSION In our in-vitro environment, we found no evidence of signal drifts or fluctuations associated with the tested devices, thus showing a lack of electromagnetic interference with data transmission in the tested frequency ranges.
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Affiliation(s)
- Azzurra Invernizzi
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands.
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands.
| | - Shereif Haykal
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Valeria Lo Faro
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
| | - Vincenzo Pennisi
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lars Choritz
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Geoffrion D, Harissi-Dagher M. Improving glaucoma management for the Boston keratoprosthesis type 1: tubes versus lasers. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1809378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Dominique Geoffrion
- Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Ophthalmology, Université de Montreal, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Université de Montreal, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
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Al-Nosairy KO, van den Bosch JJON, Pennisi V, Mansouri K, Thieme H, Choritz L, Hoffmann MB. Use of a novel telemetric sensor to study interactions of intraocular pressure
and ganglion-cell function in glaucoma. Br J Ophthalmol 2020; 105:661-668. [DOI: 10.1136/bjophthalmol-2020-316136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/07/2020] [Accepted: 06/03/2020] [Indexed: 11/03/2022]
Abstract
Aims
(1) To test the feasibility of simultaneous steady-state pattern
electroretinogram (ssPERG) and intraocular pressure (IOP) measurements with an
implanted IOP sensor. (2) To explore the scope of this approach for detecting
PERG changes during IOP manipulation in a model of lateral decubitus
positioning (LDP; lateral position).
Methods
15 healthy controls and 15 treated glaucoma patients participated in the
study. 8 patients had an IOP sensor (Eyemate-IO, Implandata Ophthalmic Products
GmbH) in the right eye (GLAIMP) and 7 had no sensor and
with glaucoma in the left eye. (1) We compared PERGs with and without
simultaneous IOP read-out in GLAIMP. (2) All participants
were positioned in the following order: sitting1 (S1), right LDP
(LDR), sitting2 (S2), left LDP
(LDL) and sitting3 (S3). For each position, PERG
amplitudes and IOP were determined with rebound tonometry (Icare TA01i) in all
participants without the IOP sensor.
Results
Electromagnetic intrusions of IOP sensor read-out onto ssPERG recordings
had, due to different frequency ranges, no relevant effect on PERG amplitudes.
IOP and PERG measures were affected by LDP, for example, IOP was increased
during LDR versus S1 in the lower eyes of
GLAIMP and controls (5.1±0.6 mmHg,
P0.025=0.00004 and 1.6±0.6 mmHg,
P0.025=0.02, respectively) and PERG amplitude was
reversibly decreased (−25±10%, P0.025=0.02 and −17±5%,
P0.025, respectively).
Conclusions
During LDP, both IOP and PERG changed predominantly in the lower eye. IOP
changes induced by LDP may be a model for studying the interaction of IOP and
ganglion-cell function.
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Mansouri K, Rao HL, Weinreb RN. Short-Term and Long-Term Variability of Intraocular Pressure Measured with an Intraocular Telemetry Sensor in Patients with Glaucoma. Ophthalmology 2020; 128:227-233. [PMID: 32663530 DOI: 10.1016/j.ophtha.2020.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the short-term and long-term variability of intraocular pressure (IOP) in eyes with primary open-angle glaucoma. DESIGN Prospective study. PARTICIPANTS Twenty-two patients previously implanted with a sulcus-based IOP sensor (EyeMate, Implandata GmbH, Germany). METHODS Twenty-two patients previously implanted with the EyeMate were requested to obtain at least 4 IOP measurements daily. Data were grouped according to the eye and the medication so that an eye treated with a particular medication was considered as one group, and the same eye treated with a different medication during the observation period was considered as a different group. A day was divided into 7 periods: night, midnight to 5:59 am; early, 6 am to 7:59 am; morning, 8 am to 10:59 am; noon, 11 am to 1:59 pm; afternoon, 2 pm to 5:59 pm; evening, 6 pm to 8:59 pm; and late, 9 pm to 11:59 pm. Short-term variability during a particular period was defined as the variability in IOP measurements obtained during that period on different days within 3 months of each other. Long-term variability was defined as the variability in IOP measurements obtained during a particular period on different days over a period of 1 year or more. Variability was assessed using intraclass correlation coefficients (ICCs). RESULTS The mean age of study participants was 67.8 ± 6.8 years and 36.4% were women. The mean follow-up duration of patients was 19.2 ± 21.3 months (median, 9 months; range, 1-58 months). Overall, 92 860 IOP measurements over 15 811 measurement days were obtained and analyzed during the study period. The number of measurements obtained from each eye ranged from 1 daily to 277 daily. Intraclass correlation coefficients for short-term variability among the 7 periods during the day ranged from 0.52 (morning) to 0.66 (early). Long-term ICCs ranged from 0.29 (night) to 0.51 (late). CONCLUSIONS Continual IOP monitoring showed that IOP has moderate short-term and high long-term variability in glaucoma patients. These findings demonstrate that single IOP measurements do not characterize day-to-day variations in IOP. Moreover, they show the importance of continual IOP monitoring in glaucoma patients.
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Affiliation(s)
- Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland; Department of Ophthalmology, University of Colorado School of Medicine, Denver, Colorado
| | | | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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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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Perucho-González L, García-Feijoó J. Evaluation and treatment of glaucoma 24hours a day. Where are we and where are we going? ACTA ACUST UNITED AC 2020; 95:345-352. [PMID: 32345482 DOI: 10.1016/j.oftal.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
Current management of glaucoma generally involves medical, laser, or surgical treatment in order to achieve an intraocular pressure (IOP) control which is commensurate with either stability or delayed progression of the disease. Although the follow-up of glaucoma patients is usually carried out with sporadic and isolated intraocular pressure measurements, the literature already indicates that this might not the best option to manage glaucoma patients. This article reviews the importance of 24hours intraocular pressure monitoring based on studies and publications that exist in this regard to date. A critical review on the methodology of these publications has been conducted. The need is stressed for further studies on the intraocular pressure patterns in different types of glaucoma, as well as the pattern with different therapies used in glaucoma aimed at optimising the management of the disease.
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Affiliation(s)
- L Perucho-González
- Fundación para la Investigación Biomédica, Hospital Clínico San Carlos, IdISSC, Departamento de Oftalmología, Universidad Complutense de Madrid, RETICS, Madrid, España.
| | - J García-Feijoó
- Fundación para la Investigación Biomédica, Hospital Clínico San Carlos, IdISSC, Departamento de Oftalmología, Universidad Complutense de Madrid, RETICS, Madrid, España
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37
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The Value of Intraocular Pressure Telemetry in Monitoring the Therapeutic Effect of Glaucoma Medications. J Glaucoma 2020; 29:e38-e40. [PMID: 32205830 DOI: 10.1097/ijg.0000000000001498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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