Learn about an implantable wireless device has identified new ways to help physicians diagnose and monitor glaucoma.
What: An implantable wireless device has identified new ways to help physicians diagnose and monitor glaucoma by continuously measuring and recording a number of new pressure parameters in the eye and not just relying on intraocular pressure (IOP) measurements. These new parameters could lead to improvement in diagnosing and following patients with glaucoma.
Where: Javien JA, et al. Effect of Body Position on Intraocular Pressure (IOP), Intracranial Pressure (ICP), and Translaminar Pressure (TLP) Via Continuous Wireless Telemetry in Nonhuman Primates, Investigative Ophthalmology & Visual Science, 2020; Javien JA, et al. Quantification of Translaminar Pressure Gradient (TLPG) With Continuous Wireless Telemetry in Nonhuman Primates, Translational Vision Science & Technology, 2020
BrightFocus Connection: J. Crawford Downs PhD, senior author of both papers, received support for this research from the National Glaucoma Research program. He is professor of ophthalmology and vice-chair of research for the University of Alabama-Birmingham Department of Ophthalmology and founding director of its interdisciplinary Ocular Biomechanics and Biotransport Program.
Why It Is Important: High intraocular pressure (IOP), which refers to the fluid pressure in the eye, is used as a parameter to diagnose and track glaucoma in patients. Until recently, reducing IOP has been the main focus of glaucoma treatment. However, glaucoma in many patients continues to progress despite treatment aimed at lowering IOP. For glaucoma patients with normal IOP, lowering IOP is not a treatment option. Therefore, new parameters and treatments are needed.
Recent studies suggest that pressure from cerebrospinal fluid (CSF) surrounding the optic nerve head – the main site of damage in glaucoma – might also be involved in glaucoma progression. It has been proposed that measuring pressure within the site of damage might provide a useful way to diagnose and monitor glaucoma.
With support from BrightFocus, Downs and colleagues created a wireless pressure device that can measure CSF, IOP, and the pressure difference between the two parameters, also known as translaminar pressure (TLP). Another benefit: the device can measure pressure continuously, which has never been possible before, adding another layer of testing that can help identify unique pressure characteristics in glaucoma patients compared to healthy individuals.
Downs and colleagues implanted their novel technology in non-human primates. They found that measuring intracranial pressure (another method of measuring CSF pressure) and TLP might be more important to measure in glaucoma than measuring IOP alone.
In a subsequent study (Javien JA, et al, 2020), they used the wireless device to examine another parameter, known as the translaminar pressure gradient (TLPG). This measurement captures information about laminar thickness and TLP, providing additional structural information about the eye which improves the ability of their device to track and diagnose glaucoma. This suggests that TLPG may also be highly relevant for diagnosing glaucoma compared to solely measuring IOP.
Together, these studies emphasize that a more comprehensive analytical approach is needed to accurately diagnose and monitor glaucoma severity and progression. These researchers advise clinicians to consider measuring TLP and CSF pressure, along with IOP, as glaucoma risk factors when evaluating patients.
- J. Crawford Downs 2016-18 NGR grant
- Glaucoma and Eye Pressure (a BrightFocus expert article, 2018)
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