Nocturnal IOP Reduction Matters
John R Martinelli MD OD FAAO
Teaching The Fine Art of Patient Management
Do you understand the dynamics?...
Nocturnal intraocular pressure (IOP) reduction is key in managing glaucoma, particulary normal tension glaucoma (NTG). There is a not too surprising link between expected elevated nocturnal IOP and glaucomatous progression, emphasizing the importance of understanding and addressing these dynamics when managing our patients.
Minimizing retinal ganglion cell (RGC) death by reducing IOP during nighttime hours when it typically peaks is an approach which is especially critical for our NTG patients - who present with unique treatment challenges due to their lower baseline IOP. Clinical benefits of nocturnal IOP reduction include?slowed progression and improved outcomes, particularly in vulnerable NTG clinical scenarios for which hypoxic, ischemic, or ocular perfusion pressure issues may often be contributing.
While treatment options for reliably lowering nocturnal IOP are limited, historically trabeculectomy and now the innovative?Ocular Pressure Adjusting Pump (OPAP) have shown positive results. The OPAP has demonstrated the ability to reduce mean nocturnal IOP by up to 35%, with the added advantage of improving ocular perfusion.
For us, implementing strategies to manage increased nocturnal IOP, while also preseriving optic nerve integrity "from the backside", must not be overlooked for comprehensive management. Let's look forward to adding new therapeutic approaches potentially revolutionizing our ability to preserve vision for our glaucoma patients.
-JRM
Go to the article in Ophthalmology:
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