CLINICAL APPLICATION OF A SELF-TONOMETER

自眼压计的临床应用

基本信息

批准号：
2158942
负责人：
RAN C. ZEIMER
金额：
$ 16.36万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1993
资助国家：
美国
起止时间：
1993-08-16 至 1995-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2158942
关键词：
circadian rhythms clinical biomedical equipment diagnosis quality /standard disease /disorder proneness /risk eye disorder diagnosis eye fundus photography glaucoma surgery glaucoma test home health care human subject human therapy evaluation intraocular pressure longitudinal human study pathologic process patient care management perimetry

项目摘要

Elevated IOP is clearly the dominant risk factor in glaucoma as the probability of damage to the optic nerve increases with increasing pressures. The IOP, however, is not constant during the day and can have large fluctuations, especially in glaucoma patients. As mentioned in the NEI National Plan and by the Study Section: "We still do not know if it is true average pressure, the occasional peak, or the variation...that is the most important. Nor do we completely understand the spontaneous variations of IOP. Thus home tonometry has much appear." In response to this need, a Self-Tonometer has been developed that can be used by the patient alone, at home or at work, and has been shown to be safe and accurate. The clinical application indicates so far that new and valuable information can be gained by home tonometry. Future studies will address some of the areas in which information is still lacking: 1) The effort in the past has led to the recruitment and beginning of follow-up of primary open angle glaucoma patients with apparently well-controlled IOP and of low tension glaucoma patients. These patients, and additional recruits, will be followed up prospectively by home tonometry, clinical evaluation and stereo disc photography. This will us allow to better characterize the behavior of IOP with time and to assess the predictive value of the parameters of the IOP diurnal variations for the progression of glaucomatous damage. 2) Patients who had surgery following a progression in visual field loss will be followed up after it is determined by, office tonometry, that they have well-controlled IOPs. This will provide information on the nature of the IOP diurnal variations and the curve types following different surgeries (laser trabeculoplasty, partial-thickness and full-thickness filtering surgery); comparison of the degree of long-term normalization of the diurnal IOP variations achieved by the different surgeries versus medical treatment; and assessment of the value of diurnal variation parameters in predicting further progression of glaucoma in this group which is particularly sensitive to further damage. 3) We have detected the presence of significant IOP peaks upon wakening. Self-Tonometry will be performed close to the time of wakening in order to assess the prevalence of early morning peaks in normals, and subjects with low tension glaucoma, open angle glaucoma or ocular hypertension. The presence of such peaks in a significant portion of the population would indicate that home tonometry has a particular diagnostic importance as the only practical method to detect potentially damaging IOPs. 4) Finally, more clinical experience will define the kind of patients needing home tonometry and the benefits that can be expected in diagnosis and management.

升高的IOP显然是青光眼的主要危险因素视神经损害的可能性随着增加而增加压力。但是，IOP在白天并不恒定，可以大波动，特别是在青光眼患者中。如 NEI国家计划和研究部分：“我们仍然不知道它是否是真正的平均压力，偶尔的峰或变化...那就是最重要的。我们也不完全理解自发变化 iop。因此，出现了很多家用沟通。”根据这种需求，已经开发了自我调节，可以单独使用患者使用家中或工作中，已被证明是安全而准确的。临床申请表明，新的和有价值的信息可以是由家庭沟通能获得。未来的研究将解决一些领域仍然缺乏哪些信息：1）过去的努力导致招募和开始的一级敞开角度青光眼的随访具有良好控制的IOP和低张力青光眼的患者患者。这些患者和其他新兵将被跟进前瞻性地通过家庭沟通，临床评估和立体声光盘摄影。这将允许更好地描述IOP的行为随着时间的时间并评估IOP参数的预测值青光眼损伤进展的昼夜变化。 2）患者在视野损失进展后进行手术的人将是在办公室TONOMETRY确定后，随后控制良好的IOPS。这将提供有关性质的信息 IOP昼夜变化和曲线类型在不同的手术之后（激光小梁成形术，部分厚度和全厚度过滤外科手术）;比较长期标准化程度不同手术与医学实现的昼夜差异治疗;并评估昼夜变化参数的价值预测这一组中青光眼的进一步发展对进一步损害特别敏感。 3）我们已经检测到存在醒来后的显着IOP峰值。将执行自我调节接近醒来的时间，以评估早期的患病率正常的早晨峰和低张力青光眼的受试者开放角度青光眼或眼高血压。这样的峰会存在大部分人口将表明家庭沟通能力作为唯一的实用方法，具有特殊的诊断重要性检测潜在破坏IOPS。 4）最后，更多的临床经验将定义需要家庭沟通的患者的种类及其好处可以在诊断和管理中预期。