Diurnal Intraocular Pressure Variability Assessment

描述（由申请人提供）：原发性开角型青光眼（POAG）是一种眼部疾病，其特征为进行性视神经损伤、视野丧失，在许多情况下，眼内压（IOP）升高。治疗性降低IOP可防止POAG的进展，并且是POAG唯一已知的治疗方法。但是仅仅降低IOP并不总是足够的，在接受IOP降低治疗的青光眼患者中，青光眼进展和失明并不罕见。已知IOP随时间波动，并且尽管平均IOP水平似乎在治疗上是足够的，但最近在治疗的青光眼眼中IOP的大波动与进展相关。因此，IOP变异性是要评估的重要参数。目前的IOP变异性模型是单日昼夜IOP变异性。我们对昼夜IOP行为的了解是基于许多正常眼和青光眼眼的单日24小时（或更短时间）昼夜IOP评估。基于这些一天的时间测量，假设该IOP节律在个体的对侧眼睛之间是对称的，并且每天保持恒定的节律。这一建议挑战了这一教条。基于我们自己的初步研究和极少数表明患者的昼夜IOP节律随时间变化的研究，我们假设正常眼和青光眼眼的IOP变异性是随时间变化的混沌事件，并且知道给定眼睛在给定日期的昼夜IOP节律不允许预测任何其他日期的昼夜节律。反驳存在一个规则的和持续的昼夜IOP节律将迫使范式转移到更长期的指标IOP的变化。通过收集基线和1天、1周、1个月、6个月和1年后的昼夜IOP测量值，我们可以实现我们的特定目标，以表征正常和青光眼眼的眼内压的短期（天）、中期（周至月）和长期（年）昼夜变异性。我们假设在正常眼和昏迷眼重复昼夜测量眼内压将显示患者之间、对侧眼之间以及患者和眼内随时间的昼夜IOP节律的显著变化。

DESCRIPTION (provided by applicant): Primary open-angle glaucoma (POAG) is an ocular disease characterized by progressive optic nerve damage, visual field loss and in many cases, elevation of intraocular pressure (IOP). Therapeutically lowering IOP confers protection against progression of POAG, and is the only known treatment for POAG. But simply lowering IOP is not always enough, and glaucomatous progression and blindness are not uncommon in patients receiving IOP-lowering treatment for glaucoma. IOP is known to fluctuate over time, and large fluctuations of IOP in treated glaucomatous eyes have recently been associated with progression despite mean IOP levels that appear to be therapeutically adequate. Thus, IOP variability is an important parameter to assess. The current model for IOP variability is single-day diurnal IOP variability. Our knowledge of diurnal IOP behavior is based on many single-day 24-hour (or less) diurnal IOP assessments in normal and glaucomatous eyes. Based on these one-day-in-time measurements, it is assumed that this IOP rhythm is symmetric between fellow eyes of individuals and remains a constant rhythm from day to day. This proposal challenges that dogma. Based upon our own preliminary studies and a very few studies which suggest that diurnal IOP rhythms change in patients over time, we hypothesize that IOP variability is a chaotic event over time in both normal and glaucomatous eyes, and that knowing the diurnal IOP rhythm of a given eye on a given day does not permit prediction of the diurnal rhythm on any other day. Disproving the existence of a regular and sustained diurnal IOP rhythm would force a paradigm shift toward more long-term indices of IOP variability. By collecting diurnal IOP measurements at baseline and 1 day, 1 week, 1 month, six months, and one year later, we can achieve our specific aims to characterize the short- (days), intermediate- (weeks to months), and long-term (year) diurnal variability of intraocular pressure in normal and glaucomatous eyes. We hypothesize that repeated diurnal measurements of intraocular pressure in normal and glaucomatous eyes will demonstrate significant variability in the diurnal IOP rhythms between patients, between fellow eyes, and within patients and eyes over time.