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Recent Advances in the Treatment of Glaucoma – The Need to Maintain Intraocular Pressure Over 24 Hours

European Ophthalmic Review, 2011,5(1):33-7 DOI:


In the treatment of glaucoma, maintenance of intraocular pressure (IOP) over a 24-hour period is of considerable importance. Some glaucoma medications do not sustain low IOP, allowing it to fluctuate with the potential to damage the optic nerve, leading to blindness. Several topically applied prostaglandins have become available, which have the advantage of maintaining 24-hour control. With these developments, it is timely to consider the relative merits of glaucoma surgery compared with medical treatments including eye drops and systemic medications, and which of the medications provides the most benefit to patients. Medications that control IOP over 24-hour periods require monitoring methods to assess their efficacy. Most determination procedures are carried out in a clinician or ophthalmologist’s office and provide only a single measure at one point in time. These require fixed equipment and cannot provide an overview of IOP variation over time or indicate whether treatments are providing continuous control. A development to address this monitoring need is the Sensimed Triggerfish®. This system uses a soft contact lens with an embedded pressure-sensing chip and associated monitoring equipment to provide multiple readings over a 24-hour period. The initial clinical experience with this device led to an immediate treatment change in two-thirds of patients. A clinical trial evaluating the efficacy of a new prostaglandin treatment, tafluprost, over 24 hours using the contact lens IOP monitoring system is currently underway. Based on the initial data, tafluprost effectively reduces IOP during the full 24-hour period, further supporting its use in the treatment of glaucoma.

Support: The publication of this article was funded by Santen Oy.
Keywords: Alpha-agonist, beta-adrenergic blocker, glaucoma, intraocular pressure, prostaglandin, tafluprost
Disclosure: The authors have no conflicts of interest to declare.
Received: February 25, 2011 Accepted: May 03, 2011
Correspondence: Tarek Shaarawy, Director, Glaucoma Sector, Department of Ophthalmology, University of Geneva, 22, Rue Alcide Jentzer, 1211 Genève, Switzerland. E:

Elevated intraocular pressure (IOP) is the most important and the only modifiable, known risk factor for glaucoma1–8 and consequently, most therapeutic interventions are directed at its modification.1–31 Both the peak levels2–4,18,21 and fluctuations15,19,23 have been known to impact disease development and progression, even in cases with statistically normal pressures.1,2,6,9,10,15,20,30 Most authors concur that IOP peaks tend to be associated with visual field (VF) decline,10,22,31 but whether or not IOP fluctuation is a risk factor for progression of glaucoma is still controversial.10,11,13–16,19,23,26 This article is an attempt to elucidate the role of 24-hour IOP control and its relevance to current glaucoma practice, as well as emerging therapeutic and diagnostic techniques.
The Efficacy of Intraocular Pressure Reduction
The efficacy of IOP reduction in retarding the progression of glaucoma over a wide spectrum of disease – from low to high IOPs and from early to advanced disease – has been conclusively demonstrated.2–4,18,21
In the Advanced glaucoma intervention study (AGIS), long-term IOP fluctuation was associated with VF progression in subjects with low mean IOP but not in patients with high mean IOP.15 Diurnal and long-term IOP fluctuations were not found to be significant risk factors for progression of early glaucoma or ocular hypertension (OHT) in the Early manifest glaucoma trial (EMGT),13 the Malmo ocular hypertension study,12 or the Ocular hypertension treatment study (OHTS).23
Lowering IOP by at least 18% (mean) from baseline has been shown to result in at least a 40% reduction in rates of worsening of glaucoma over five years.2,5,18,21,28
The mean IOPs of those who progress to blindness, however, have been reported to not differ from those who do not, with the severity of glaucoma at the time of diagnosis and the range of IOPs found during follow-up (long-term IOP fluctuation) being important predictive factors.17,27
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Keywords: Alpha-agonist, beta-adrenergic blocker, glaucoma, intraocular pressure, prostaglandin, tafluprost