Surgery May Be Better For Some Glaucoma Patients Than Drops

Elevated IOP (eye pressure) is a strong risk factor for glaucoma, and prospective, randomized clinical trials have left little doubt that its reduction delays or prevents disease onset and progression. Not having been studied prospectively, the role of IOP fluctuation is decidedly less certain – and more contentious. However, recently developed technology allows IOP measurements over a 24-hour cycle to address this question.

Muniesa Royo and colleagues used a contact lens sensor to compare IOP fluctuations and prevalence of nighttime spikes. Not surprisingly, surgically treated patients had fewer pressure fluctuations and nighttime spikes. 

Although I’m concerned that the level of patient adherence with medications was not monitored (potentially giving surgical patients an artificial advantage), this study invites us to reevaluate both our diagnostic and treatment methods. It is a reminder of the limitations of applanation tonometry (in office eye pressure tests) in detection and management of glaucoma and also suggests we may need to rethink our treatments. For example, patients progressing despite “good” eye pressure control may be better served by surgical intervention earlier in the disease process. Of course, careful monitoring over time and appropriate treatment adjustments will ultimately determine which patients need tighter IOP control.