The significance of measurements of diurnal curve on progression of glaucoma is unclear.
Systematic review
The aim of the systematic review «Medical Advisory Secretariat.. Diurnal tension cur...»1 was conducted to determine whether the use of a diurnal tension curve (multiple IOP measurements over a minimum 8 hour duration) is more effective than not using a diurnal tension curve (single IOP measurements) to assess IOP fluctuation as a risk factor for the development or progression of glaucoma and to determine whether the use of a diurnal tension curve is beneficial for glaucoma suspects or patients with progressive glaucoma despite normal single office IOP measurements and leads to a more effective disease management strategy.
Literature search was performed on July 22, 2010 for studies published from January 1, 2006 until July 14, 2010. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then by a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology.
Inclusion criteria were open angle glaucoma (established or OHT high risk) in an adult population, IOP measurement by Goldmann applanation tonometry, number and timing of IOP measurements explicitly reported (e.g., 5 measurements a day for 5 visits to generate a diurnal curve or 1 measurement a day [no diurnal curve] every 3 months for 2 years). IOP parameters include fluctuation (range [peak minus trough] or standard deviation) and mean outcome measure = progression or development of glaucoma. Study reports results for ≥ 20 eyes. The outcome of interest was progression or development of glaucoma.
There is very low quality evidence (retrospective studies, patients on different treatments) for the use of a diurnal tension curve or single measurements to assess short or long-term IOP fluctuation or mean as a risk factor for the development or progression of glaucoma. There is very low quality evidence (expert opinion) whether the use of a diurnal tension curve is beneficial for glaucoma suspects or patients with progressive glaucoma, despite normal single office IOP measurements, and leads to a more effective disease management strategy.
To test the hypothesis that 24-hour IOP-related patterns recorded with a contact lens sensor (CLS) correlate with prior rates of visual field progression, a multicenter, retrospective cohort study was conducted at 50 ophthalmology care centers in 13 countries «De Moraes CG, Mansouri K, Liebmann JM ym. Associat...»2. Participants included 445 patients (445 eyes) with treated, manifest open-angle glaucoma. Of the 445 patients included, 238 (53.5%) were women and 394 (88.5%) were white. The mean (SD) age and MD values at the time of CLS recording were 68.9 (11.2) years and -9.0 (7.0) dB. The mean rate of MD change was -0.46 (0.5) dB/y in 5.2 (3) years of follow-up. After adjusting for baseline MD severity, age, and treatment, the following CLS variables were associated with fast visual field progression: mean peak ratio while awake (β = -0.021; 95% CI, -0.04 to -0.003), number of long peaks during sleep (β = 0.036; 95% CI, 0.005 to 0.067), night bursts ocular pulse frequency SD (β = 0.027; 95% CI, 0.004 to 0.051), and night bursts ocular pulse amplitude SD (β = 19.739; 95% CI, 1.333 to 38.145). Regression models including CLS variables had better fit than Goldmann IOP when testing the association with rates of progression.