Much of my focus has been on high-frequency monitoring of intraocular pressure with currently available technology. The current standard in ophthalmology practice seems to be monitoring intraocular pressure at a frequency of once every three to twelve months, depending on specific patient factors. In contrast, my research efforts look at what is possible when intraocular pressure is monitored as frequently as hundreds of times per day for many consecutive days. We have a small number of research subjects who have been participating in high-frequency intraocular pressure monitoring for about one year so far.
Today's best technology for the type of research we are doing is a high quality non-contact tonometer. However, work is under way on future intraocular pressure monitoring devices based on concepts from the fields of nanotechnology and microtechnology.
Dr. Robert Ritch has been spearheading some of these efforts. In four days time he will be hosting the 14th Annual Glaucoma Foundation Think Tank with, as usual, a focus on microtechnology and nanotechnology. Last year's program was very focused on high-frequency intraocular pressure monitoring - what is often called continuous intraocular pressure monitoring. ("High-frequency" is a more accurate descriptor, but "continuous" gets the idea across that the monitoring occurs many times per second, 24-hours per day, every day.) Researcher Georg Michelson spoke on the current status of devices for continuous monitoring of intraocular pressure in animals and humans at the 13th Annual Glaucoma Foundation Think Tank.
There was a recent news announcement about plans for commercial marketing of such a device, and I believe this product is based on the work out of Georg Michelson's lab. Below is the link the the announcement and the news release itself.
I have a feeling the ophthalmology field wants to jump directly from the 50-year old technology of Goldmann applanation tonometry to micro- and nanotechnology based high-frequency intraocular pressure monitoring devices. I too am excited about the new technologies, but in the years between now and the practical commercial availability of these new devices, there is a tremendous amount we can learn from high-frequency intraocular pressure research using non-contact tonometers with innovative study designs. This is an untapped area that is rich with potential knowledge. (Devices such as Pascal Dynamic Contour tonometers and pneumotonometers, both of which are capable of recording IOP over extended periods of time such as several minutes, are also examples of current technology that can be incorporated into such research.)
Here is the news announcement:
Sensors can monitor production processes, unmask tiny cracks in aircraft hulls, and determine the amount of laundry in a washing machine. In future, they will also be used in the human body and raise the alarm in the event of high pressure in the eye, bladder or brain.
If the pressure in the eye is too high, nerve fibers die, resulting in visual field loss or blindness. Since increased intraocular pressure, also known as glaucoma, is not usually painful, the condition is often diagnosed too late. Moreover, such patients often tend to develop cataracts when they get older – the lenses of their eyes become opaque. In such cases, surgeons remove the natural lens and replace it with an artificial one. To avoid further loss of nerve fibers, the intraocular pressure is then regulated as accurately as possible with the help of medication. Unfortunately, the pressure continues to vary despite medication, obligating the patient to have it constantly monitored by physicians and the medication dosage adjusted accordingly.
In future, a sensor developed by researchers at the Fraunhofer Institute for Microelectric Circuits and Systems IMS in Duisburg will obviate the need for constant visits to the physician by such patients. “We integrate the 2.5 by 2.6 millimeter sensor in the artificial lens,” says Thomas van den Boom, group manager for biohybrid systems at the IMS. “This doesn’t impair the patient’s vision.” The top and bottom of the sensor are formed by electrodes; the top electrode is flexible, in contrast to its rigid counterpart on the bottom of the sensor. When the intraocular pressure increases, the top electrode is pushed in, reducing the distance between the top and bottom of the sensor and thus increasing the capacitance. Using a tiny antenna, the implant then sends the pressure data to a reader that is fitted into the frame of a pair of spectacles. The patient can view the results on an auxiliary device and determine whether the pressure has reached a critical level. An antenna in the spectacle frame supplies the sensor with the required energy via an electromagnetic field. “The power consumption of the sensor must be kept to an absolute minimum,” explains van den Boom. “All unused components are put in a kind of standby mode and only activated when needed.”
The permanent eye implant is currently undergoing clinical trials and could come into general use in two to three years’ time. But the sensor is not only suitable for use in the eye: When implanted in blood vessels in the thigh or the upper arm it can also help patients with chronic hypertension. “Conventional devices for measuring blood pressure at home are not suitable for determining the correct medication dosage,” says van den Boom. The sensor is also expected to benefit patients suffering from increased intracranial pressure or those with incontinence problems.