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Not A Typical IOP Day!

    Submitted by dave on Mon, 11/13/2006 - 10:59pm

     Today was not a typical day! For one thing, we took 200 IOP measurements today! For another thing, my IOP values were not well controlled. It was like my emotions were directly connected to my IOP today, and my emotions were varied. Consequently, today's data shows a large range from the maximum value to the minimum value. That range is 16.7, way above yesterday's value of 11 (which itself was above previous values of 9-10).

    Technical aside: that range is based on the averages. If we look at individual measurements (which aren't shown in this blog), the range is even more extreme. In my right eye, the maximum measurement was 35 and the minimum was 14 mm Hg (before tonight's Timoptic). That's a range of 21!

    That variation in my IOP today is ridiculous. (And I feel troubled by it.) The only consolation I can take from today is that during the first two years that I had glaucoma, pressures around 30 (or higher) in my right eye were probably the norm. Every time I went to my ophthalmologist, my pressures were around 20. However, as soon as we started this IOP project, I found out that my pressures were often a lot higher than that. The second day of this project I had one IOP value of 29 (with every single value for the day above 20) in my right eye. The next day I had an IOP value of 34. And just 3 days prior, my ophthalmologist had examined me and found my pressures to be 17 (left) and 21 (right) using a Goldman tonometer!

    Clearly, the office visits were not telling the full story. It was after this point that my doctor had me start using Timoptic in my right eye. I had not done that for the prior two years, and I'm sure my typical IOP was usually much higher than what the once-every-six-months-ophthalmologist-exams indicated. So today, as bad as it was, still represents an improvement over my situation of prior years.

    The other difference between today and prior times is that today I knew some steps I could take to lower my IOP. Before I knew this -- and while I was on Xalatan only -- my IOP would range from the 20's to the 30's. The range was smaller than today only because my IOP would never get as low as it did today.

    TricksNotice that once again the weight lifting lowered my IOP significantly. One time during the day, my IOP went from 26 to 16 after working out. Another time it went from 22 (or 27 if you take the preceding high) to 16.7. Those efforts to engage in activities that I have found to reduce my IOP helped me achieve a low individual reading of 15 in my right eye today. However, in the preceding week, while the Timoptic was still exerting some effect, I achieved lows of around 10 or 11 in my right eye after similar activities, so my best efforts today couldn't match the low IOP values from prior days.

    The cartoon to the left is supposed to represent the fact that I used all the tricks I know to lower my IOP today, including working out twice. The results didn't match preceding days. I believe that's due to the effect of the Timoptic "extended release" gel forming solution finally wearing off. The extreme range from low to high is also probably a reflection of the Timoptic wearing off.

    Today is the 8th day since I used Timoptic last (which was 5-Nov). In my opinion the data shows that the Timoptic effect lasts a lot longer than one day for me. (I think they also show that the Timoptic dampens the effect of my emotions -- and stress -- on my IOP.)

    I pretty much knew today represented a change in trend as soon as we took the first IOP measurements. The value for my right eye was 26, as you'll see in the table below, but one of the individual measurements in that average was 29. There has not been an individual measurement that high in the last week, so I pretty much knew right away that the Timoptic effect had finally worn off after 8 days. It appears that the effect of the gel forming solution lasts for several days and then suddenly goes away. On one hand, it would be nice to have more data on this. However, on the other hand, I don't want more days with IOP values as high as today. I've spoken to my doctors about this and I'm confident that we are moving in the right direction - and that direction will not give many opportunities for testing the extreme limits of how long the Timoptic gel forming solution effect lasts for me.

    Given the situation, we pulled out the stops and collected 200 IOP measurements today (a new record).

    The overall average values today were:

    Left 14.2; Right 19.7 (differential 5.5) The average over all 200 individual measurements was 17.5 for both eyes.

    The differential of 5.5 does show what happens when the effect of the Timoptic in my right eye wears off. 

    As I said above, I tried a lot of different tricks today in order to record their effect without the Timoptic present.

    Even though I intended to do a bunch of positive things today, reality interfered a bit. I found myself doing some slightly stressful computer work a couple different times today. One of those periods produced an IOP in my right eye of 27.7. When I finally got a break from that work, my IOP was still 24.7. At this time I did one of my typical series of activities: I cooked; I played Frisbee with my dog; I did some eye "exercises." After all that, my IOP was as low as 17.7 (right eye). At this point, I realized that I was not thinking about the future at all. I wasn't doing business planning in my head, and I wasn't thinking about money or bills. I repeated the measurements and my IOP was similar (16.7).

    The next thing I did is pretty interesting. I know this data won't convince the skeptics, but I still find the results very interesting. I made a conscious decision to think about business and money. I've never done this before, but I sensed an opportunity to test one of my assumptions. I have assumed that that type of thinking raises my IOP based on the trends I've seen in the data. I had just never done a direct experiment like this to measure it. As soon as I purposefully thought about the future, my IOP jumped up to 22. This change was immediate - the 2 minutes between time stamps is because each IOP value we show consists of multiple measurements, and it takes a couple minutes to collect them all.

    We have 6 measurements on my right eye with an average IOP of 17 while I wasn't thinking about the future, and 12 measurements after I thought about the future - and the average IOP was 21.

    What's interesting is that after I had the thoughts that raised my IOP, trying to think relaxing thoughts didn't work. Previously, I was just relaxed without trying to be relaxed (this was after playing with my dog, etc.). After the "thought experiment" that raised my IOP, I tried to be relaxed but it didn't really work. My IOP didn't come back down.

    But it can be even worse than that. Take a look at the data for 11:44 AM. This is an example of an extended relaxation period. I used a proven relaxation technique from 11:23 to 11:44. My IOP went up over this period and by 11:44 it was near the high of the day - the effect is similar to thinking stressful thoughts! (And no one I know has any idea why this relaxation technique raises my IOP.)

    I joked in an earlier post about not being able to relax. That's not entirely true. I have over 14 years of training in one of the most well-researched relaxation techniques known. I have spent tens of thousands of dollars on professional training and coaching in that technique. I have a relative who is certified to teach the technique at the highest levels and I take advantage of that person's advice often. So it isn't like I'm clueless about how to relax. When I do these relaxation techniques (depending on which one I do), I can achieve states that feel very relaxing. I do get deeply relaxed. It's just that those relaxed states consistently translate into higher IOP values. Today's data (at 11:44 AM) is just one more example among many. However, I hoped what I was doing today was going to lower my IOP - after all, that was my goal today. And the technique I used was slightly different from prior instances that raised my IOP, so I intended to achieve a lower IOP. It just goes to show that I can't assume much about my IOP. Having the numbers so we can make decisions without assumptions or guessing has made a huge difference in how my doctors and I approach my glaucoma.

    After my second workout of the day, my IOP values were relatively good for a while. Then I resumed working at the computer, and my pressures shot back up. Today is unusual in that it shows several cycles between low IOP values and high IOP values. There is a clear connection between the IOP values and the activities. That trend is present in all the data, but today shows it well with 200 measurements (and without the dampening effect of the Timoptic).

    The last comment I'll make about today is that the measurements at 11:30 PM caught me completely by surprise. The values of:

    Left 12.7; Right 14.7

    were like prior days! Those are great numbers. I don't know what to make of that. The only thing I can suggest is that just prior to this IOP exam, I finished a project that was about 2 weeks late. It wasn't a big project, but I was relieved to finally get it finished. Nothing I did earlier today allowed me to reach IOP values that low. (Granted, it helps that it was late in the evening because my IOP is usually lower in the evening.) But, I was shocked to see those numbers on a day like today.

    In fact, I think I was so shocked that when we repeated the measurements, the values were higher. We repeated again, and matched the value of 14.7 for my right eye. But then we repeated several more times and got higher numbers. People will draw different conclusions from this. Unfortunately, I feel that today's post is already too long for me to launch into an extended discussion of why those measurements between 11:30 PM and 11:42 PM have meaning. I'll just say that after 7934 IOP measurements in the last couple months, I am fairly confident that these numbers aren't due to errors of any type. There is meaning in those measurements.  

    Here are all of today's IOP values:

    Time Left Right SD L SD R Comments
    9:59 20.0 26.0 2.646 3.606  
    10:02 15.3 21.7 0.577 2.517 Repeated measurements.
    11:08 15.7 25.7 2.082 2.082  
    11:23 15.3 19.7 2.082 0.577 After brushing teeth.
    11:26 13.7 23.3 1.528 2.517 Repeated measurements. Trying to relax.
    11:30   20.3   1.528 Repeated measurements.
    11:36   21.3   2.309 Repeated measurements.
    11:44 17.3 26.2 1.528 5.070 Repeated measurements. Extended relaxation period.
    12:16 16.0 20.0 1.000 1.000 After 5m frisbee with my dog, 5m long swing, 3m Bates sunning, 5m frisbee.
    12:40 11.3 16.0 0.577 2.000 After 14m weight workout (legs).
    12:45 11.7 17.0 0.577 0.000 Repeated measurements.
    13:07 13.3 18.3 2.309 1.528 After eating (milk and nuts).
    13:25 13.7 19.3 1.528 1.528 After shower.
    14:37 16.3 27.7 2.082 3.512 Working at computer. Feeling stress.
    16:27 17.7 24.7 0.577 2.082 Working at computer. Feeling stress.
    16:50 13.3 18.7 1.528 1.155 Cooking.
    17:08 13.0 21.0 0.000 0.000 After 5m frisbee with my dog, 2m Bates sunning, 4m long swing, 1m frisbee.
    17:10 14.0 17.7 1.000 0.577 Repeated measurements.
    17:16 14.7 16.7 1.528 0.577 Not thinking about the future (without trying to control my thoughts).
    17:18   22.0   1.000 Thinking about business planning, money, etc.
    17:22   20.0   1.000 Trying to relax. (It seems that once I think stressful thoughts, it is difficult to get rid of the effects.)
    17:23   20.3   0.577 Repeated measurements.
    17:26   21.7   2.082 Trying to think relaxing thoughts
    17:39 11.3 16.7 0.577 0.577 After 8m weight lifting (chest).
    17:41 11.3 15.0 0.577 1.000 Relaxing.
    17:42 11.7 15.7 1.155 0.577 Repeated measurements.
    18:00 12.0 18.0 1.000 1.732 After cooking.
    18:33 13.0 18.3 1.732 2.082 After eating.
    20:22 16.0 24.7 1.732 2.517 Working at computer.
    23:08 14.7 21.0 2.517 3.000  
    23:09   19.3   2.309 Repeated measurements. Trying to relax.
    23:30 12.7 14.7 1.155 0.577 After brushing teeth. Finished a project that was 2 weeks overdue.
    23:32 14.0 18.3 2.000 2.082 The shock of the prior measurement gave me anxiety about this measurement.
    23:36   14.7   0.577 Repeated measurements. Trying to relax.
    23:39   18.0   1.732 Repeated measurements. Trying to relax.
    23:42   17.3   1.528 Repeated measurements. Trying to relax.
    23:55         TIMOPTIC R.eye only. Xalatan L. eye.
    0:08 14.7 22.3 2.309 2.309 After laying down.
    2:05 14.0 11.0 1.000 0.000 Playing on computer.

    As a reminder, I'll mention that these values are all averages. There are 200 individual measurements underlying these averages. There are 66 values above. Each of those consists of 3 measurements except in one case where we took 5 measurements (11:44 AM, right eye -- to be more confident of that individual value because it was unexpectedly high). 

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