Fluctuations in IOP have been pinpointed as a potential cause for glaucoma and a factor in worsening the eye damage caused by the disease, writes Joseph Caprioli, M.D., of the Jules Stein Eye Institute, UCLA, in an accompanying editorial.
Why should IOP fluctuation be damaging? Theories abound about the mechanisms of retinal ganglion cell damage in glaucoma, but no single cellular or molecular cause satisfactorily explains the condition in all patients, Dr. Caprioli writes. Long-term variability may disrupt homeostatic mechanisms. Irregular and large IOP fluctuations may cause a loading and unloading of stresses, and as opposed to conditions of static stress, the tissue is unable to compensate and damage occurs.
I would propose for your consideration IOP modulation rather than IOP reduction as appropriate treatment, he concludes. This would not only lead to robust IOP reduction in patients with advancing disease but also establish the goal of reducing IOP fluctuation, particularly in patients with disease progression even at lower pressures. Specific guidelines, however, must await a better understanding of the pathophysiologic consequences of IOP fluctuation in glaucoma.