This represents a limitation against collecting real-life experience with the device in various populations and prevents information being obtained around the potential technical problems occurring in less experienced hands and in different ethnic groups. data collection. Treatment decisions, advancement Alda 1 of therapy and even medical procedures are often reached on the basis of limited IOP evidence. Clearly, there is much room to enhance our decision-making and to develop new algorithms for everyday practice. The precise way in which daytime IOP readings can be used as predictors of night-time or 24-h IOP characteristics remains to be Alda 1 determined. In practice it is important to identify those at-risk glaucoma patients for whom a complete 24-h curve is necessary and to distinguish them from those for whom a daytime curve consisting of three IOP measurements (at 10:00, 14:00 and 18:00) would suffice. By employing a staged approach in determining the amount of IOP evidence needed and the rigour required for our monitoring approach for the individual patient, our decisions will be based on more comprehensive data, while at the same time this will optimize use of resources. The patients clinical picture should be the main factor that determines which method of IOP monitoring is usually most appropriate. A diurnal or ideally a 24-h IOP curve will positively impact the management of glaucoma patients who show functional/anatomical progression, despite an apparently acceptable IOP in the medical center. The potential impact of nocturnal IOP elevation remains poorly investigated. The ideal answer in the future is the development of noninvasive methods for obtaining continuous, Goldmann comparative IOP data on all patients prior to important treatment decisions. Moreover, an important area of future research is usually to establish the precise relationship between 24-h IOP characteristics and glaucoma progression. primum PPARG movensin glaucoma development, the decision to treat glaucoma suspects rests greatly around the IOP level documented during follow-up. Thus, an apparently low level of recorded IOP may show misleading and may mask the real risk of glaucoma development. On the other hand, an erroneously high level of IOP may lead to unnecessary administration of medication with potentially harmful effects on a long-term basis [75]. Therefore, Alda 1 to obtain a true picture of IOP levels for any glaucoma suspect, several IOP readings are required [37, 76]. While a diurnal IOP curve may suffice in most cases, a complete 24-h or 48-h curve may be needed in selected cases to unmask periods of exposure to higher levels of IOP during the night [37, 76]. The concept of a biological rhythm of IOP has been well documented since the beginning of the twentieth century by the works of Maslenikow, Duke-Elder and Henkind and has been extensively examined, especially since the late 1970s by several controlled studies [30]. A biological rhythm may either be circadian (established in the absence of any environmental influence) or nyctohemeral (established under the influence of alternating light and dark) [30]. To investigate the biological rhythm of IOP, recordings over a total 24-h period are required [37, 76]. Moreover, there is some evidence that to establish detailed IOP fluctuation characteristics, in some cases 48-h monitoring is required [77, 78]. The probability of identifying a circadian or nyctohemeral rhythm increases when the measurement frequency of a Alda 1 biological parameter increases over time (thus the number of measurements over 24?h) and vice versa, rendering near-continuous rather than individual measurements the ideal method of recording [79]. Several studies have confirmed the presence of a nyctohemeral IOP rhythm, but not a true circadian IOP rhythm (i.e. not a rhythm generated by the internal biological clock of the suprachiasmatic nucleus in the absence of any influence of the environment) [30]. In healthy human subjects, the amplitude of IOP nyctohemeral fluctuation varies between 3 and 5?mmHg, ranging from a peak in the morning to a trough recorded any time during the 24-h period [30, 31, 37, 38, 79]. Interestingly, the amplitude of the IOP nyctohemeral fluctuation varies extensively among healthy individuals but is fairly consistent in the same individual and is.
