title: Long-term home monitoring of intraocular pressure in pediatric glaucoma.
abstract: Diurnal fluctuation of intraocular pressure (IOP), implicated in progression of adult glaucoma, has been reported in children only in the context of office and short-term home monitoring. The purpose of this study was to evaluate long-term patterns of IOP fluctuation and changes resulting from outflow-enhancing intervention in pediatric glaucoma.
  
  
  
  Parent-measured home-based rebound tonometry (Icare, Finland Oy) in pediatric glaucoma patients was studied prospectively. IOP was monitored for more than 1 month, with requested measurements at least 3 times daily. Demographic and glaucoma-related information were collected for each participant. IOP was recorded at home on electronic data sheets. It was then evaluated for trends including mean overall IOP, IOP pre- and post-planned IOP-lowering interventions, and IOP spikes over determined time intervals.
  
  
  
  IOP was measured in 14 eyes of 7 children (mean age, 9.3 ± 2.4 years) over a mean of 164.3 days (range, 75-341), with a mean of 2.46 readings daily. Six eyes of 5 children underwent attempted outflow improvement, with improved mean IOP before versus after intervention (26.6 vs 15.5 mm Hg, P < 0.0001) and decreased mean daily IOP fluctuation (8.4 vs 4.6 mm Hg, P < 0.001) for each. An IOP reading 20% greater than mean for an individual eye over the entire period (a pressure "spike") occurred in 19.3 ± 6.7% over 1 day, 62.9 ± 18.0% over 3 days, 80.8 ± 12.2% over 7 days, and 92.9 ± 9.4% over 14 days.
  
  
  
  Long-term home monitoring in pediatric glaucoma proved feasible in this study population and often demonstrated large IOP fluctuations. A 14-day period of home monitoring provided >90% chance of identifying an IOP spike. Successful outflow improvement lowered both mean IOP and mean daily IOP fluctuations.
authors.affiliation: Duke University Department of Ophthalmology, Durham, North Carolina.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Bitner
authors.affiliation: Duke University Department of Ophthalmology, Durham, North Carolina. Electronic address: sharon.freedman@duke.edu.
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
mesh_terms: D002648:Child; D005260:Female; D005387:Finland; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D011446:Prospective Studies; D014065:Tonometry, Ocular