Factors Affecting Intraocular Pressure Measurement and New Methods for Improving Accuracy; What Can IOP Tell Us about Glaucoma? How Can Practitioners Improve IOP Utility and Glaucoma Outcomes?

An increased awareness of how central corneal thickness (CCT) and corneal material properties such as corneal hysteresis has changed both tonometry accuracy and the resultant understanding of glaucoma risk. New research findings and methods of tonometry provide differing information on the diagnosis and treatment of ocular conditions which should be understood to appropriately incorporate this information into individual patient care. Additionally, a useful re-examination of what IOP can tell us about glaucoma empowers practitioners to improve glaucoma outcomes. All clinically utilized tonometry methods are estimates of true IOP, which is only assessed using direct intracameral techniques. Different described tonometry techniques are associated with their own overall bias and interpatient variability, due most typically to tissue biomechanics

Variability of Consecutive Lumbar Puncture Opening Pressures

Lumbar puncture (LP) opening pressures (OPs) are known to fluctuate based on diurnal, environmental, and pathologic conditions. Despite their dynamic nature, single OPs are often deemed sufficient for diagnosis of elevated intracranial pressures (ICPs) in nonspecialists' hands. The purpose of this study was to determine the variability of consecutive LP OPs at a large referral center to determine the potential range of variability for a given LP O

Rates of Diplopia in Ahmed FP7, Baerveldt 250 and 350 Patients Compared to Medical Controls

Precis: Diplopia was present in similar to 20% of patients with Ahmed FP7 (FP7) or Baerveldt 350 (B350), compared with 5% to 6% in those with Baerveldt 250 (B250) or controls, suggesting risk of diplopia should be included in preoperative counseling. Purpose: The purpose of this study was to examine the prevalence of diplopia and strabismus in patients with B250, B350, or FP7 glaucoma drainage devices (GDD). Materials and Methods: In this cohort study, glaucoma patients 18 years and above who had received, or would be receiving, a B250, B350, or FP7 GDD, and medically treated controls were consecutively enrolled from August 8, 2017, through July 31, 2019. The Diplopia Questionnaire was administered >= 30 days postoperatively, and upon enrollment to the controls. All diplopic patients underwent orthoptic measurements, which were reviewed by a strabismus specialist. Patients with GDDs in quadrants other than superotemporal, multiple GDDs, or scleral buckles were excluded. Bonferroni correction was applied for pairwise comparisons. Results: Diplopia was reported in 23/129 (17.8%) GDD patients and 5/99 (5.1%) control patients (P = 0.003): 8/35 (22.9%) FP7, 2/32 (6.3%) B250, and 13/62 (21.0%) B350, with significant differences between FP7 versus controls (P = 0.014) and B350 versus controls (P = 0.011). Diplopia was attributable to GDD in 2 FP7 (5.9%, 95% confidence interval: 0.7-19.2), 0 B250, and 4 B350 (6.5%, 95% confidence interval: 1.7-15.2) patients, without significant differences between the GDDs. Conclusions: Patients with the larger (B350) or the higher profile plate (FP7) GDDs were more likely to experience diplopia than controls, and diplopia was attributable to the GDD in similar to 6% of patients with either a FP7 or a B350 GDD. Since diplopia can affect patients' quality of life, preoperative counseling for GDD surgery, particularly B350 and FP7, should include a discussion of the risk of diplopia