Integrative Biomedical Research (Journal of Angiotherapy)
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN  3068-6326
  1. You are here:
  2. Home
  3. Journals
  4. Biological Sciences
Integrative Biomedical Research (Journal of Angiotherapy)
Latest Issue

Volume 9 Number 1 2025

Article Contents

REVIEWS   (Open Access)
Contents Vol 8 (1)

Assessment and Clinical Significance of Intraocular Pressure in Ocular Physiology and Glaucoma Management: Role of Pharmacists and Healthcare Professionals

Adel Dakhel D Alharbi 1, Ghadyan Salem A Sammari 1, Waleed Abdullah Alghamdi 1, Khalid Assaf Mohammed Almutairi 1, Ali Ali Alotaibi 1, Awadh Hamid Alhafi 1, Muteb Marshad Alanazi 1, Naief Qalit Almutairi 1, Ahmed Nijr Owaidh Alrahimi 1, Yousef Mesfer Almutairi 1, Ali Abdullah Almntshre 1

+ Author Affiliations

Integrative Biomedical Research (Journal of Angiotherapy) 8 (1) 1-12 https://doi.org/10.25163/angiotherapy.8110305

Submitted: 07 November 2023 Revised: 14 January 2024  Published: 15 January 2024 

Abstract

Background: Intraocular pressure (IOP) is a critical physiological parameter maintained by aqueous humor (AH) dynamics, balancing production by the ciliary body and drainage through trabecular and uveoscleral pathways. Disruptions in this equilibrium can lead to ocular hypertension, glaucoma, or hypotony, with significant implications for vision. Glaucoma, a leading cause of irreversible blindness, is strongly associated with elevated IOP, though normal-tension glaucoma also occurs. This article examines the physiological regulation of IOP, its clinical assessment, and the role of Pharmacists and healthcare professionals in managing IOP-related disorders, particularly glaucoma. Methods: The review discusses tonometry techniques (Goldmann applanation, rebound, and non-contact tonometry), IOP measurement challenges (corneal thickness, diurnal variations), and emerging technologies (continuous IOP monitoring). It also evaluates diagnostic criteria for ocular hypertension, glaucoma, and hypotony, along with therapeutic interventions. Results: Normal IOP ranges between 10–21 mmHg, but isolated readings may not fully capture disease risk. Goldmann applanation tonometry remains the gold standard, though corneal biomechanics influence accuracy. Ocular hypertension does not always progress to glaucoma, while normal-tension glaucoma occurs despite normal IOP. Emerging biomarkers and 24-hour monitoring may improve early detection and personalized treatment. Conclusion: IOP assessment is essential for glaucoma management but must be interpreted alongside structural and functional tests. Interprofessional collaboration ensures accurate monitoring and timely intervention. Future advancements in continuous IOP monitoring and precision medicine may enhance patient outcomes.

Keywords: Intraocular pressure, glaucoma, tonometry, aqueous humor, ocular hypertension, optic neuropathy

References

Acott, T. S., Kelley, M. J., Keller, K. E., Vranka, J. A., Abu-Hassan, D. W., Li, X., Aga, M., & Bradley, J. M. (2014). Intraocular pressure homeostasis: Maintaining balance in a high-pressure environment. Journal of Ocular Pharmacology and Therapeutics, 30(2–3), 94–101.

Bader, J., Zeppieri, M., & Havens, S. J. (2023). Tonometry. StatPearls Publishing.

Bhartiya, S., Gangwani, M., Kalra, R. B., Aggarwal, A., Gagrani, M., & Sirish, K. N. (2019). 24-hour intraocular pressure monitoring: The way ahead. Romanian Journal of Ophthalmology, 63(4), 315–320.

Boey, P. Y., & Mansberger, S. L. (2014). Ocular hypertension: An approach to assessment and management. Canadian Journal of Ophthalmology, 49(6), 489–496.

Brusini, P., Salvetat, M. L., & Zeppieri, M. (2021). How to measure intraocular pressure: An updated review of various tonometers. Journal of Clinical Medicine, 10(17). https://doi.org/10.3390/jcm10173904

Brusini, P., Salvetat, M. L., Zeppieri, M., Tosoni, C., & Parisi, L. (2006). Comparison of ICare tonometer with Goldmann applanation tonometer in glaucoma patients. Journal of Glaucoma, 15(3), 213–217.

Buffault, J., Labbé, A., Hamard, P., Brignole-Baudouin, F., & Baudouin, C. (2020). The trabecular meshwork: Structure, function and clinical implications. Journal Français d’Ophtalmologie, 43(7), e217–e230.

Campbell, P., Edgar, D. F., & Shah, R. (2022). Inter-optometrist variability of IOP measurement for modern tonometers and their agreement with Goldmann applanation tonometry. Clinical and Experimental Optometry, 105(3), 347–348.

Casson, R. J. (2022). Medical therapy for glaucoma: A review. Clinical and Experimental Ophthalmology, 50(2), 198–212.

Conlon, R., Saheb, H., & Ahmed, I. I. (2017). Glaucoma treatment trends: A review. Canadian Journal of Ophthalmology, 52(1), 114–124.

Costagliola, C., dell'Omo, R., Agnifili, L., Bartollino, S., Fea, A. M., Uva, M. G., Zeppa, L., & Mastropasqua, L. (2020). How many aqueous humor outflow pathways are there? Survey of Ophthalmology, 65(2), 144–170.

Dai, C., Khaw, P. T., Yin, Z. Q., Li, D., Raisman, G., & Li, Y. (2012). Structural basis of glaucoma: The fortified astrocytes of the optic nerve head are the target of raised intraocular pressure. Glia, 60(1), 13–28.

Dietze, J., Blair, K., Zeppieri, M., & Havens, S. J. (2024). Glaucoma. StatPearls Publishing.

Erichev, V. P., Khachatryan, G. K., & Khomchik, O. V. (2021). Current trends in studying pathogenesis of glaucoma. Vestnik Oftalmologii, 137(5 Suppl 2), 268–274.

Erickson, D. H., Goodwin, D., Rollins, M., Belaustegui, A., & Anderson, C. (2009). Comparison of dynamic contour tonometry and Goldmann applanation tonometry and their relationship to corneal properties, refractive error, and ocular pulse amplitude. Optometry, 80(4), 169–174.

Esporcatte, B. L., & Tavares, I. M. (2016). Normal-tension glaucoma: An update. Arquivos Brasileiros de Oftalmologia, 79(4), 270–276.

Feder, R. S., Olsen, T. W., Prum, B. E., Summers, C. G., Olson, R. J., Williams, R. D., & Musch, D. C. (2016). Comprehensive adult medical eye evaluation preferred practice pattern guidelines. Ophthalmology, 123(1), P209–P236.

Fernández-Vigo, J. I., Kudsieh, B., Shi, H., De-Pablo-Gómez-de-Liaño, L., Fernández-Vigo, J. Á., & García-Feijóo, J. (2022). Diagnostic imaging of the ciliary body: Technologies, outcomes, and future perspectives. European Journal of Ophthalmology, 32(1), 75–88.

Göbel, K., Rüfer, F., & Erb, C. (2011). Physiology of aqueous humor formation, diurnal fluctuation of intraocular pressure and its significance for glaucoma. Klinische Monatsblätter für Augenheilkunde, 228(2), 104–108.

Grüb, M., & Mielke, J. (2004). Aqueous humor dynamics. Der Ophthalmologe, 101(4), 357–365.

Hoffmann, E. M., & Lamparter, J. (2016). Differentiation of ocular hypertension. Der Ophthalmologe, 113(8), 715–728.

Hollows, F. C., & Graham, P. A. (1966). Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. British Journal of Ophthalmology, 50(10), 570–586.

Jasien, J. V., Turner, D. C., Girkin, C. A., & Downs, J. C. (2019). Cyclic pattern of intraocular pressure and transient IOP fluctuations in nonhuman primates measured with continuous wireless telemetry. Current Eye Research, 44(11), 1244–1252.

Jonas, J. B., Aung, T., Bourne, R. R., Bron, A. M., Ritch, R., & Panda-Jonas, S. (2017). Glaucoma. The Lancet, 390(10108), 2183–2193.

Kass, M. A., Heuer, D. K., Higginbotham, E. J., Johnson, C. A., Keltner, J. L., Miller, J. P., Parrish, R. K., Wilson, M. R., & Gordon, M. O. (2002). The Ocular Hypertension Treatment Study. Archives of Ophthalmology, 120(6), 701–713.

Khazaeni, B., Zeppieri, M., & Khazaeni, L. (2023). Acute angle-closure glaucoma. StatPearls Publishing.

Kiel, J. W., Hollingsworth, M., Rao, R., Chen, M., & Reitsamer, H. A. (2011). Ciliary blood flow and aqueous humor production. Progress in Retinal and Eye Research, 30(1), 1–17.

Leydhecker, W., Akiyama, K., & Neumann, H. G. (1958). Intraocular pressure in normal human eyes. Klinische Monatsblätter für Augenheilkunde, 133(5), 662–670.

Lu, S. H., Chong, I. T., Leung, S. Y. Y., & Lam, D. C. C. (2019). Characterization of corneal biomechanical properties and determination of natural intraocular pressure using CID-GAT. Translational Vision Science and Technology, 8(5), 10.

Mahabadi, N., Zeppieri, M., & Tripathy, K. (2024). Open angle glaucoma. StatPearls Publishing.

Mansouri, K., & Weinreb, R. N. (2015). Ambulatory 24-hour intraocular pressure monitoring in the management of glaucoma. Current Opinion in Ophthalmology, 26(3), 214–220.

Mark, H. H. (2012). Armand Imbert, Adolf Fick, and their tonometry law. Eye, 26(1), 13–16.

Martin, T. M., Smith, J. R., & Rosenbaum, J. T. (2002). Anterior uveitis: Current concepts of pathogenesis and interactions with the spondyloarthropathies. Current Opinion in Rheumatology, 14(4), 337–341.

McLaren, J. W. (2009). Measurement of aqueous humor flow. Experimental Eye Research, 88(4), 641–647.

McMonnies, C. W. (2014). The significance of intraocular pressure elevation during sleep-related postures. Clinical and Experimental Optometry, 97(3), 221–224.

Mehran, N. A., Sinha, S., & Razeghinejad, R. (2020). New glaucoma medications: Latanoprostene bunod, netarsudil, and fixed combination netarsudil-latanoprost. Eye, 34(1), 72–88.

Obuchowska, I., & Mariak, Z. (2005). Choroidal detachment—Pathogenesis, etiology and clinical features. Klinika Oczna, 107(7–9), 529–532.

Pang, I. H., & Clark, A. F. (2020). Inducible rodent models of glaucoma. Progress in Retinal and Eye Research, 75, 100799.

Pardianto, G. (2015). Recent awareness and consideration of intraocular pressure fluctuation during eye surgery. Journal of Cataract and Refractive Surgery, 41(3), 695.

Prum, B. E., Rosenberg, L. F., Gedde, S. J., Mansberger, S. L., Stein, J. D., Moroi, S. E., Herndon, L. W., Lim, M. C., & Williams, R. D. (2016). Primary open-angle glaucoma preferred practice pattern guidelines. Ophthalmology, 123(1), P41–P111.

Sagri, D., Lösche, C. C., Bestges, B. B., & Krummenauer, F. (2015). Is there really agreement between rebound and Goldmann applanation tonometry methods? Klinische Monatsblätter für Augenheilkunde, 232(7), 850–857.

Schuster, A. K., Wagner, F. M., Pfeiffer, N., & Hoffmann, E. M. (2021). Risk factors for open-angle glaucoma and recommendations for glaucoma screening. Der Ophthalmologe, 118(Suppl 2), 145–152.

Shiose, Y. (1990). Intraocular pressure: New perspectives. Survey of Ophthalmology, 34(6), 413–435.

Singh, K., & Shrivastava, A. (2009). Intraocular pressure fluctuations: How much do they matter? Current Opinion in Ophthalmology, 20(2), 84–87.

Summaries for patients. (2013). Screening for glaucoma: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 159(7), I-28.

Twa, M. D. (2018). Intraocular pressure and glaucoma. Optometry and Vision Science, 95(2), 83–85.

Vranka, J. A., Kelley, M. J., Acott, T. S., & Keller, K. E. (2015). Extracellular matrix in the trabecular meshwork: Intraocular pressure regulation and dysregulation in glaucoma. Experimental Eye Research, 133, 112–125.

Wang, Y. X., Xu, L., Wei, W. B., & Jonas, J. B. (2018). Intraocular pressure and its normal range adjusted for ocular and systemic parameters. The Beijing Eye Study. PLoS One, 13(5), e0196926.

Warjri, G. B., & Senthil, S. (2022). Imaging of the ciliary body: A major review. Seminars in Ophthalmology, 37(6), 711–723.

Zeppieri, M., & Gurnani, B. (2023). Applanation tonometry. StatPearls Publishing.

Zeppieri, M., Brusini, P., & Miglior, S. (2005). Corneal thickness and functional damage in patients with ocular hypertension. European Journal of Ophthalmology, 15(2), 196–201.

PDF
Abstract
Export Citation

View Dimensions


View Plumx


View Altmetric



0
Save
0
Citation
108
View
0
Share