The amplitude of diurnal variation of intraocular pressure is the
earliest indicator for glaucoma – preceding changes in the neuronal structure
or even perimetry quite often for more than a decade (Goldmann, 1958,
Sampaolesi, 1964). To allow for frequent assessment of intraocular pressure for
a dense diurnal curve co-operation of the patient is necessary. As in patients
with arterial hypertension for self measurement of blood pressure, glaucoma
detection and follow up also could benefit applying this principle. Furthermore
patients’ compliance is improved. The new automatic self tonometer, following
Goldmanns’ principle, but using a microprocessor controlled applanation surface
detection and force application recently became available and was used for a
study to investigate the advantage of this new method to define glaucoma. A
number of eye departments in Germany investigated groups of open angle
glaucoma, secondary glaucoma, “normal-tension”-glaucoma to prove this new
method, comparing the results with conventional examination methods.
Marked diurnal variations were found in all groups, even in so far as
“normal-tension”-glaucoma classified patients. After surgical or medical
therapy a more sensitive control is possible, allowing adjustment of the
therapy, avoiding further damage by reduced perfusion pressure.
Precondition for use of this new method is permanent monitoring of the results by the ophthalmologist (which even can be arranged by telemetric transmission of the results to the ophthalmologist’s office). Of course the patient must be able and willing to use this new instrument, needing short primary instruction by the ophthalmologist.