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Remote Tonometry Identifies Significant Variability in the Timing of Intraocular Pressure Response to Topical

Jasdeep Sabharwal1, Margaret Tharp2, Natalie Hamilton3

  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; North Bay Eye Associates, Petaluma, California.

Ophthalmology. Glaucoma
|May 20, 2026
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Summary

Stopping topical prostaglandin analog (PGA) treatment resulted in a longer time to reach maximum intraocular pressure (IOP) change compared to restarting PGA. The time to IOP plateau varied widely, often exceeding standard washout periods.

Keywords:
GlaucomaHome tonometryIntraocular pressure

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Ocular Hypertension Management

Background:

  • Topical prostaglandin analogs (PGAs) are commonly used to lower intraocular pressure (IOP) in glaucoma and ocular hypertension.
  • Assessing the duration of PGA effects is crucial for treatment management and clinical research.
  • Standardized washout periods are often used, but their adequacy may vary.

Purpose of the Study:

  • To quantify the time to maximum intraocular pressure (IOP) change after discontinuing and resuming topical prostaglandin analog (PGA) therapy.
  • To characterize the variability in IOP response using remote tonometry.

Main Methods:

  • Prospective observational study involving patients with primary open-angle glaucoma or ocular hypertension.
  • Patients used rebound home tonometry for daily IOP measurements during baseline, a 4-week PGA washout, and a 4-week PGA restart period.
  • Exponential decay models determined the time to 90% of maximum IOP change (T90%) during washout and restart phases.

Main Results:

  • Twenty subjects (34 eyes) completed the study, with mean IOPs of 15.6 mmHg (Baseline), 17.3 mmHg (Washout), and 15.9 mmHg (Restart).
  • IOP was significantly higher during the washout period compared to baseline and restart (p < 0.001).
  • The time to reach 90% of maximum IOP change (T90%) was significantly longer and more variable during washout (median 18.5 days) than during restart (median 2.2 days, p < 0.001).

Conclusions:

  • Discontinuing topical PGAs leads to a significantly longer duration for IOP to reach its maximum change compared to restarting the medication.
  • The time to IOP plateau following PGA cessation is highly variable and frequently extends beyond the conventional 4-week washout period.
  • These findings have implications for evaluating the clinical efficacy of PGAs and refining washout protocols in research settings.