iCare HOME2 Monitoring of Diurnal Ocular Perfusion Pressure in Patients With Nonarteritic Ischemic Optic Neuropathy

Authors

• Benjamin V. Packard, Spencer Fox Eccles School of Medicine (BP, AR, BO-A), University of Utah, Salt Lake City, Utah; Department of Ophthalmology (BP, CP, SC, SV, BW, JEAW), John Moran Eye Center, University of Utah, Salt Lake City, Utah; Department of Ophthalmology (MS), George Washington University School of Medicine, Washington, District of Columbia; and Department of Ophthalmology (CJ), University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.
• Meghan Sharma
• Andy Renschler
• Catherine J. Johnson
• Chase E. Paulson
• Blessing S. Ofori-Atta
• Susan Chortkoff
• Sravanthi Vegunta
• Barbara M. Wirostko
• Judith E. Warner

Document Type

Journal Article

Publication Date

3-24-2026

Journal

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society

DOI

10.1097/WNO.0000000000002450

Abstract

BACKGROUND: This study evaluated time-of-day differences in intraocular pressure (IOP), mean arterial pressure (MAP), and ocular perfusion pressure (OPP) in eyes affected by nonarteritic anterior ischemic optic neuropathy (NAION), and compared these measures between NAION-affected and unaffected eyes at each time period. METHODS: Adults aged 18-90 years with a confirmed diagnosis of NAION were enrolled in this nonrandomized prospective observational cohort study. Participants were trained to measure blood pressure (BP) and IOP using an automated BP cuff and the iCare HOME2 rebound tonometer. In participants with only 1 eye affected by NAION, the unaffected eye was used as a control. Measurements were collected at 7 predefined daily time points (4:00, 6:00, 9:00, 12:00, 15:00, 18:00, and 21:00) for at least 7 consecutive days. MAP and OPP were calculated as 1/3 systolic + 2/3 diastolic pressure and 2/3 × (MAP - IOP), respectively. Early morning (4:00, 6:00), midday (9:00, 12:00, 15:00), and evening (18:00, 21:00) measurements were compared using linear mixed-effects models. The main outcome measures were intraday measurements of IOP, MAP, and OPP. RESULTS: A total of 27 eyes of 15 patients were included in the study. Among NAION-affected eyes, mean OPP and MAP were lowest in the early morning. No IOP elevations were noted in the early waking hours. On average, OPP was 1.69 mm Hg higher and MAP was 2.70 mm Hg higher at midday than in the morning, while IOP increased by 0.76 mm Hg (all 95% confidence interval [CI]). In the evening, OPP was 1.83 mm Hg higher and MAP was 2.49 mm Hg higher than in the morning (both 95% CI). Evening IOP was 0.31 mm Hg lower than in the morning, but this difference was not statistically significant ( P = 0.08). CONCLUSIONS: Early morning low OPP in nonglaucomatous eyes with NAION seems to be correlated with low MAP, rather than elevated IOP. These findings help support a role for impaired local perfusion in the early waking hours in the pathogenesis of NAION and highlight the potential utility of IOP and BP diurnal monitoring in at-risk patients.

APA Citation

Packard, Benjamin V.; Sharma, Meghan; Renschler, Andy; Johnson, Catherine J.; Paulson, Chase E.; Ofori-Atta, Blessing S.; Chortkoff, Susan; Vegunta, Sravanthi; Wirostko, Barbara M.; and Warner, Judith E., "iCare HOME2 Monitoring of Diurnal Ocular Perfusion Pressure in Patients With Nonarteritic Ischemic Optic Neuropathy" (2026). GW Authored Works. Paper 8838.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8838

Department

Ophthalmology