The essence of the physiological intraocular pressure. Part 1. Criteria: IOP, rigidity and fluctuation

Purpose: 1. To identify the reasons for the relatively low reliability of the traditional «IOP level» criterion for the diagnosis of age-related ocular hypertension (AOG) and open-angle glaucoma (OAG).

2. To show the absolute practical advantages and the need for a gradual transition in the field of evidence-based medicine from the traditional criterion «level of IOP» to modern functional criteria: «rigidity» and «scleral fluctuation», determined by dynamic rapid diagnosis.

Methods: Theoretical analysis and results of our own clinical trials of traditional and new econometric methods of AOG and OAG diagnostics based on the following criteria: IOP, rigidity and fluctuation.

Results: ORA pneumoanalyzer can be used in rapid diagnostics in the conditions of polyclinic network for reasonable and objective choice of AOG and OAG prevention and treatment methods, as well as their differential diagnosis. It allows for an instant, accurate and numerical identification of the elderly patient's current IOP level abnormality as compared to his «younger» IOP levels, and its correspondence to normal IOP range. Also, according to the measured current levels of sclera rigidity and fluctuation, it is possible to reliably estimate the decrease in the functional ability of the fibrous tunic of the eye (FTE) in relation to the fluctuation necessary to maintain the normal circulation of intraocular fluid and the volume of the eye.

Conclusion: Scleral rigidity and micro-fluctuations play a fundamental role in the mechanisms of the IOP level formation. With age, both FTE rigidity and consequently IOP level tend to increase. Physiologically, AOG can play a necessary role in maintaining normal metabolic processes even in old age. If a patient's IOP level in his youth is unknown, the doctor often cannot adequately assess the abnormality of the current IOP values. In the meantime, pathological FTE rigidity in OAG patients is always significantly higher than the normal rigidity level in AOG. On the contrary, scleral fluctuations tend to correspondingly decrease. This allows for an adequate AOG and OAG differential diagnostics. In both AOG and OAG, it is necessary to restore the scleral functions, which can account for physiologically and patho-genically justified preventive or therapeutic effects.

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