The essence of the physiological intraocular pressure. Part 3. A modern method of differential diagnosis of age-related eye hypertension and OAG by means of dynamic pneumatic action

PURPOSE: 1. To show new possibilities of differential Express diagnostics for reliable and objective discernment between age-related eye hypertension (AEH) and OAG using pneumatic analyzers ORA or Corvis ST according to the testing methodology developed by the authors. 2. To determine the specifics of changes in IOP level and functional ability of the sclera to microfluctuations of the eye volume after volumetric intraocular interventions.

METHODS: A theoretical analysis and the results of clinical trials of the author's method of AEH and OAG differential Express-diagnostics by the criteria of "rigidity" and "scleral fluctuation".

RESULTS: There is a practical possibility of using the upgraded rapid diagnosis by means of ORA and Corvis ST pneumatic analyzers for a reliable differentiation between AEH and OAG as well as the optimal choice of AEH prevention and OAG treatment methods in the conditions of polyclinic network. This makes it possible to accurately and quantitatively identify current IOP level abnormality and the normal IOP range in an elderly patient according to his IOP level in his youth. Moreover, according to the measured current levels of scleral rigidity and fluctuation, it is possible to reliably discern AEH and OAG and identify the degree of the decrease in the fibrous tunic functional ability to fluctua- tion necessary to maintain the normal circulation of watery moisture and eye volume.

CONCLUSION: Rigidity and micro fluctuation of the sclera play the principal role in the mechanisms of IOP level formation. IOP increases with age due to a corresponding age-related increase in fibrous tunic rigidity. From the standpoint of physiology, AEH is useful and necessary for the eye to maintain normal metabolic processes, even in old age. The lack of information concerning patient’s IOP level in his youth often hinders an adequate assessment of current IOP level normality. Pathological scleral rigidity level in OAG patients is always significantly higher than the normal rigidity level in AEH patients. Meanwhile, scleral fluctuation level shows the opposite trend. Both patterns allow for an objective differentiation between AEH and OAG. Restoring scleral functions in AEH and OAG patients may be physiologically and pathogenetically justified for both preventive and therapeutic effects.

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