Discussion of tonometry parameters in the classification of primary open-angle glaucoma
https://doi.org/10.53432/2078-4104-2025-24-4-3-11
Abstract
Historically, intraocular pressure has been the key classification criterion for glaucoma. However, the boundaries of normal IOP remain a subject of debate despite the abundance of criteria that define the patient's status. A critically important but often unknown parameter is the individual baseline IOP of the patient prior to the onset of the disease. Another important aspect is the role of tono- meters and the potential measurement errors that depend on concomitant local and systemic factors. Which devices provide the most accurate IOP measurements, and how can measurement errors be avoided? In addition, there is a need for a more thorough approach to the interpretation of tonometry results in patients with normal tension glaucoma, where IOP is within the "normal" range but the disease continues to progress. These issues remain relevant and still require further discussion. The modern grading of IOP levels in individuals diagnosed with glaucoma requires a shift from average population norms to more personalized algorithms, which should be considered in future glaucoma classifications, given their significance for diagnostic search and assessment of disease progression risk.
About the Authors
A. V. Kuroyedov
Pirogov Russian National Research Medical University; Mandryka Central Clinical Hospital
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Head of the Academic Department of Ophthalmology, Head of the Ophthalmology Сenter
1 Ostrovityanova St., Moscow, 117997
8A Bolshaya Olenya St., Moscow, 107014
M. D. Kats
Filatov State Clinical Hospital No. 15
Russian Federation
Russian Federation
ophthalmologist
23 Veshnyakovskaya St., Moscow, 111539
A. Yu. Brezhnev
Kursk State Medical University
Russian Federation
Russian Federation
Cand. Sci. (Med.), Аssociate Professor, ophthalmologist
3 Karla Marksa St., Kursk, 305000
References
1. Strakhov V.V., Erichev V.P. Glaucoma: classification and terminology. Critical remarks. National Journal glaucoma 2025; 24(1):3-7. https://doi.org/10.53432/2078-4104-2025-24-1-3-7
2. Von Graefe A. Über die Iridectomie bei Glaucom und über den glaucomatösen Process. Albrecht von Graefes Arch Ophthalmol 1857; 3(2):456-555.
3. Von Graefe A. Weitere Zusätze über Glaucom und die Heilwirkung der Iridectomie. Archiv für Ophthalmologie 1859; 5(2):127-165.
4. Polyak B.L. Pervichnaya glaucoma [Primary Glaucoma]. Moscow, Medgiz Publ., 1952. Pp. 98-119.
5. Krasnov M.M. Mikrokhirurgiya glaukom [Microsurgery of Glaucoma]. Moscow, Meditsina Publ., 1974. Pp. 5-28.
6. Nesterov A.P., Bunin A.Ya. The New Classification of Primary Glaucoma. Russian Annals of Ophthalmology 1977; 93(5):38-43.
7. Samoylov A.Ya. Rukovodstvo po glaznym bolezniam [Guide to Eye Diseases]. Moscow, Medgiz Publ., 1940; 1:321 p.
8. Leydhecker W., Akiyama K., Neumann H.G. Der introkulare Druck gesunder menschlichen Augen. Klin Monbl Augenheilk 1958; 133: 662-670.
9. Hollows F.C., Graham P.A. Intraocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol 1966; 50: 570-86.
10. Nesterov A.P. Glaukoma [Glaukomа]. Moscow, Meditsina Publ., 1995. 256 p.
11. Kuroyedov A.V., Brezhnev A.Yu., Lovpache J.N. et al. Sergeeva V.M. The feasibility of adopting «stepwise» initial approaches in treatment of patients with different stages of glaucoma. National Journal glaucoma 2018; 17(4):25-54.
12. Pervichnaya otkrytougolnaya glaucoma. Natsional’noe rukovodstvo [Primary Open-Angle Glaucoma. National Guide]. Ed. by E.A. Egorov, A.V. Kuroyedov. Moscow, GEOTAR-Media Publ., 2023. 1032 p.
13. Fokin V.P., Balalin S.V., Boriskina L.N. Tolerance and Intolerance of the Optic Nerve in Primary Open-Angle Glaucoma. Volgograd, 2016. 208 p
14. Vodovozov A.M. Tolerant and intolerant intraocular pressure in glaucoma. Volgograd, BI, 1991. 160 p.
15. Vodovozov A.M., Boriskina L.N. The Significance of the Intolerance Index in Determining the Prognosis of Glaucoma. Russian Ophthalmological Journal 1985; 1:36-39.
16. European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition – Chapter 3: Treatment principles and options. Br J Ophthalmol 2017; 101(6):130-195. https://doi.org/10.1136/bjophthalmol-2016-EGSguideline.003.
17. Avdeev R.V., Alexandrov A.S., Bakunina N.A. et al. Comparison of treatment regimens for patients with primary open-angle glaucoma with signs of disease progression. Part 1. IOP levels. National Journal glaucoma 2018; 17(1):14-28.
18. Colton D., Ederer F. The Distribution of Intraocular Pressure in the General Population. Surv Ophthalmol 1980; 25(3):123-129.
19. Nesterov A.P. The main principals of diagnostics of the primary open glaucoma. Russian Annals of Ophthalmology 1998; 114(2)3-6.
20. Panina N.B. O normah vnutriglaznogo davleniya. Glaukoma i drugie zablevaniya glaz [About the norms of intraocular pressure. Glaucoma and Other Eye Diseases]. Leningrad, 1971. Pp. 7-12.
21. Alexeev V., Egorov E., Martynova E. Intraocular pressure levels distribution in normal population. Russian Journal of Clinical Ophthalmology 2001; 1(2):38-40.
22. Pokrovskii A.S. Range of intraocular pressure in healthy people. Oftalmologičeskie vedomosti 2012; 2:83-86.
23. Egorov E.A., Erichev V.P., Kuroedov A.V. et al.Tonometric intraocular pressure reference values in healthy population. National Journal glaucoma 2018; 17(2):91-98.
24. Svetlova O.V., Koshits I.N., Pankratov R.M. et al. On adequate zones of true intraocular pressure in healthy and glaucoma eyes. National Journal glaucoma 2023; 22(1):3-23. https://doi.org/10.53432/2078-4104-2023-22-1-3-23
25. Svetlova O.V., Koshits I.N., Pankratov R.M. et al. The relationship between intraocular pressure and age-related variations in ocular rigidity. Russian Annals of Ophthalmology 2024; 140(3):11 18. https://doi.org/10.17116/oftalma202414003111
26. Movsisyan A.B., Kuroedov A.V., Arkharov M.A. et al. Epidemiological analysis primary open-angle glaucoma incidence and prevalence in Russia. Russian Journal of Clinical Ophthalmology 2022; 22(1):3-10. https://doi.org/10.32364/2311-7729-2022-22-1-3-10
27. Neroev V.V., Mikhaylova L.A., Malishevskaya T.N. et al. Glaucoma epidemiology in the Russian Federation. Russian Ophthalmological Journal 2024; 17(3):7-12. https://doi.org/10.21516/2072-0076-2024-17-3-7-12
28. Nesterov A.P. Glaucomatous Optic Neuropathy. Collection of Scientific Papers of the Research Institute of Eye Diseases. Alma-Ata, 1987. Pp. 45-52.
29. Nesterov A.P. Glaukoma [Glaukomа]. Moscow, Medical Information Agency Publ., 2008. 360 p.
30. Sheveleva L.N., Leonova A.G. Proceedings of the Kazakh Research Institute of Eye Diseases. Alma-Ata. 1968; 1:195-204.
31. Kooner K.S., AlBdoor M., Cho B.J., Adams-Huet B. Risk factors for progression to blindness in high tension primary open angle glaucoma: Comparison of blind and nonblind subjects. Clinical Ophthalmology 2008; 2(4):757-762. https://doi.org/10.2147/opth.s3139.
32. Fomin N.E., Kuroyedov A.V., Zavadski P.Ch. et al. Characteristics of predictors for the development of end-stage primary open-angle glaucoma. National Journal glaucoma 2024; 23(3):3-13. https://doi.org/10.53432/2078-4104-2024-23-3-3-13
33. Kass M.A., Heuer D.K., Higginbotham E.J. et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002; 120:701-713. https://doi.org/10.1001/archopht.120.6.701.
34. Leske M.C., Heijl A., Hussein M. et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol 2003; 121(1):48-56. https://doi.org/10.1001/archopht.121.1.48.
35. Lichter P.R., Musch D.C., Gillespie B.W. et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108(11):1943-1953. https://doi.org/10.1016/s0161-6420(01)00873-9.
36. AGIS Investigators: The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 2000; 130(4): 429-440. https://doi.org/10.1016/s0002-9394(00)00538-9.
37. Kats M.D., Kuroyedov A.V., Arkharov M.A. Changes in target IOP values in glaucoma patients depending on the number of surgical interventions they underwent. National Journal glaucoma 2023; 22(1):55-65. https://doi.org/10.53432/2078-4104-2023-22-1-55-65
38. Antonov A.A., Agadzhanyan T.M. Dynamics of the corneal compensated intraocular pressure in different terms after fistulizing glaucoma surgery. Siberian Scientific Medical Journal 2018; 38(5):49-54. https://doi.org/10.15372/ssmj20180508
39. Nesterov A.P., Vagin B.I., Budnik V.M. Maklakov–Nesterov Applanometer. 6th Congress of Ophthalmologists of Russia: Theses. Moscow, 1994. Pp. 379-379.
40. Kanngiesser H.E., Kniestedt C., Robert Y.C. Dynamic contour tonometry: presentation of a new tonometer. J Glaucoma 2005; 14:344-350.
41. Goldblum D., Kontiola A.I., Mittag T. Et al. Non-invasive determination of intraocular pressure in the rat eye. Comparison of an electronic tonometer (TonoPen), and a rebound (impact probe) tonometer. Graefes Arch Clin Exp Ophthalmol 2002; 240:942-946. https://doi.org/10.1007/s00417-002-0571-y.
42. Nesterov A.P. Piletskii G.K., Piletskii N.G. Transpalpebral tonometer for measuring intraocular pressure. Russian Annals of Ophthalmology 2003; 119:3-5.
43. Dunbar G.E., Shen B.Y., Aref A.A. The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives. Clin Ophthalmol 2017; 11:875-882. https://doi.org/10.2147/OPTH.S109708.
44. Nesterov A.P. Primary Glaucoma (Achievements, Unresolved Issues). M.: Second Moscow Lenin Order State Medical Institute named after N.I. Pirogov, 1983. 31 p.
45. Volkov V.V. Glaukoma otkrytougolnaya [Open-angle glaucoma]. Moscow, MIA Publ., 2008. 348 p.
46. Egorov E.A., Kuroyedov A.V., Zavadskiy P.Ch. et al. Target intraocular pressure level in patients with different stages of low-tension glaucoma. Russian Journal of Clinical Ophthalmology 2025; 25(1):9-19. https://doi.org/10.32364/2311-7729-2025-25-1-2
47. Glaukoma: Natsinalnoe rukovodstvo [Glaukomа: National Guide]. Ed. by E.A. Egorov, V.P. Erichev. Moscow, GEOTAR-Media, 2019. 352 p.
48. Ministry of Health of the Russian Federation. Clinical guidelines «Primary open-angle glaucoma». 2024. https://cr.minzdrav.gov.ru/view-cr/96_2 (Access date: 17.08.2025)
Review
For citations:
Kuroyedov A.V., Kats M.D., Brezhnev A.Yu. Discussion of tonometry parameters in the classification of primary open-angle glaucoma. National Journal glaucoma. 2025;24(4):3-11. (In Russ.) https://doi.org/10.53432/2078-4104-2025-24-4-3-11
Views:
307
Email this article 