June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Use of a protective eye shield to reduce variability in and magnitude of limbal strain during simulated sleep in adults with glaucoma
Author Affiliations & Notes
  • Alison Flatau
    Fischell Dept. of Bioengineering, University of Maryland, College Park, Maryland, United States
    Dept. of Aerospace Engineering, University of Maryland, College Park, Maryland, United States
  • Francisco Solano
    Hospital Beneficência Portuguesa São Paulo , São Paulo , Brazil
  • Joan L. Jefferys
    Wilmer Eye Institute, Baltimore, Maryland, United States
  • Christopher Damion
    Dept. of Aerospace Engineering, University of Maryland, College Park, Maryland, United States
  • Harry A Quigley
    Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Alison Flatau, Cummins TriStar LLC (F), Sensed AG (F), US patent # 14/349,954 applied for by Alison Flatau (not a company); Title: Noninvasive system and method for mitigating sleep-position related eye loads (P); Francisco Solano, None; Joan Jefferys, None; Christopher Damion, None; Harry Quigley, Sensimed AG (C)
  • Footnotes
    Support  Contributions by AF and CD are based upon work supported in part by the National Science Foundation under Grant No. #13377502 (Program Manager Dr. T.A. Conway). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. HQ, JJ and FS were supported in part by EY01765 (Core Facility Grant to Wilmer Institute) and by unrestricted support from William T. Forrester and from Livingston and Saranne Kosberg. This support allowed the co-authors to make the indicated contributions to design and conduct of the study; supported collection, management, analysis, and interpretation of the data; and preparation and review of this manuscript for publication. The authors acknowledge the supply of instrumentation and data from Sensimed, though data analysis was performed by the authors alone.
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3135. doi:
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    • Get Citation

      Alison Flatau, Francisco Solano, Joan L. Jefferys, Christopher Damion, Harry A Quigley; Use of a protective eye shield to reduce variability in and magnitude of limbal strain during simulated sleep in adults with glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3135.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Eyes of glaucoma patients may be damaged during sleep. We conducted a prospective randomized interventional trial to test our hypothesis that wearing a protective eye shield or “mask” would reduce variability in and the magnitude of limbal strain experienced in glaucoma eyes when sleeping in a position with one side of the face down (FD), resting against a pillow. We also test our hypothesis that facial geometry influences responses to the FD position, and that in some individuals, facial features "mimic" the effects of the mask.

Methods : The study was conducted at the Wilmer Eye Institute with 36 glaucoma patients. A contact-lens sensor (CLS) measured change in limbal strain (output in mVeq) during simulated sleep for intervals of up to 60 minutes in sitting, lateral-decubitus, FD (CLS-instrumented eye toward pillow) and supine positions. Eighteen subjects wore a mask during one of two FD intervals, with randomized assignment of the interval during which the mask was worn. Dimensions of 18 facial features were acquired from 3-D scanned images of 23 subjects.
Estimates of means, 95% confidence intervals and p-values for change in CLS with position are derived from Generalized Estimating Equation (GEE) linear models that take into account correlations among repeat measurements on a given participant.

Results : Among all subjects tested without the mask, strain increased with FD posture and decreased with leaving FD (34.1 and -32.4 mVeq, respectively, p=0.01, 0.02, n=36). Wearing the mask reduced these changes by 22.3 and 34.5 mVeq each (p=0.09, 0.16). Including all subjects, wearing the mask reduced the variation in strain while FD (median difference in standard deviation = -22.8 mVeq, p=0.03, n=36). In study eyes with past progressive field loss, the mask reduced mean strain increase moving to FD by 44.8 mVeq (p=0.02, n=12). In contrast, eyes with no past field progression had only a 6.8 mVeq (p=0.68, n=19) increase moving to FD and no mask effect (p=0.73).
Preliminary analysis of facial scans suggests a longer distance from eye to nose tip reduces eye-pillow contact when FD. Statistical support for this was found in the CLS data on moving away from the FD position (p=0.04, n=23).

Conclusions : Wearing a sleep mask reduced limbal strain and variation in limbal strain during simulated sleep in FD posture, particularly in eyes with progressive visual field loss.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.


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