Nocturnal spikes
Hi, wondering if anyone has been in similar situations. Diagnosed with POAG in June 2025 and pressure was fluctuating between 30-40. Average RNFL drop from 95 to 81 at time of diagnosis. After treatment with SLT and three drops daily, daytime IOP is largely controlled 12-18 but waking IOP is between usually 25-32 which showed huge fluctuations of average 16-18 mmHg. The latest OCT scan revealed again further loss of average RNFL to 66. Over 1 year span, RNFL dropped by 29 which apparently is very abnormal. I measured my IOP 1-2 hours after sleeping and IOP climbs quite rapidly during this short period. This spike was despite sleeping on wedge pillow. Read that IOP does not climb that quickly so it is a little unusual. Am very lost now and wanted to know if anyone has any similar experiences or advice to share? Thank you!
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Yes, many people have reported similar experiences with difficulty controlling nocturnal IOP.
Over 1 year span, RNFL [thickness] dropped by 29 which apparently is very abnormal.
Yes, 29 microns is a lot of loss in one year. In well-controlled glaucoma, you'd expect the number to be closer to 1 micron. Zero loss of RNFL thickness is ideal, of course.
Read that IOP does not climb that quickly so it is a little unusual.
I'm not sure where you read that, but IOP can indeed rise or fall very rapidly. I know of well-documented changes of 10 mmHg within a few seconds of time.
Everything you describe has been reported by others quite often over the history of FitEyes. It is not necessarily easy to solve nocturnal IOP issues, but there are several approaches, including:
- change glaucoma medications or add additional medications. Some medications, such as timolol, are less effective at night compared to daytime.
- consider surgery (including MIGS) to further manage IOP
- consider lifestyle changes (although these are likely just supplementary to the above suggestions)
Don't wait another year.
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