Home Tonometry Assists Glaucoma Drainage Device Management in Childhood Glaucoma

Abstract

Précis: Home tonometry is useful in detecting tube-opening and alarming intraocular pressures (IOPs) after Baerveldt glaucoma drainage device (GDD) implantation in childhood glaucoma, allowing for timely physician response and individualized patient care. Purpose: The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory childhood glaucoma. Materials and Methods: As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated. Results: Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post–tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients. Conclusions: Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in childhood glaucoma may improve the care of these challenging patients.

Assessing the Reliability of Intraocular Pressure Measurements Using Rebound Tonometry

“…The IOP sampling rate in glaucoma is exceedingly low—on the order of 2 to 3 measurements per year in most patients—largely due to the lack of a widely acceptable, easy to use, and affordable home tonometer. The iCare HOME device has been shown to be user-friendly in feasibility studies22,23 and has been used to detect after-hours IOP elevations24 and to monitor IOP after various surgical procedures 25,26. However, the aforementioned limited agreement between Goldmann and RT limits integration of HOME measurements into the broader clinical picture: what does a HOME IOP of 23 mm Hg measured by a patient at 10 pm mean in the context of in-office Goldmann measurements of 18 to 21 mm Hg over the past 12 months?…”

“…The iCare HOME device has been shown to be user-friendly in feasibility studies 22,23 and has been used to detect afterhours IOP elevations 24 and to monitor IOP after various surgical procedures. 25,26 However, the aforementioned limited agreement between Goldmann and RT limits integration of HOME measurements into the broader clinical picture: what does a HOME IOP of 23 mm Hg measured by a patient at 10 PM mean in the context of in-office Goldmann measurements of 18 to 21 mm Hg over the past 12 months? In contrast, if high levels of agreement can be demonstrated between IOP measured by a trained operator using the ic100 The disposable nature of the rebound tonometer's probe tip-the only part of the instrument that makes contact with the eye-is a feature of renewed significance in 2021.…”

Teleophthalmology in Saudi Arabia

“…[ 24 ] Another important application in glaucoma is monitoring patients using an intraocular pressure (IOP) home measuring device. [ 25 26 ]…”

Telehealth in Ophthalmology

“…Since IOP fluctuates throughout the day, home-monitoring could potentially provide a more comprehensive depiction of IOP rather than a one-time measurement in the clinic. This can prove useful in monitoring treatment response and complications, tracking decreases in IOP after selective laser trabeculoplasty in adults and even detecting 92.3% of spontaneous tube openings in pediatric glaucoma patients (53,54). VF can also be assessed at home with virtual reality headsets and smartphones, showing a strong correlation to the standard automated perimetry with fewer fixation losses (55,56).…”