<p>Self-monitoring of intraocular pressure using Icare HOME tonometry in clinical practice</p>

Abstract

Purpose: To determine the value of self-monitoring of diurnal intraocular pressure (IOP) by Icare Home rebound tonometer in patients with glaucoma and ocular hypertension. Methods: Patients with open-angle glaucoma or ocular hypertension, controlled IOP at office visits, and at least 3 years of follow-up in the glaucoma clinic were included. Progression of glaucoma was based on medical records and defined by documented structural and/or visual field change. Patients were trained to correctly perform self-tonometry and instructed to measure diurnal IOP in a home setting for 3 days. IOP characteristics (mean, peak IOP, fluctuation of IOP as range, and SD of IOP) were documented and compared between the progressive and stable eyes. Results: Ninety-four patients (50 females) with a mean (SD) age of 57.1 (14.7) years were included. Among the 94 eyes from 94 subjects, 72 (76.6%) eyes had primary open-angle glaucoma, ten (10.6%) had pigmentary glaucoma, four (4.3%) had exfoliative glaucoma, and eight (8.5%) eyes had ocular hypertension. Thirty-six eyes showed progression and 58 eyes were stable. Patients with progression were older than those with stable disease (mean (SD) 65.8 (8.4) years vs 51.7 (15.3) years, P<0.001). The progression group had higher average IOP (mean (SD) 15.8 (4.0) mmHg vs 13.3 (3.7) mmHg, P =0.002), peak IOP (mean (SD) 21.8 (5.8) mmHg vs 18.6 (4.8) mmHg, P =0.01), and greater IOP fluctuation range (mean (SD) 11.6 (4.8) vs 9.1 (3.5) mmHg, P =0.011) compared to non-progression group. Conclusion: Self-monitoring of IOP using Icare Home tonometry provides more complete data on variability of IOP to assist in the management of glaucoma.

<p>Icare Home Tonometer: A Review of Characteristics and Clinical Utility</p>

“…Cvenkel et al 36 assessed 117 suspected glaucoma, open-angle glaucoma, or ocular hypertension participants, of which 96 participants (82%) fulfilled requirements for certification. The mean age of participants was 57.4 ± 14.9 years.…”

“…Cvenkel et al provided the Icare HOME to patients with glaucoma or ocular hypertension and found that eyes with significantly higher average IOP, peak IOP, and higher IOP fluctuation as measured on the Icare HOME were the eyes that showed progression in glaucoma (defined as significant visual field deterioration or optic nerve head/retinal nerve fiber layer changes), despite stable in-office IOP measurements. 36 Additionally, Awadalla et al found that a significant reduction in mean IOP after selective laser trabeculoplasty could be detected when providing Icare HOME devices to patients after their procedure. 37 These studies demonstrate the Icare HOME’s role in obtaining an accurate IOP profile to assist in treatment decision-making, which complement similar findings from our own practice.…”

Role of 24-Hour Intraocular Pressure Monitoring in Glaucoma Management

“…The IOP measurements obtained with RTONE were shown to be strongly correlated with Goldmann applanation tonometer used in clinic visits, and for patients with NTG with a progression that was disproportionate to their office IOP measurements, the use of RTONE can reveal higher IOP spikes which was unidentified during office hours. Therefore, self-tonometry is definitely a valuable adjunct to spot office measurements as it provides a more complete data on the diurnal change of IOP which may assist in glaucoma management [22]. However, it should also be noted that self-tonometry is rather technically challenging for elder glaucoma patients and also could not take sleeping IOP measurements [23].…”

Tele-consultations in the wake of COVID-19 – Suggested guidelines for clinical ophthalmology

“…Devices which can be used by patients to measure these parameters are still undergoing development and refinement. [ 13 14 ] Hence, “home-tonometry” and “home-perimetry” is still a work in progress. The inability to acquire information regarding IOP, optic disc or visual field changes through a tele-consultation highlights the futility of this interface for the management of chronic glaucoma.…”