Measurement of Intraocular Pressure by Patients With Glaucoma

Abstract

The ability of patients to measure their own intraocular pressure (IOP) would allow more frequent measurements and better appreciation of peak IOP and IOP fluctuation.OBJECTIVE To examine whether patients with glaucoma can perform self-tonometry using a rebound tonometer and examine patient acceptability. DESIGN, SETTING, AND PARTICIPANTS An observational study in which IOP was assessed using Goldmann applanation tonometry and a rebound tonometer. Consecutive patients were provided with a patient information sheet and those consenting to take part in the study received standardized self-tonometry training and were then instructed to measure their own IOP under observation. This study was conducted at a glaucoma clinic at a university hospital from March 1, 2016, to December 30, 2016, and included both eyes of 100 patients with glaucoma or ocular hypertension. MAIN OUTCOMES AND MEASURESThe percentage of patients who could successfully perform self-tonometry. Complete success was defined by a good technique and an IOP reading within 5 mm Hg of that obtained by a clinician using the same device. A 3-item questionnaire was used to examine perceptions of self-tonometry among patients. RESULTS Among the 100 patients, the mean (SD) age was 67.5 (10.9) years (53% female). A total 73 of 100 patients (73%) met the complete success criteria. An additional 6 patients could use the device but had IOP readings greater than 5 mm Hg different from those obtained by the clinician. On average, IOP by the rebound tonometer was 2.66 mm Hg lower than Goldmann applanation tonometry (95% limits of agreement, −3.48 to 8.80 mm Hg). The IOPs with the rebound tonometer were similar whether obtained by self-tonometry or investigator, with excellent reproducibility with an intraclass correlation coefficient of 0.903 (95% CI, 0.867-0.928). A total of 56 of 79 successful or partially successful patients (71%) felt self-tonometry was easy, with 73 of 79 (92%) reporting self-tonometry to be comfortable, and a similar number happy to perform self-tonometry in the future. CONCLUSIONS AND RELEVANCEMost patients could perform self-tonometry and the method was acceptable to patients. Self-tonometry has the potential to improve patient engagement, while also providing a more complete picture of IOP changes over time.

Icare^® rebound tonometers: review of their characteristics and ease of use

“… 31 Pronin et al reported that the IOP difference was −2.5 mmHg (95% LOA was between −4.71 and 9.88 mmHg) with self-measurement and −2.6 mmHg (95% LOA was between −3.48 and 8.8 mmHg) with measurement by a second party compared to GAT. 32 Mudie et al reported that the IOP difference between GAT was −0.33 mmHg (95% LOA was unclear) with self-measurement. 33 Only Takagi et al reported that the IOP difference between GAT was 0.70 mmHg (95% LOA was between −3.07 and 4.46 mmHg) with self-measurement and 0.91 mmHg (95% LOA was between −2.75 and 4.56 mmHg) as measured by a second party.…”

Influence of the Water-Drinking Test on Intraocular Pressure, Schlemm's Canal, and Autonomic Nervous System Activity

“…12 No anesthesia or calibration was required during the procedure. 13 The iCare tonometer uses a P value to indicate the quality of the measurement taken, and we discarded any iCare reading with an error bar.…”

Twenty-four hour intraocular pressure measurements and home tonometry

“…IOP measurements with the Icare HOME tonometer were within 5 mm Hg of the GAT measurements. The Icare measurements, however, were consistently lower than the GAT measurements, especially in the lower IOP ranges [30].…”