What does the future of home tools for glaucoma look like? Yvonne Ou, MD, offered an overview during Friday’s Glaucoma Subspecialty Day.
Nanodroppers may reduce eye drop side effects and early bottle exhaustion. Adaptable onto most bottles, nanodroppers decrease drop size and have the potential to reduce systemic and local side effects and to increase the number of doses from a bottle. One study found that using the nanodropper with a wide range of medications more than doubled the number of drops dispensed from each drug.1 Other studies are being done to look at the nanodropper’s effect on lowering IOP, said Dr. Ou.
At-home VA tests are comparable to those in clinic. Three home VA tests were found to be accurate and analogous to office checks in a systematic review of pragmatic trials (1,227 studies screened, 10 included).2 DigiVis, iSight Professional, and Peek Acuity—used with either accompanying digital devices or PDF printouts—showed good efficacy, according to Dr. Ou.
Home visual field tests have significant differences. Several different types of home visual field tests are being evaluated in studies. These include web-based and tablet-based methods, said Dr. Ou. One study compared perimetric outcomes in patients with mild glaucoma from a tablet perimeter used at home and a virtual reality (VR) perimeter used in the clinic to a Humphrey Visual Field (HVF) analyzer. Results showed that mean deviation and pattern standard deviation did not differ significantly. However, the tablet tended to overestimate light sensitivity in the nasal field and underestimate light sensitivity in the temporal field. The VR perimeter underestimated light sensitivity but was closer to the HVF than the tablet.3 More research is needed to tell if these tests can detect glaucoma progression, said Dr. Ou.
The promise of home optic nerve imaging. There are smartphone adapters that can take fundus photographs using an iPhone or other device, said Dr. Ou. She highlighted a study that looked at home OCT for age-related macular degeneration where the home OCT algorithm and human grading of an OCT in the clinic agreed in 96% of the scans.
Home tonometry has many uses. Detecting peak IOP that occurs outside of clinic hours, evaluating treatment efficacy of a new medication, and remotely monitoring patients postoperatively are just a few of the applications of home tonometry. Several studies have shown the efficacy of home tonometry in detecting therapy-related IOP changes, said Dr. Ou.
Wearable devices. While home tonometry devices require patients to take measurements themselves, wearable devices like the Sensimed Triggerfish—a contact lens with an embedded microsensor—can measure IOP continuously, said Dr. Ou. Another wearable on the horizon is Eyemate, an implantable IOP sensor that transmits readings through an external handheld device.
Dr. Ou is optimistic that with continued technology innovation and clinical research more of these tools will soon become available for glaucoma patients. —Reena Mukamal
1 St Peter D et al. Med Devices (Auckl). 2023;16:71-79.
2 Thirunavukarasu AJ et al. PLoS One. 2023;18(6):e0281847.
3 Kang J et al. Ophthalmol Glaucoma. 2023;6(5):509-520.
Financial disclosures: Yvonne Ou, MD: Janssen Pharmaceuticals, Inc.: C; Oculinea: C.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation For definitions of each category, see aao.org/eyenet/disclosures.
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