• Glaucoma

    Review of: The utility of iCare HOME tonometry for detection of therapy-related intraocular pressure changes in glaucoma and ocular hypertension

    Scott A, Kanaster K, Kaizer A, et al. Ophthalmology Glaucoma, January-February 2022

    This US, single-site, prospective controlled trial assessed the accuracy of the home-based iCare HOME tonometer device in detecting intraocular pressure (IOP) changes in patients with glaucoma or ocular hypertension.

    Study design

    Twenty-seven patients (43 eyes) had baseline IOP checked with Goldmann applanation tonometry (GAT) and were instructed to measure IOP with the iCare HOME device at 4 time intervals per day for 1 week prior to starting a change in treatment. Patients were either treatment-naïve and beginning their first IOP-lowering medication, on stable medical management for glaucoma, or were designated for either a second glaucoma medication or selective laser trabeculoplasty. After 4–6 weeks of treatment, patients recorded another set of 4 daily IOP measurements across 1 week and returned to the clinic for another GAT measurement.

    Outcomes

    In the 11 eyes that underwent treatment change resulting in a significant (≥20%) IOP reduction as detected by GAT, iCare HOME also detected a therapeutic response for 90.9% of these eyes in at least 1 time period and 45.5% of eyes during all 4 time periods. In the 14 eyes that exhibited no response detected with GAT, the iCare HOME detected a response for 71.4% of eyes in ≥1 time period and 7.1% of eyes at all 4 time periods.

    Limitations

    Limitations of this study include its small sample size and potential for selection bias, given that self-selected participants may be more motivated to use home monitoring. The extensive exclusion criteria in this study also limits its generalizability.

    Clinical significance

    This study demonstrates the utility of home tonometry with the iCare HOME device as a reliable tool for detecting therapy-related changes in IOP response from medical and laser treatments outside of clinical settings. Home monitoring also provides additional valuable information regarding treatment effects on intraday and interday fluctuations via the increased number of IOP measurements, which may help clinicians to better treat patients who have significant IOP fluctuations and not overtreat those who may show no treatment effect on office-based GAT measurement.