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  • At-Home Tonometry Identifies At-Risk Patients

    By Jean Shaw
    Selected by Henry D. Jampel, MD, MHS
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    Journal Highlights

    Ophthalmology Glaucoma, November/December 2021

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    McGlumphy et al. compared at-home and in-clinic tonometry in patients with glaucoma. They found that self-tonometry can identify a subset of at-risk glaucoma patients who experience clinically significant fluctuations in IOP that are not identified by in-clinic tonometry alone.

    For this retrospective cross-sectional study, the researchers evaluated data from 61 patients (107 eyes) who took at-home IOP readings with the iCare Home tonometer. The patients’ mean age was 63.2 years (standard deviation [SD], 14 years), and 59% were women. Measurements taken at home were compared with in-clinic readings taken during five visits that occurred before the home tonometry trials. Main out­come measures included in-clinic and at-home IOP measurements (mean, maximum, minimum, range, standard deviation, and coefficient of variation). The mean daily maximum and mean daily range of IOP were calculated to describe recurrent IOP spiking.

    The results showed that mean IOP was 14.5 mm Hg (SD, 4.7 mm Hg) in the clinic, versus 13.6 mm Hg (SD, 5.1 mm Hg) at home. Self-tonometry iden­tified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than did in-clinic testing (p < .001). Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mm Hg, 5 mm Hg, or 10 mm Hg in 31%, 15%, and 6% of patients, respec­tively. In addition, maximum daily IOP occurred outside of clinic hours on 50% of days assessed and occurred between 4:30 a.m. and 8:00 a.m. on 24% of days.

    In multivariable analysis, patient characteristics that predicted deviations between mean daily maximum and mean clinic IOP or target IOP were younger age, male gender, and absence of prior filtering surgery.

    Additional prospective studies are needed, the authors said. In the inter­im, these findings indicate that self-to­nometry can identify at-risk glaucoma patients who are experiencing large IOP deviations outside of standard office hours.

    The original article can be found here.