TY - JOUR
T1 - Home Self-tonometry Trials Compared with Clinic Tonometry in Patients with Glaucoma
AU - McGlumphy, Elyse J.
AU - Mihailovic, Aleksandra
AU - Ramulu, Pradeep Y.
AU - Johnson, Thomas V.
N1 - Funding Information:
Supported by Research to Prevent Blindness, Inc., New York, New York (Career Development Award [T.V.J.] and unrestricted grant to Wilmer Eye Institute); the National Eye Institute, National Institutes of Health, Bethesda, Maryland (grant no.: K08EY031801 [T.V.J.]); and the American Glaucoma Society (MAPS Award [E.J.M.]). iCare HOME tonometers and equipment were purchased from iCare USA, Raleigh, North Carolina. No representative from that company provided input into study design, data analysis, or manuscript preparation.
Publisher Copyright:
© 2021 American Academy of Ophthalmology
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Purpose: This study examined characteristics of intraocular pressure (IOP) as measured during home tonometry in comparison with in-clinic tonometry in patients with glaucoma. Design: Retrospective cross-sectional study of glaucoma patients who completed 1 week of self-tonometry at a single academic center. Participants: Patients with glaucoma who completed home tonometry trials with the iCare HOME tonometer (iCare USA) for any reason. Methods: Home IOP measurements were compared with in-clinic tonometry performed during the 5 visits preceding home tonometry. Maximum daily IOP was correlated to time of day. Generalized estimating equations were used to evaluate patient characteristics and clinic-derived variables that predicted differences between home and clinic IOP. Main Outcome Measures: IOP mean, maximum, minimum, range, standard deviation and coefficient of variation were compared between clinic and home tonometry. IOP mean daily maximum (MDM) and mean daily range were calculated to describe recurrent IOP spiking. Results: A total of 107 eyes from 61 patients were analyzed. Mean age was 63.2 years (standard deviation [SD], 14.0 years) and 59.0% were women. Mean clinic and home IOPs were 14.5 mmHg (SD, 4.7 mmHg) and 13.6 mmHg (SD, 5.1 mmHg). Home tonometry identified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than clinic tonometry (P < 0.001). Maximum daily IOP occurred outside of clinic hours (8 AM–5 PM) on 50% of days assessed and occurred between 4:30 AM and 8 AM on 24% of days. Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mmHg, 5 mmHg, or 10 mmHg in 31%, 15%, and 6% of patients, respectively. Patient characteristics that predicted significant deviations between MDM and mean clinic IOP or target IOP in multivariate models included younger age, male gender, and absence of prior filtering surgery. Conclusions: Self-tonometry provides IOP data that supplements in-clinic tonometry and would not be detectable over daytime in-clinic diurnal curves. A subset of patients in whom home tonometry was ordered by their glaucoma clinician because of suspicion of occult IOP elevation demonstrated reproducible IOP elevation outside of the clinic setting. Such patients tended to be younger and male and not to have undergone previous filtering surgery.
AB - Purpose: This study examined characteristics of intraocular pressure (IOP) as measured during home tonometry in comparison with in-clinic tonometry in patients with glaucoma. Design: Retrospective cross-sectional study of glaucoma patients who completed 1 week of self-tonometry at a single academic center. Participants: Patients with glaucoma who completed home tonometry trials with the iCare HOME tonometer (iCare USA) for any reason. Methods: Home IOP measurements were compared with in-clinic tonometry performed during the 5 visits preceding home tonometry. Maximum daily IOP was correlated to time of day. Generalized estimating equations were used to evaluate patient characteristics and clinic-derived variables that predicted differences between home and clinic IOP. Main Outcome Measures: IOP mean, maximum, minimum, range, standard deviation and coefficient of variation were compared between clinic and home tonometry. IOP mean daily maximum (MDM) and mean daily range were calculated to describe recurrent IOP spiking. Results: A total of 107 eyes from 61 patients were analyzed. Mean age was 63.2 years (standard deviation [SD], 14.0 years) and 59.0% were women. Mean clinic and home IOPs were 14.5 mmHg (SD, 4.7 mmHg) and 13.6 mmHg (SD, 5.1 mmHg). Home tonometry identified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than clinic tonometry (P < 0.001). Maximum daily IOP occurred outside of clinic hours (8 AM–5 PM) on 50% of days assessed and occurred between 4:30 AM and 8 AM on 24% of days. Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mmHg, 5 mmHg, or 10 mmHg in 31%, 15%, and 6% of patients, respectively. Patient characteristics that predicted significant deviations between MDM and mean clinic IOP or target IOP in multivariate models included younger age, male gender, and absence of prior filtering surgery. Conclusions: Self-tonometry provides IOP data that supplements in-clinic tonometry and would not be detectable over daytime in-clinic diurnal curves. A subset of patients in whom home tonometry was ordered by their glaucoma clinician because of suspicion of occult IOP elevation demonstrated reproducible IOP elevation outside of the clinic setting. Such patients tended to be younger and male and not to have undergone previous filtering surgery.
KW - Glaucoma
KW - Rebound tonometer
KW - Remote monitoring
KW - Risk factor
KW - Tonometry
UR - http://www.scopus.com/inward/record.url?scp=85118811814&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118811814&partnerID=8YFLogxK
U2 - 10.1016/j.ogla.2021.03.017
DO - 10.1016/j.ogla.2021.03.017
M3 - Article
C2 - 33845191
AN - SCOPUS:85118811814
SN - 2589-4196
VL - 4
SP - 569
EP - 580
JO - Ophthalmology. Glaucoma
JF - Ophthalmology. Glaucoma
IS - 6
ER -