Twenty-four-hour efficacy of preservative-free tafluprost for open-angle glaucoma patients, assessed by home intraocular pressure (Icare-ONE) and blood-pressure monitoring

Performance of home-based self-tonometry (iCare HOME (TA022)) for measuring intraocular pressure among healthy and glaucoma patients

Introduction: The purpose of this study was to compare iCare HOME (TA022) with Goldmann applanation tonometer and to evaluate the self-tonometry measurements among the Indian population. Methods: Eligible patients underwent iCare HOME training through guided demonstration (verbal, pictorial, video) and practised self-tonometry measures using iCare HOME. Certification for independent iCare HOME measure was provided if first iCare HOME intraocular pressure (IOP) measurement fell within ± 5 mmHg of Goldmann applanation tonometer (GAT) measurement which was measured by the trained clinician (principal investigator). Certified participants underwent simulated home self-tonometry measurements using iCare HOME, and agreement with GAT IOP measurements was assessed. Results: Seven of 83 participants (8.43%) failed to complete the study due to difficulty in performing the task, leading to non-certification. Patients who could use the iCare HOME had a mean age of 53 ± 15.55years (53% males; 46% females). Only one in 12 subjects did not qualify to use iCare HOME. The overall mean difference between iCare HOME and GAT was 0.83 mmHg (95%, 3.92 and -2.25). At various pressure ranges, 7-16 mmHg, 17-23 mmHg and >23 mmHg, the mean difference between iCare HOME and GAT was 1.22 mmHg (95%, 4.32 and -1.86), 0.77 mmHg (95%,3.69 and -2.19), -0.11 mmHg (95%, 2.52 and -2.74) respectively. The intra-class correlation coefficient of the iCare HOME device was 0.997(95% CI,0.995-0.998). Conclusions: Patients were able to perform self- tonometry using iCare HOME with good reliability and safety. iCare HOME can be used to address the issue of difficulty in acquiring frequent and diurnal IOP measurements by patients doing self-tonometry from home.

The utility of home tonometry for peri-interventional decision-making in glaucoma surgery: Case series

Purpose

To describe twelve cases in which home intraocular pressure (IOP) monitoring complimented clinical decision-making in glaucoma management.

Observations

Home IOP monitoring elucidated peaks and amplitudes of variation that were not captured by in-clinic IOP measurements during the pre- or post-interventional period.

Conclusions & Importance

Home monitoring can establish pre-treatment IOP patterns that are not evident during in-clinic measurements. Home monitoring can also demonstrate response to treatment more quickly than in-clinic monitoring, and provide more information about nyctohemoral fluctuations than is ascertained by in-clinic tonometry.

Home Self-tonometry Trials Compared with Clinic Tonometry in Patients with Glaucoma

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 calulated 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.

The role of self-dependent tonometry in improving diagnostics and treatment of patients with open angle glaucoma

Monitoring intraocular pressure in patients with open-angle glaucoma at different stages of the deve­lopment of the disease using self-measurement by a portable Icare® HOME tonometer. In study, patients were divided into 3 groups depending on the treatment prescribed. With the help of near-day monitoring, hidden IOP elevations that are not recorded during a single IOP measurement on an outpatient appointment with a doctor were detected. Perspective possibilities of prescribing drugs and regulating the mode of instillation on the basis of individual time periods of increasing intraocular pressure on the example of one of the patient. Assessment of the convenience of the method from the personal experience of using the device by patients.

Additive intraocular pressure-lowering effects of the Rho kinase inhibitor ripasudil in Japanese patients with various subtypes of glaucoma

PURPOSE

The present study aimed to investigate the effectiveness of adjunctive therapy involving the Rho-associated, coiled-coil-containing protein kinase (ROCK) inhibitor ripasudil in lowering intraocular pressure (IOP) in patients with different subtypes of glaucoma, on the basis of the time of IOP measurement STUDY DESIGN: Retrospective study METHODS: In total, 58 patients who underwent adjunctive therapy with ripasudil at a single institution were included. They were classified into a primary open-angle glaucoma (POAG) group, an exfoliation glaucoma (XFG) group, and a secondary glaucoma associated with uveitis, or steroid glaucoma (SG), group. The average IOPs within 6 months before (pre-IOP) and after (post-IOP) the addition of ripasudil were compared among the 3 groups. The IOP values of the morning-visit and afternoon-visit groups were also compared to reflect the peak effectiveness of ripasudil.

RESULTS

The IOP reductions in the POAG (n = 38), XFG (n = 6), and SG (n = 14) groups were -1.1, +0.5, and +0.5 mmHg, respectively. Significant reductions in IOP were observed in the POAG group (P = .014). The IOP reductions in the POAG morning-visit and afternoon-visit groups were -1.9 and +0.5 mmHg, respectively. IOP was significantly reduced in the morning-visit POAG group after treatment with ripasudil (P = .002). The IOP values measured during morning visits were lower than those measured during afternoon visits (IOP reduction: -1.3 mmHg; P = .011).

CONCLUSIONS

The findings of the present study indicate that ripasudil is effective as an adjunctive therapy for lowering IOP in patients with POAG; these reductions are more significant when measured closer to the time of peak effectiveness.

Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial

SIGNIFICANCE

This article shows that self-tonometry can provide robust measures of diurnal intraocular pressure (IOP) and also detect changes to IOP in response to treatment within a short period of monitoring. These advances in IOP monitoring may contribute to improved management of glaucoma patients and suspects.

PURPOSE

The aim of this study was to prospectively investigate the utility of rebound self-tonometry performed over several weeks for detecting diurnal IOP fluctuations in glaucoma patients and suspects and also initial response to topical treatment in glaucoma patients.

METHODS

Forty patients were recruited following glaucoma-specific examination. Subsequent to successful training with the iCare HOME tonometer, patients were instructed to measure IOP, in a sitting position, four times a day over 4 to 6 weeks. Date, time, laterality, and IOP downloaded from the tonometer and clinical examination data, including applanation IOP and corneal thickness, were analyzed. A user satisfaction survey was also administered at study completion. t Test and analysis of variance were used to compare groups and IOP across days. Pearson correlation was used to compare measurements to Goldmann applanation tonometry and IOP measurements from the first day/s to the overall mean IOP.

RESULTS

Twenty-seven patients (18 suspects and 9 glaucoma patients) completed data collection. Patients self-measured IOP on 118 (±29) occasions for 40 (±7.4) days. Two dominant patterns of fluctuation were revealed: peak IOP upon awakening (n = 11) and at midday (n = 13). Diurnal IOP measured in the first 7 days showed strong correlation to diurnal IOP across the entire study period (r = 0.82, P < .0001). Within 24 hours of treatment commencement (latanoprost 0.005% ophthalmic solution), IOP reduced from 23.9 (±5.2) to 16.1 (±2.6) mmHg. Overall, patients rated the instrument as easy to use, although difficulties with correct alignment were expressed.

CONCLUSIONS

Rebound self-tonometry demonstrated utility for measuring diurnal IOP fluctuations in most patients, hence enhancing management of patient with or at risk of developing glaucoma.

The Icare HOME (TA022) Study: Performance of an Intraocular Pressure Measuring Device for Self-Tonometry by Glaucoma Patients

PURPOSE

To evaluate the Icare HOME (TA022) device (Icare Oy, Vanda, Finland) for use by glaucoma patients for self-tonometry.

DESIGN

Prospective performance evaluation of a medical device.

PARTICIPANTS

One hundred eighty-nine participants with glaucoma or suspected glaucoma were recruited from the Wilmer Eye Institute, Baltimore, Maryland, between July 2014 and April 2015.

METHODS

Participants had standardized training and had to be able use the Icare HOME device independently. Subjects also had to be able to obtain the first intraocular pressure (IOP) measurement within 5 mmHg of Goldmann applanation tonometry (GAT). Those certified obtained 3 IOP measures using the HOME device, and these were compared with Icare TA01i and GAT IOP measurements.

MAIN OUTCOME MEASURES

The agreement between Icare HOME and reference tonometers was used to assess precision. The intraclass correlation coefficient was used to assess within-patient reliability for the HOME device.

RESULTS

Eighteen of 189 recruited patients were ineligible to take part in the study. Forty-four of 171 patients (25.7%) started but failed to complete the study: 7 stopped because of time concerns, 10 of 171 patients (6%) stopped because of difficulty using the device during certification, and 27 of 171 patients (16%) failed to be certified based on IOP. The HOME and GAT measurements agreed within 5 mmHg in 116 of 127 participants (91.3%); 2 participants (1.6%) had a difference of more than 7 mmHg. The mean difference between the Icare HOME and GAT measurements was -0.33 mmHg (standard deviation, 3.11 mmHg). The overall intraclass correlation coefficient for the HOME device was 0.92 (95% confidence interval, 0.89-0.95).

CONCLUSIONS

Not all participants could learn how to use the Icare HOME device, but for those who could, most were able to obtain measurements similar to those obtained by GAT. The Icare HOME device is safe and reliable for self-tonometry, but nearly 1 in 6 individuals may fail to certify in use of the device based on large differences in IOP when comparing GAT with the Icare HOME measurements. The device has the potential to address an unmet need by providing more frequent IOP measurements in a patient's day to day life.