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Swaminathan S, Kisielewski AM, Nowroozzadeh MH, Hallaj S, Lee D, Kolomeyer NN, Myers JS, Razeghinejad R. A comparison of iCare and Goldmann applanation tonometry measurements during the COVID-19 pandemic: a retrospective study. Int Ophthalmol 2024; 44:260. [PMID: 38910200 PMCID: PMC11194190 DOI: 10.1007/s10792-024-03220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To evaluate factors associated with differences in intraocular pressure (IOP) readings between iCare and Goldmann applanation tonometry (GAT) in established glaucoma patients. METHODS This retrospective comparative study included clinical data of 350 eyes from 350 established glaucoma patients who had iCare and GAT IOP measured by an ophthalmic technician and a glaucoma specialist, respectively. The main outcome measure was the difference in IOP measurements of the right eyes with iCare and GAT. RESULTS The intraclass correlation coefficient (ICC) between GAT and iCare was 0.90. The mean IOP difference between tonometers was - 0.18 ± 2.89 mmHg. Bland-Altman plots indicated a 95% limit of agreement of - 5.8 to 5.5 mmHg. Central corneal thickness (CCT) and age were significantly correlated with the difference in IOPs of the iCare and GAT. GAT-IOP and age were significantly associated with the absolute difference in measured IOP of the two tonometers. The difference in measurements was not significantly associated with prior glaucoma surgery, average global index of optical coherence tomography, axial length, technician years of experience and certification, and IOP range. CONCLUSION Although there is good agreement between the iCare and GAT mean values, these devices are not interchangeable in glaucoma patients due to the wide range of the limit of agreement.
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Affiliation(s)
- Shreya Swaminathan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA.
| | - Amber M Kisielewski
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | | | - Shahin Hallaj
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Natasha N Kolomeyer
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
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Kratz A, Zbidat R, Kishner R, Cohen M, Shalata W, Goldberg I. Assessment of the iCare HOME2, a New Intraocular Pressure Self-Measurement Tonometer. J Glaucoma 2023; 32:926-929. [PMID: 37671544 DOI: 10.1097/ijg.0000000000002298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/13/2023] [Indexed: 09/07/2023]
Abstract
PRCIS The iCare HOME2 tonometer generally can be considered reliable for most eyes and clinical settings, although it may produce slightly overestimated or underestimated intraocular pressure (IOP) readings in thicker and thinner corneas, respectively. PURPOSE To evaluate the accuracy, correlation, and analysis of differences in IOP measurements between the gold standard Goldmann applanation tonometer (GAT) and the new, self-measurement iCare HOME2 tonometer (icare). PATIENTS AND METHODS In this retrospective study, patients were randomly selected from those who attended a routine examination in our clinic. After a complete ocular examination, each patient's IOP was measured and recorded with GAT and iCare HOME2. Central corneal thickness was measured. Eyes with any corneal morbidity were excluded. Pearson correlation coefficient was used to determine the correlation between paired IOP measurements. Bland-Altman plots were graphed for the analysis of differences in IOP between the instruments. RESULTS One hundred thirty-five eyes of 70 patients were included in the study. The mean IOP measured with GAT was 16.3 ± 6.5 mm Hg (range: 3-56). The mean IOP measured with iCare HOME2 was 16.5 ± 7.3 mm Hg (range: 3-55), ( P = 0.47). A strong, significant positive correlation was found for paired IOP measurements by the 2 instruments ( r = 0.94; P < 0.0001). A small systematic proportional bias was seen for the paired IOP measurements, meaning that with higher IOPs the iCare HOME2 yielded higher IOP readings than GAT, but this difference was clinically insignificant. The instrument underestimated IOPs with corneas thinner than 522 µm, whereas it overestimated IOPs when corneas were thicker than this. CONCLUSION The iCare HOME2 could be a reliable tonometer for most eyes and clinical settings. Central corneal thickness measurement is recommended in patients who use the instrument.
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Affiliation(s)
- Assaf Kratz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Rabia Zbidat
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rina Kishner
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Cohen
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Walid Shalata
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ivan Goldberg
- Glaucoma Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Kadambi SV, Aishwarya M, Leelavathy C, George R, Balekudaru S, Lingam V, Baskaran M. Clinical utility, feasibility of home tonometry using iCare HOME by glaucoma patients. Indian J Ophthalmol 2023; 71:2727-2732. [PMID: 37417112 PMCID: PMC10491071 DOI: 10.4103/ijo.ijo_147_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/21/2023] [Accepted: 05/21/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To determine agreement between diurnal variation testing (DVT) of intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) and iCare HOME (IH) by an optometrist (OP) and home monitoring by participants (PT). Methods Patients (18-80 years) with glaucoma and suspects were enrolled. IH IOP and GAT were taken by an OP at 2 h intervals from 8 AM to 4 PM on Day 1 and PT between 6 AM and 9 PM, for the next 2 days. IOP, date, and time were viewed via iCare LINK software. Results: In total, 72.9. ( 51/70) PT trained were able to take reliable readings. One hundred two eyes (51 patients, age 53 ± 16 yrs) were analyzed. Correlation between optometrist (OP) and participants (PT) was strong and positive {IH OP-IH PT- r = 0.90, p-0.0001;IH PT-GAT- r = 0.79, p-0.0001}. Agreement by Bland Altman plots was limited {IH OP-IH PT mean 0.1 mmHg (95% LOA -5.3 to 5.5), IH PT-GAT 2.2 mmHg (-5.7 to 10.1)}. Intraclass correlation coefficient for IH OP-IH PT was 1.18 (95% CI 1.37-1.09). Intradevice {0.95 (95% CI 0.94-0.97)} and interrater repeatability {0.91 (0.79-0.96)} were good. 37% of eyes had a synchronous peak on GAT and IH during the day DVT. Conclusion Home tonometry by iCare HOME is easy, feasible, but due to limited agreement cannot substitute GAT DVT.
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Affiliation(s)
- Sujatha V Kadambi
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - M Aishwarya
- Department of Optometry, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - C Leelavathy
- Department of Optometry, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Ronnie George
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Shantha Balekudaru
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Vijaya Lingam
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Mani Baskaran
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Sohail M, Hirji SH, Liebmann JM, Glass LD, Blumberg DM. Remote Contrast Sensitivity Testing Seems to Correlate With the Degree of Glaucomatous Macular Damage. J Glaucoma 2023; 32:533-539. [PMID: 36897654 DOI: 10.1097/ijg.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/18/2023] [Indexed: 03/11/2023]
Abstract
PRCIS Remote contrast sensitivity (CS) testing through a free downloadable home test correlates with glaucomatous macular damage measured by 10-2 visual field (VF) testing. PURPOSE To assess the feasibility and validity of home CS monitoring as a measure of glaucomatous damage using a free downloadable smartphone application. METHODS Twenty-six participants were asked to remotely use the Berkeley Contrast Squares (BCS) application, a free downloadable tool that records the user's CS for varying degrees of visual acuity. An instructional video detailing how to download and use the application was sent to the participants. Subjects were asked to send logarithmic CS results with a minimum 8-week test-retest window, and test-retest reliability was measured. Results were validated against office-based CS testing that was collected within the previous 6 months. Validity analysis was also carried out to determine whether CS as measured by BCS is a good predictor of 10-2 and 24-2 VF mean deviation (MD). RESULTS There was a high BCS test-retest reliability with an intraclass correlation coefficient score of 0.91 and a significant correlation between repeat test results and baseline test scores (Pearson, 0.86, P < 0.0001). There was significant agreement between unilateral CS scores as measured by BCS and office-based CS testing ( b = 0.94, P < 0.0001, 95% CI: 0.61 to 1.27). Unilateral CS as measured by BCS was significantly associated with 10-2 VF MD ( r2 = 0.27, P = 0.006, 95% CI: 3.7 to 20.6), but not with 24-2 VF MD ( P = 0.151). CONCLUSION This study suggests that a free, rapid home CS test correlates with glaucomatous macular damage as measured by 10-2 VF.
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Affiliation(s)
- Marium Sohail
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
| | - Sitara H Hirji
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Lora D Glass
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
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Dolar-Szczasny J, Barańska A, Rejdak R. Evaluating the Efficacy of Teleophthalmology in Delivering Ophthalmic Care to Underserved Populations: A Literature Review. J Clin Med 2023; 12:jcm12093161. [PMID: 37176602 PMCID: PMC10179149 DOI: 10.3390/jcm12093161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries.
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Affiliation(s)
- Joanna Dolar-Szczasny
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
| | - Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Laboratory, Medical University of Lublin, 20-090 Lublin, Poland
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
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Quérat L, Chen E. iCare® Home vs Goldmann applanation tonometry: Agreement of methods and comparison of inter-observer variation at a tertiary eye centre. Eur J Ophthalmol 2023; 33:312-318. [PMID: 35505614 PMCID: PMC9834317 DOI: 10.1177/11206721221099252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose: To investigate whether the inter-observer variation is similar between the Goldmann applanation tonometer used by healthcare staff and the iCare® Home tonometer used by glaucoma patients, volunteers and healthcare staff. Methods: Sixty-one participants were recruited to the study, including 24 glaucoma patients. Seven participants were excluded. For each participant, intraocular pressure (IOP) was measured on the same occasion by two different healthcare staff using GAT as well as by a healthcare staff and the participant using the iCare® Home tonometer. Results: Seventy-two per cent of iCare® measurements were within 3 mmHg of the GAT measurements. There was a statistically significant difference between the trainers' measurements made with iCare® Home and those made with GAT (p < 0.001), as well as between the GAT measurements made by trainers and those made by extra personnel (p = 0.017). The strongest correlation was between iCare® Home participants' and trainers' measurements (0.934). The correlation between different users with GAT was lower (0.769). The inter-user agreement was excellent for iCare® Home users (95% CI 0.93, ranging from 0.880 to 0.959) and moderate for GAT users (95% CI 0.741, ranging from 0.558 to 0.849). Conclusion: Our study found that tonometry with iCare® Home has similar or less inter-user variation compared with GAT.
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Affiliation(s)
- Laurence Quérat
- Laurence Quérat, Department of Anterior Segment Disorders, St Erik Eye Hospital, Eugeniavägen 12, 171 64 Solna, Sweden.
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Antonov AA, Vostrukhin SV, Volzhanin AV, Vitkov AA. [The effect of body position on the results of central and paracentral rebound tonometry]. Vestn Oftalmol 2023; 139:28-34. [PMID: 37067929 DOI: 10.17116/oftalma202313902128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
PURPOSE This study analyzes the fluctuations of intraocular pressure (IOP) and clarifies the error of paracentral rebound tonometry associated with change in body position. MATERIAL AND METHODS The study included 45 healthy volunteers aged 25.4±2.1 years. First we performed rebound tonometry in the sitting position in the center of the cornea and 3-4 mm from the temporal and nasal sides (Icare-c, Icare-n, Icare-t, respectively) and bidirectional applanation tonometry (IOPcc - corneal compensated, IOPg - Goldmann tonometry). Then we measured Icare-c, Icare-n, Icare-t in the supine position, and after 5 minutes repeated Icare-c in the supine position. After this, we measured Icare-c, IOPcc and IOPg in the sitting position. RESULTS AND DISCUSSION Initial IOPcc and IOPg were 4.6±2.8 and 14.8±2.8 mm Hg. Initial Icare-c, Icare-t, and Icare-n measurements amounted to 15.0±1.9, 15.7±1.5 and 16.3±1.3 mm Hg; in the supine position the measurements were 16.4±2.1, 17.2±1.7 and 17.1±1.9 mm Hg. Paracentral measurements differed from Icare-c in both sitting and supine positions; only between Icare-t and Icare-n measured in the supine position there were no significant differences. The results of Icare-c, Icare-t, and Icare-n in body position change were comparable. Icare-c measured after 5 minutes in the supine position increased up to 16.6±2.4 mm Hg. Final IOPcc and IOPg did not differ from the initial measurements. Final Icare-c was lower than the initial result by 0.8±0.2 mm Hg, and lower than both supine Icare-c measurements by 2.1±0.2 and 2.6±0.2 mm Hg. CONCLUSION Paracentral rebound tonometry findings exceed those of rebound tonometry in central cornea, but in body position change the alteration of measurements in the same points on the cornea are comparable. In the supine position IOP increases on average by 1.0-1.5 mm Hg compared to the sitting position.
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Affiliation(s)
- A A Antonov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | | | - A V Volzhanin
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Vitkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Mizohata H, Ikesugi K, Kondo M. Frequent self-monitoring of intraocular pressure can determine effectiveness of medications in eyes with normal tension glaucoma: A case report. Medicine (Baltimore) 2022; 101:e32478. [PMID: 36595993 PMCID: PMC9803456 DOI: 10.1097/md.0000000000032478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE It is difficult to follow changes in the intraocular pressure (IOP) in glaucomatous eyes comprehensively because of the limited number of outpatient examinations. We report our findings in a case of normal tension glaucoma (NTG) in which frequent self-measurements of the IOP were used to evaluate the IOP-lowering effect of different medications. PATIENT CONCERNS A 50-year-old man with NTG had a nasal step visual field defect in his right eye and was being treated with 0.005% latanoprost (LAT) ophthalmic solution (XALATAN®). DIAGNOSIS The patient was diagnosed with NTG. INTERVENTIONS The patient had a mean IOP in the right eye of 10.9 ± 1.5 mm Hg (68 measurements in 1 month, Period A) during treatment with 0.005% LAT ophthalmic solution. During the second month (Period B), the mean IOP in the same eye was 9.8 ± 1.7 mm Hg (59 measurements) with treatment with a LAT and carteolol fixed combination (LCFC). And during the third month (Period C), the mean IOP was 7.4 ± 1.1 mm Hg (57 measurements) on the same right eye after the addition of brimonidine and brinzolamide fixed combination ophthalmic solution to the LCFC ophthalmic solution. OUTCOMES Comparisons of the IOPs between Periods A and B and between B and C showed that the reductions in the IOP were significant. CONCLUSION We conclude that frequent self-measurements of the IOP can determine that small changes of the IOPs are significant.
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Affiliation(s)
- Hideki Mizohata
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kengo Ikesugi
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
- * Correspondence: Kengo Ikesugi, Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (e-mail: )
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
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Strzalkowska A, Pirlich N, Stingl JV, Schuster AK, Rezapour J, Wagner FM, Buse J, Hoffmann EM. Intraocular Pressure Measurement in Childhood Glaucoma under Standardized General Anaesthesia: The Prospective EyeBIS Study. J Clin Med 2022; 11:2846. [PMID: 35628971 PMCID: PMC9144815 DOI: 10.3390/jcm11102846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: We aimed to compare intraocular pressure (IOP) measurements using iCare® PRO rebound tonometry (iCare) and Perkins applanation tonometry (Perkins) in childhood glaucoma subjects and healthy children and the influence of anaesthesia depth, age and corneal thickness. Material: Prospective clinical, case-control study of children who underwent an ophthalmologic examination under general anaesthesia according to our protocol. Children were 45.45 ± 29.76 months old (mean ± SD (standard deviation)). Of all children, 54.05% were female. IOP was taken three times (T1−T3), according to duration and the depth of anaesthesia. The order of measurement alternated, starting with iCare. Agreement between the device measurements was evaluated using Bland−Altman analysis. Results: 53 glaucoma subjects and 22 healthy controls. Glaucoma subjects: IOP measured with iCare was at T1: 27.2 (18.1−33.8), T2: 21.6 (14.8−30.6), T3: 20.4 mmHg (14.5−27.0) and Perkins 17.5 (12.0−23.0), 15.5 (10.5−20.5), 15.0 mmHg (10.5−21.0) (median ± IQR (interquartile range)). Healthy controls: IOP with iCare: T1: 13.3 (11.1−17.0), T2: 10.6 (8.1−12.4), T3: 9.6 mmHg (7.7−11.7) and Perkins 10.3 (8.0−12.0), 7.0 (5.5−10.5), 7.0 mmHg (5.5−8.5) (median ± IQR). The median IOP was statistically significantly higher with iCare than with Perkins (p < 0.001) in both groups. The mean difference (iCare and Perkins) was 6.0 ± 6.1 mmHg for T1−T3, 7.3 at T1, 6.0 at T2, 4.9 mmHg at T3. Conclusion: The IOP was the highest in glaucoma subjects and healthy children at T1 (under sedation), independently of the measurement method. iCare always leads to higher IOP compared to Perkins in glaucoma and healthy subjects, regardless of the duration of anesthesia.
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Affiliation(s)
- Alicja Strzalkowska
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Nina Pirlich
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany;
| | - Julia V. Stingl
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Jasmin Rezapour
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Felix M. Wagner
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Justus Buse
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
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10
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Ye Y, Yang F, Ding L, Xia F, Niu L, Wang X, Zhao J, Zhou X. Comparison of Icare HOME and non-contact tonometer in intraocular pressure measurement in the early stage after ICL V4c implantation. Eur J Ophthalmol 2022; 32:3303-3311. [PMID: 35422146 DOI: 10.1177/11206721221093990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To investigate the characteristics of intraocular pressure (IOP) measurements using the Icare HOME rebound tonometer (RBT) and non-contact tonometer (NCT) during the early stage after implantable collamer lens (ICL) V4c implantation, and to assess the agreement between the two methods. Methods This prospective case series study included 104 eyes of 53 patients (mean age 28.77 ± 5.34 years), who underwent ICL V4c implantation. IOP was measured preoperatively, and at 0.5, 1, 2, 4, and 24 h postoperatively by Icare HOME and NCT, respectively. Results All surgeries were uneventful. IOP measurements by Icare and NCT preoperatively were 14.03 ± 2.90 mmHg and 14.09 ± 2.87 mmHg, respectively.The corresponding values were 12.56 ± 8.09 mmHg and 14.12 ± 6.52 mmHg (P > 0.05) at postoperative 0.5 h, 19.21 ± 8.74 mmHg and 19.60 ± 7.66 mmHg at postoperative 1 h (P > 0.05), 21.21 ± 8.10 mmHg and 20.31 ± 6.93 mmHg at postoperative 2 h (P > 0.05), 16.11 ± 5.89 mmHg and 17.04 ± 4.84 mmHg at postoperative 4 h (P > 0.05), and 14.04 ± 3.88 mmHg and 14.78 ± 2.80 mmHg at postoperative 24 h, respectively (P > 0.05). There was good agreement based on intraclass correlation coefficients (ICCs) between NCT and Icare HOME (all ICCs > 0.6 at different time points [range, 0.6986–0.956]). The Bland-Altman plot showed a mean percentage of over 95.81% of the points falling within the limits of agreement. There was a significant difference in the low IOP measurements (<10 mmHg) between Icare HOME and NCT (7.28 ± 2.55 vs. 10.65 ± 2.48, P < 0.001). Conclusion Icare HOME can be used for IOP measurement after ICL V4c implantation and demonstrated good agreement with NCT, except in cases with low intraocular pressure (<10 mmHg).
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Affiliation(s)
- Yuhao Ye
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Fangwen Yang
- The second affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Lan Ding
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Fei Xia
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lingling Niu
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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11
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Powell S, Doolan E, Curtin K, Doyle A, O'Brien C. Audit of outcomes following attendance at the City West drive-through IOP glaucoma clinic during the COVID-19 pandemic. Ir J Med Sci 2022; 191:2813-2822. [PMID: 35034276 PMCID: PMC8761105 DOI: 10.1007/s11845-021-02893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glaucoma is the leading cause of irreversible blindness globally. During the COVID-19 pandemic, an enforced reduction in capacity resulted in the deferral of routine outpatient appointments for glaucoma patients. AIM This study analyses patient outcomes following the establishment of a drive-through intra-ocular pressure (IOP) clinic during the COVID-19 pandemic to alleviate increased pressure on the tertiary glaucoma services at Royal Victoria Eye and Ear Hospital (RVEEH) and Mater Misericordiae University Hospital (MMUH) between August 2020 and June 2021. METHODS A 1-lane driveway system was established in a marquee on the grounds of City West hotel. IOPs were measured in patients' cars using a hand held iCare100 tonometer. Results were reviewed by a consultant ophthalmologist. At hospital follow-up clinic visits, IOP was measured using the Goldmann applanation tonometer (GAT). RESULTS Three hundred one patients of a total of 672 who attended the drive-through clinic have subsequently attended a designated hospital follow-up appointment. In this cohort, the mean drive-through iCare IOP of 19.4 mmHg ± 6.0 was significantly higher (< 0.005) than the mean GAT IOP at the pre-drive through clinic visit (16.3 mmHg ± 3.7) and the post drive-through hospital follow-up visit (17.2 mmHg ± 4.1). Two hundred twenty-six (75%) patients did not need any treatment change, 53 (18%) required eye drop medication changes, 10 (3%) underwent a laser procedure, 4(1%) required surgical intervention, and 8 (3%) were discharged. When patient outcomes were analysed according to IOP grade assigned at the drive-through clinic, those with an iCare IOP < 21 were significantly less likely to require a treatment change. The cohort with iCare IOP ≥ 30 were significantly more likely to have a laser or surgical intervention. CONCLUSION The implementation of a drive-through IOP clinic was a safe and effective way to monitor glaucoma patients during COVID-19, and identify those at high risk of poor IOP control or requiring a change in treatment.
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Affiliation(s)
- Sarah Powell
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Emer Doolan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Karen Curtin
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Aoife Doyle
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Colm O'Brien
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.
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12
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Ogle JJ, Soo Hoo WC, Chua CH, Yip LWL. Accuracy and Reliability of Self-measured Intraocular Pressure in Glaucoma Patients Using the iCare HOME Tonometer. J Glaucoma 2021; 30:1027-1032. [PMID: 34628422 DOI: 10.1097/ijg.0000000000001945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Abstract
PRCIS The iCare HOME tonometer is a useful tool which can be used by patients for fairly accurate and reliable self-measurement of intraocular pressure (IOP). PURPOSE The aim was to compare the accuracy of IOP measurements of trained glaucoma patients using the iCare HOME tonometer before and after a week of self-monitoring at home and study the repeatability of patient measurements done at home. MATERIALS AND METHODS A total of 40 glaucoma patients had IOPs measured using the Goldmann applanation tonometer and the iCare HOME. Patients were trained to use the iCare HOME and measured their IOP twice daily over a loan period of 7 days. Bland-Altman analysis was used to assess agreement between Goldmann applanation tonometer and iCare HOME readings. Intraclass correlation coefficient compared inter-rater reliability of iCare HOME measurements, and test-retest variability for the patient's readings over the 7-day period were analyzed. A 5-point Likert scale questionnaire was used to assess the patient's experience with the device. RESULTS Up to 32 patients (80%) were able to obtain IOP readings within 3 mm Hg of the glaucoma nurse clinician's readings at the preloan visit, and up to 36 patients (90%) at the postloan visit. Good inter-rater reliability was observed between iCare HOME measurements by the glaucoma nurse clinician and patients. At the postloan visit, inter-rater reliability was good for right eye readings and excellent for left eye readings. No distinct trend in test-retest variability was identified over the 7-day period. 65% of patients agreed the device was easy to use and 89% would recommend the device to other glaucoma patients. CONCLUSION Patients trained to use the iCare HOME device can do so with fair accuracy compared with trainers with accuracy improving within 1 week of usage.
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Affiliation(s)
- Jeanne J Ogle
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
| | - Wai Cheng Soo Hoo
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
| | - Chun Hau Chua
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
| | - Leonard W L Yip
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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13
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Wong SH, Tsai JC. Telehealth and Screening Strategies in the Diagnosis and Management of Glaucoma. J Clin Med 2021; 10:jcm10163452. [PMID: 34441748 PMCID: PMC8396962 DOI: 10.3390/jcm10163452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Telehealth has become a viable option for glaucoma screening and glaucoma monitoring due to advances in technology. The ability to measure intraocular pressure without an anesthetic and to take optic nerve photographs without pharmacologic pupillary dilation using portable equipment have allowed glaucoma screening programs to generate enough data for assessment. At home, patients can perform visual acuity testing, web-based visual field testing, rebound tonometry, and video visits with the physician to monitor for glaucomatous progression. Artificial intelligence will enhance the accuracy of data interpretation and inspire confidence in popularizing telehealth for glaucoma.
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14
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Abstract
Early detection and monitoring are critical to the diagnosis and management of glaucoma, a progressive optic neuropathy that causes irreversible blindness. Optical coherence tomography (OCT) has become a commonly utilized imaging modality that aids in the detection and monitoring of structural glaucomatous damage. Since its inception in 1991, OCT has progressed through multiple iterations, from time-domain OCT, to spectral-domain OCT, to swept-source OCT, all of which have progressively improved the resolution and speed of scans. Even newer technological advancements and OCT applications, such as adaptive optics, visible-light OCT, and OCT-angiography, have enriched the use of OCT in the evaluation of glaucoma. This article reviews current commercial and state-of-the-art OCT technologies and analytic techniques in the context of their utility for glaucoma diagnosis and management, as well as promising future directions. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Alexi Geevarghese
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA.,Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA.,Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA.,Department of Physiology and Neuroscience, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
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15
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Nakakura S, Asaoka R, Terao E, Nagata Y, Fukuma Y, Oogi S, Shiraishi M, Kiuchi Y. Evaluation of rebound tonometer iCare IC200 as compared with IcarePRO and Goldmann applanation tonometer in patients with glaucoma. EYE AND VISION 2021; 8:25. [PMID: 34193284 PMCID: PMC8247177 DOI: 10.1186/s40662-021-00249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022]
Abstract
Background This study investigated the agreement between a new rebound tonometer, IC200, and IcarePRO and Goldmann applanation tonometry (GAT). Methods This was a prospective cross-sectional study. We measured the intraocular pressure (IOP) in 145 eyes of 145 glaucoma patients in the sitting position using GAT, IcarePRO, and IC200. IcarePRO and IC200 measurements were also obtained in the supine position. IC200 measurement was performed using two modes: single six (IC200-single) and automatic (IC200-continuous) six-measurements mode. Results All tonometers provided high reproducibility in both positions (all intraclass correlation coefficients > 0.90), although it was highest with GAT, followed by IC200-continuous and IC200-single and then IcarePRO. In the sitting position, the mean (± SD) IOPs of GAT, IcarePRO, IC200-single, and IC200-continuous were 14.5 ± 2.9 mmHg, 13.3 ± 3.2 mmHg, 11.6 ± 3.2 mmHg, and 11.5 ± 3.2 mmHg, respectively. IOPs measured with IcarePRO or IC200 were significantly lower than those with GAT, particularly in patients with low IOP. IOPs measured with all tonometers were significantly elevated in the supine position as compared with the sitting position, but this difference was significantly greater with IC200-single and IC200-continuous compared with IcarePRO. IOP elevation was significant in eyes without bleb versus those with bleb, but this finding was not observed when IOP was measured with IcarePRO. The IOPs of the single and continuous modes of IC200 were interchangeable in both positions. Conclusions GAT, IcarePRO, and IC200 had sufficiently high reproducibility, but measurements with IcarePRO may not be accurate in the supine position. Elevation of IOP in the supine position, especially in eyes with bleb, was more sensitively captured with IC200 than with IcarePRO. Trial registration Japan Clinical Trials Register, No. UMIN000039982. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-021-00249-z.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan.
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. .,Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
| | - Etsuko Terao
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yuki Nagata
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yasuko Fukuma
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Satomi Oogi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Miku Shiraishi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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16
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The Utility of iCare HOME Tonometry for Detection of Therapy-Related Intraocular Pressure Changes in Glaucoma and Ocular Hypertension. Ophthalmol Glaucoma 2021; 5:85-93. [PMID: 34082179 DOI: 10.1016/j.ogla.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess whether iCare HOME rebound tonometry can detect therapy-related changes during self-monitoring of intraocular pressure (IOP). DESIGN Prospective clinical trial. PARTICIPANTS A total of 43 eyes (n = 27 subjects) with open-angle glaucoma or ocular hypertension were enrolled during standard-of-care clinic visits. Participants were grouped into control eyes managed on stable therapy (n = 18 eyes) or therapy change eyes undergoing selective laser trabeculoplasty (SLT, n = 8 eyes), initiating topical therapy (n = 8 eyes), or adding a second medication to existing monotherapy (n = 9 eyes). METHODS Subjects recorded IOP 4 times daily for 1 week using iCare HOME tonometry. Upon tonometer return, subjects underwent SLT or new medication start; an additional week of iCare HOME measurements was collected after 4 to 6 weeks. Control subjects recorded an additional week of measurements after 6 weeks. Measurements were grouped into 4 time periods (5-10 am, 10 am to 3 pm, 3-8 pm, 8 pm to 1 am). Goldmann applanation tonometry (GAT) was performed at each study visit for comparison. MAIN OUTCOME MEASURES Detection of therapy response defined as an IOP reduction of ≥20%. RESULTS For eyes that demonstrated a therapy response by GAT (n = 11), iCare HOME detected a therapy response in 90.9% of eyes in ≥1 time period and 45.5% of eyes in all 4 time periods. In eyes without a GAT-measured therapy response (n = 14), iCare HOME detected a response for 71.4% (n = 10) of eyes in ≥1 time period and for 7.1% of eyes (n = 1) at all 4 time periods. In treatment eyes, intraday and interday average minimum and maximum IOP, as well as interday IOP range, were significantly reduced after therapy without a significant change in intraday IOP range. Control group eyes did not demonstrate a significant change in average IOP minimum, maximum, or range between study weeks. CONCLUSIONS Home tonometry with iCare HOME reliably detects therapy-related IOP changes in patients with glaucoma and ocular hypertension. Treatment responses correlated well with in-office GAT and may detect treatment responses missed by GAT. Intraocular pressure measurements via home tonometry provide additional clinical information regarding intraday and interday IOP fluctuation beyond standard of care in office GAT measurements. The iCare HOME is a valuable tool to monitor therapeutic efficacy in patients with glaucoma.
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17
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Abstract
Glaucoma is the second cause of irreversible blindness in the world. Intraocular pressure (IOP) is a recognized major risk factor for the development and progression of glaucomatous damage. Goldmann applanation tonometry (GAT) is internationally accepted as the gold standard for the measurement of IOP. The purpose of this study was to search for correlations between Goldmann tonometry and corneal mechanical properties and thickness by means of in vitro tests. IOP was measured by the Goldmann applanation tonometer (GIOP), and by a pressure transducer inserted in the anterior chamber of the eye (TIOP), at increasing pressure levels by addition of saline solution in the anterior chamber of enucleated pig eyes (n = 49). Mechanical properties were also determined by inflation tests. The GAT underestimated the real measurements made by the pressure transducer, with most common differences in the range 15–28 mmHg. The difference between the two instruments, highlighted by the Bland–Altman test, was confirmed by ANOVA, normality tests, and Mann–Whitney’s tests, both on the data arranged for infusions and for the data organized by pressure ranges. Pearson correlation tests revealed a negative correlation between (TIOP-GIOP) and both corneal stiffness and corneal thickness. In conclusion, data obtained showed a discrepancy between GIOP and TIOP more evident for softer and thinner corneas, that is very important for glaucoma detection.
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18
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McGlumphy EJ, Mihailovic A, Ramulu PY, Johnson TV. Home Self-tonometry Trials Compared with Clinic Tonometry in Patients with Glaucoma. Ophthalmol Glaucoma 2021; 4:569-580. [PMID: 33845191 DOI: 10.1016/j.ogla.2021.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Elyse J McGlumphy
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aleksandra Mihailovic
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas V Johnson
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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19
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Rosenfeld E, Rabina G, Barequet D, Mimouni M, Fischer N, Kurtz S. Role of home monitoring with iCare ONE rebound tonometer in glaucoma patients management. Int J Ophthalmol 2021; 14:405-408. [PMID: 33747817 DOI: 10.18240/ijo.2021.03.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate intraocular pressure (IOP) measurements and fluctuations using the iCare ONE rebound tonometer (RT-ONE), during home monitoring, in diagnosed and suspected glaucoma patients. METHODS A retrospective case series of consecutive patients with known glaucoma or glaucoma suspects who were followed-up and treated between January 2016 and January 2017. The study included 80 eyes of 40 patients with a mean age of 59.1±14.6y (range, 24-78). All patients have undergone 4-5d of IOP home monitoring with RT-ONE at morning, noon, afternoon, and night time. RESULTS Baseline mean IOP, as measured in the clinic (8 a.m.-12 p.m.), was 17.4±5.1 mm Hg, compared to RT-ONE home monitoring mean IOP of 15.6±4.1 mm Hg (P=0.002). Mean IOP was significantly lower at noon, afternoon and night times compared to clinic measured IOP and morning measurements (P=0.005). IOP peak measured during home monitoring was significantly higher compared to the clinic measured IOP (21.3±5.6 mm Hg and 17.4±5.1 mm Hg, P<0.001). IOP peaks during home monitoring demonstrated a majority of 47 peaks during morning measurements, compared to 23 at noon, 19 at afternoon and only 12 at night (P<0.001). The home monitoring results led to treatment modification of 44 eyes (55%), treatment regime was insufficient for 40 (50%) eyes. CONCLUSION Home monitoring IOP with RT-ONE can provide good assessment of mean IOP, IOP fluctuations and peaks throughout the hours of the day, which lead to an accurate treatment for glaucoma patients.
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Affiliation(s)
- Eldar Rosenfeld
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Gilad Rabina
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Dana Barequet
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Affiliated to Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Shimon Kurtz
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
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20
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Abstract
PURPOSE OF REVIEW The current article reviews the impact of the coronavirus disease 2019 (COVID-19) pandemic on the delivery of ophthalmic, and specifically, glaucoma care. RECENT FINDINGS Literature from the review period includes case series demonstrating the presence of severe acute respiratory syndrome coronavirus 2 RNA in the conjunctival secretions of patients with laboratory-confirmed COVID-19. The global ophthalmology community published reports outlining the enhanced infection control measures undertaken by different institutions around the world to mitigate transmission of the novel coronavirus. Telemedicine has been increasingly implemented in glaucoma practices to reduce in-office patient volume. New data regarding the efficacy and feasibility of tools for home monitoring of intraocular pressure, virtual visual field testing, and remote disc photography are reviewed. SUMMARY COVID-19 has posed a global public health threat due to the severity of its contagion and associated morbidity and mortality. Glaucoma specialists have responded to the pandemic with innovative modifications to reduce viral transmission and optimize patient and staff safety in the office and operating room. The role of teleglaucoma has expanded and will continue to evolve as remote diagnostic devices undergo further refinement and validation.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Paul A Sidoti
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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21
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Qassim A, Mullany S, Awadalla MS, Hassall MM, Nguyen T, Marshall H, Kolovos A, Schulz AM, Han X, Gharahkhani P, Galanopoulos A, Agar A, Healey PR, Hewitt AW, Landers J, Casson RJ, Graham SL, MacGregor S, Souzeau E, Siggs OM, Craig JE. A Polygenic Risk Score Predicts Intraocular Pressure Readings Outside Office Hours and Early Morning Spikes as Measured by Home Tonometry. Ophthalmol Glaucoma 2020; 4:411-420. [PMID: 33316431 DOI: 10.1016/j.ogla.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Intraocular pressure (IOP) elevations may occur in early morning or outside office hours and can be missed during routine in-clinic IOP measurements. Such fluctuations or peaks likely contribute to glaucoma progression. We sought to investigate the relationship between an IOP polygenic risk score (PRS) and short-term IOP profile. DESIGN Cross-sectional study. PARTICIPANTS Four hundred seventy-three eyes from 239 participants with suspected or established primary open-angle glaucoma sampled from 4 outpatient clinics in Australia between August 2016 and December 2019. METHODS Participants underwent Icare HOME (Icare Oy, Vanda, Finland) tonometer measurements to record IOP 4 times daily for 5 days. Unreliable measurements were excluded. A minimum of 2 days with at least 3 reliable measurements were required. We used a validated IOP PRS derived from 146 IOP-associated variants in a linear regression model adjusted for central corneal thickness and age. MAIN OUTCOME MEASURES Highest recorded early morning IOP and mean IOP within and outside office hours. Early morning IOP spikes were defined by a higher early morning IOP than the maximum in-office hours IOP. RESULTS Reliable measurements were obtained from 334 eyes of 176 participants (mean age, 64 ± 9 years). Eyes in the highest IOP PRS quintile showed an early morning IOP increase of 4.3 mmHg (95% confidence interval [CI], 1.4-7.3; P = 0.005) and mean increase in IOP outside office hours of 2.7 mmHg (95% CI, 0.61-4.7; P = 0.013) than the lowest quintile, which were significant independently after accounting for a recent in-clinic IOP measured by Goldmann applanation tonometry. Eyes in the highest PRS quintile were 5.4-fold more likely to show early morning IOP spikes than the lowest quintile (odds ratio 95% CI, 1.3-23.6; P = 0.023). CONCLUSIONS A validated IOP PRS was associated with higher early morning IOP and mean IOP outside office hours. These findings support a role for genetic risk prediction of susceptibility to elevated IOP that may not be apparent during in-clinic hours, requiring more detailed clinical phenotyping using home tonometry, the results of which may guide additional interventions to improve IOP control.
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Affiliation(s)
- Ayub Qassim
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia.
| | - Sean Mullany
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Mona S Awadalla
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Mark M Hassall
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Thi Nguyen
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Henry Marshall
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Antonia Kolovos
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Angela M Schulz
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Xikun Han
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Anna Galanopoulos
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - Ashish Agar
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia
| | - Paul R Healey
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - John Landers
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, Australia
| | - Stuart L Graham
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | | | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Owen M Siggs
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
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22
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Liu J, De Francesco T, Schlenker M, Ahmed II. Icare Home Tonometer: A Review of Characteristics and Clinical Utility. Clin Ophthalmol 2020; 14:4031-4045. [PMID: 33262568 PMCID: PMC7695605 DOI: 10.2147/opth.s284844] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 12/03/2022] Open
Abstract
The Icare HOME (TA022, Icare Oy, Vanda, Finland) is rebound tonometer recently approved by the US Food and Drug Administration in March 2017 designed for self-measurement of intraocular pressure (IOP). IOP remains a major modifiable risk factor for glaucoma progression; however, IOP measurements typically occur through single office measurements on Goldmann applanation tonometry (GAT) and do not always reveal the complete picture of patient’s IOP patterns and daily fluctuations, which are important for accurate diagnosis and evaluation. Numerous studies have now compared the efficacy of the Icare HOME to that of GAT. The objective of this article is to review the existing literature surrounding the Icare HOME tonometer and its efficacy as a self-tonometer in comparison to GAT. The available literature has shown promising results in its accuracy of measuring IOP but suggests cautious usage in patients with central corneal thicknesses or IOP ranges that are outside of a certain range. This article will also provide details and example cases for when the Icare HOME may be most clinically useful.
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Affiliation(s)
- John Liu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Prism Eye Institute, Oakville, Ontario, Canada
| | - Ticiana De Francesco
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Prism Eye Institute, Oakville, Ontario, Canada
| | - Matthew Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Prism Eye Institute, Oakville, Ontario, Canada
| | - Iqbal Ike Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Prism Eye Institute, Oakville, Ontario, Canada
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23
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Olyntho Junior MADC, Augusto LB, Gracitelli CPB, Tatham AJ. The Effect of Corneal Thickness, Densitometry and Curvature on Intraocular Pressure Measurements Obtained by Applanation, Rebound and Dynamic Contour Tonometry. Vision (Basel) 2020; 4:vision4040045. [PMID: 33096873 PMCID: PMC7711663 DOI: 10.3390/vision4040045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Evaluate the effect of corneal thickness, densitometry and curvature on intraocular pressure (IOP) measurements obtained by Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), rebound tonometry (RT), and dynamic contour tonometry (DCT). A cross-sectional prospective study involving 40 participants was performed. Corneal measurements were obtained using Pentacam (Oculus GMbH, Wetzlar, Germany), densitometry was measured at annuli of 0–2, 2–6, 6–10 and 10–12 mm. The relationship between corneal thickness (central, 4 and 6 mm), corneal astigmatism and corneal densitometry and IOP was examined. There was a significant relationship between corneal thickness (central, 4 and 6 mm) and GAT180, GAT90, RT, and NCT (P < 0.001 for all comparisons) but not for DCT. Higher corneal densitometry (6–10 mm and 10–12 mm zones) was associated with higher IOP from GAT180 and GAT90, and higher densitometry in the 6–10 mm zone correlated with higher IOP from NCT, however corneal densitometry increased with age. Accounting for age, the relationship between corneal densitometry and IOP measurements was not significant. In eyes with greater corneal astigmatism there was a greater difference between GAT90 and GAT180 measurements. IOP measurements may be affected by corneal thickness, densitometry and curvature. DCT was less affected by properties of the cornea compared to other devices.
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Affiliation(s)
| | | | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, 13565-905 São Paulo, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, 07750-000 Vinhedo, São Paulo, Brazil
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24
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McGarva E, Farr J, Dabasia P, Lawrenson JG, Murdoch IE. Initial experience in self-monitoring of intraocular pressure. Eur J Ophthalmol 2020; 31:1326-1332. [PMID: 32340488 PMCID: PMC8358569 DOI: 10.1177/1120672120920217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background/aims Diurnal variation in intraocular pressure (IOP) is a routine assessment in glaucoma management. Providing patients the opportunity to perform self-tonometry might empower them and free hospital resource. We previously demonstrated that 74% of patients can use the Icare® HOME tonometer. This study further explores Icare® HOME patient self-monitoring. Methods Patients were trained by standard protocol to use the Icare® HOME rebound tonometer. Patient self-tonometry was compared to Goldmann applanation tonometry (GAT) over one clinical day. Following this, each patient was instructed to undertake further data collection that evening and over the subsequent two days. Results Eighteen patients (35 eyes) participated. Good agreement was demonstrated between GAT and Icare® HOME for IOPs up to 15 mm Hg. Above this IOP the Icare® tended to over-read, largely explained by 2 patients with corneal thickness >600 um. The mean peak IOP during ‘clinic hours’ phasing was 16.7 mm Hg and 18.5 mm Hg (p = 0.24) over three days. An average range of 5.0, 7.0 and 9.8 mm Hg was shown during single day clinic, single day home and three day home phasing respectively (p =<0.001). The range of IOP was lower in eyes with prior trabeculectomy (6.1 mm Hg vs 12.2 mm Hg). All patients undertook one reading in the early morning at home with an average of 4.8 readings during, and 3.1 readings after office hours. Conclusions This small study shows that self-tonometry is feasible. The findings from home phasing demonstrated higher peak and trough IOPs, providing additional clinical information. Home phasing is a viable alternative. The cost-effectiveness of this approach has yet to be addressed.
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Affiliation(s)
- Emily McGarva
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jane Farr
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Priya Dabasia
- Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - John G Lawrenson
- Division of Optometry and Visual Sciences, City, University of London, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Ian E Murdoch
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
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25
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Abstract
SIGNIFICANCE Icare HOME rebound tonometry is increasingly adopted into clinical practice for IOP phasing of glaucoma patients and suspects. Because of measurement differences with applanation tonometry and diurnal fluctuations, interpretation of the IOP measured with Icare HOME phasing can be challenging. PURPOSE The purpose of this study was to use a large patient cohort to develop a practical, analytical tool for interpreting Icare HOME measurements with respect to applanation pressure. METHODS IOP measurements using the Icare HOME and an applanation tonometer were taken prospectively in 498 consecutive patients. Bland-Altman, frequency distribution, and linear regression analysis were applied to determine measurement differences. A novel criterion, Threshold Icare HOME IOP, was developed to assist identification of elevation above target applanation pressure, considering the expected diurnal variation and measurement variability. RESULTS Icare HOME tended to underestimate applanation tonometry (mean bias, -1.7 mmHg; 95% limits of agreement, -7.0 to +3.6). Overall, differences were within ±3 mmHg in 71.5% and ±5 mmHg in 92% of patients. Based on the novel criterion developed, Icare HOME measurements that exceed target applanation pressure by 6 mmHg or greater are generally outside the 95% limit of expected observations. CONCLUSIONS The Threshold Icare HOME IOP is a novel and practical criterion that can assist clinicians in their interpretation of Icare HOME phasing measurements with respect to target applanation pressures. Elevation above the expected thresholds may prompt closer monitoring or even modifications to glaucoma management.
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26
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Awadalla MS, Qassim A, Hassall M, Nguyen TT, Landers J, Craig JE. Using Icare HOME tonometry for follow‐up of patients with open‐angle glaucoma before and after selective laser trabeculoplasty. Clin Exp Ophthalmol 2020; 48:328-333. [DOI: 10.1111/ceo.13686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mona S. Awadalla
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
| | - Ayub Qassim
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
| | - Mark Hassall
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
| | - Thi T. Nguyen
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
| | - John Landers
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
| | - Jamie E. Craig
- Department of OphthalmologyFlinders University Adelaide South Australia Australia
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27
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Review of the measurement and management of 24-hour intraocular pressure in patients with glaucoma. Surv Ophthalmol 2020; 65:171-186. [DOI: 10.1016/j.survophthal.2019.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
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28
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Rebound Self-tonometry Acquisition Time and Ease of Use Evaluated by Newly Trained Optometry Students and Optometrists. Optom Vis Sci 2020; 97:94-100. [DOI: 10.1097/opx.0000000000001481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Abstract
SIGNIFICANCE Precise measurement of intraocular pressure (IOP) is essential when diagnosing and managing glaucoma. We compared the IOP readings of three different tonometers and analyzed agreement among tonometers in eyes with high IOPs. PURPOSE The purpose of this study was to compare the IOP readings obtained using a Goldmann applanation tonometer (GAT), a rebound tonometer (RT), and a Tono-Pen (TP) in angle-closure eyes with elevated IOP before and after medical IOP-lowering therapy. METHODS Twenty-five eyes of 25 patients with angle closure and IOPs of greater than 30 mmHg were enrolled. Intraocular pressure was measured using RT (iCare Pro), TP (Tono-Pen XL), and GAT before and after medical treatment. The mean IOP readings of the tonometers were compared before and after treatment. The agreement among the tonometers was assessed via Bland-Altman analysis. RESULTS The measurements from 22 eyes of 22 patients were suitable for statistical analyses. Before medical treatment, the mean TP-IOP was significantly lower than the mean GAT-IOP (44.0 ± 10.3 vs. 50.4 ± 8.9 mmHg, respectively; P < .001), but no significant difference was evident between the RT-IOP and the GAT-IOP (50.8 ± 10.9 vs. 50.4 ± 8.9 mmHg, respectively; P = .79). After IOP-lowering treatment, the mean GAT-IOP (14.9 ± 4.7 mmHg) did not differ from either the mean RT-IOP (15.6 ± 4.4 mmHg) or the mean TP-IOP (15.4 ± 5.0 mmHg; P = .05 and P = .18, respectively). The random measurement error among tonometers was greater for high IOP readings. CONCLUSIONS Compared with RT or GAT, TP underestimated IOP in angle-closure eyes with a GAT-IOP of greater than 30 mmHg. Intraocular pressure reading agreement among the three tonometers was lower in eyes with high IOP.
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30
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Che Hamzah J, Daka Q, Azuara-Blanco A. Home monitoring for glaucoma. Eye (Lond) 2019; 34:155-160. [PMID: 31772381 DOI: 10.1038/s41433-019-0669-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/25/2019] [Accepted: 10/09/2019] [Indexed: 11/09/2022] Open
Abstract
Glaucoma services are overwhelmed and struggling to accommodate current demand. Reducing the need for hospital based services would improve our ability to see those most at risk of vision loss, which could both reduce demand and improve patient outcomes. Digital technologies that provide opportunities for home monitoring of glaucoma progression have potential to contribute to solve these challenges and, potentially, improve glaucoma care. This article will review the literatures of well-established technologies that support home monitoring for glaucoma, specifically home tonometry (with rebound tonometry) and perimetry with Moorfields Motion Displacement Test and Melbourne Rapid Field.
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Affiliation(s)
- Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Qëndresë Daka
- Department of Pathophysiology, Medical Faculty, University of Prishtina, Prishtinë, Kosovo
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
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31
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De Moraes CG, Mansouri K, Liebmann JM, Ritch R. Association Between 24-Hour Intraocular Pressure Monitored With Contact Lens Sensor and Visual Field Progression in Older Adults With Glaucoma. JAMA Ophthalmol 2019; 136:779-785. [PMID: 29800011 DOI: 10.1001/jamaophthalmol.2018.1746] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Twenty-four-hour intraocular pressure (IOP) patterns may provide more information regarding rates of visual field progression than office-hour measurements. However, little is known about the added value of 24-hour monitoring when stratifying glaucoma risk based on rates of progression. Objective To test the hypothesis that 24-hour IOP-related patterns recorded with a contact lens sensor (CLS) correlate with prior rates of visual field progression. Design, Setting, and Participants A multicenter, retrospective cohort study was conducted at 50 ophthalmology care centers in 13 countries. Participants included 445 patients (445 eyes) with treated, manifest open-angle glaucoma. The study was conducted from November 8, 1999, to September 17, 2016. Interventions Twenty-four-hour recordings of IOP-related patterns were prospectively collected with a CLS system. Retrospective visual field data of patients who underwent at least 3 prior reliable visual field tests were examined. Main Outcomes and Measures Association between CLS variables and rates of visual field mean deviation (MD) change. Results Of the 445 patients included, 238 (53.5%) were women and 394 (88.5%) were white. The mean (SD) age and MD values at the time of CLS recording were 68.9 (11.2) years and -9.0 (7.0) dB. The mean rate of MD change was -0.46 (0.5) dB/y in 5.2 (3) years of follow-up. After adjusting for baseline MD severity, age, and treatment, the following CLS variables were associated with fast visual field progression: mean peak ratio while awake (β = -0.021; 95% CI, -0.04 to -0.003), number of long peaks during sleep (β = 0.036; 95% CI, 0.005 to 0.067), night bursts ocular pulse frequency SD (β = 0.027; 95% CI, 0.004 to 0.051), and night bursts ocular pulse amplitude SD (β = 19.739; 95% CI, 1.333 to 38.145). Regression models including CLS variables had better fit than Goldmann IOP when testing the association with rates of progression. Conclusions and Relevance Results of this study indicate that 24-hour CLS recordings may be associated with prior rates of visual field progression of glaucoma. This association appears to be better than Goldmann mean IOP measured multiple times during office hours. Therefore, the CLS may be useful to assess the risk of future functional loss, even in situations when insufficient historical visual field information is available.
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Affiliation(s)
- Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland.,Department of Ophthalmology, University of Colorado, Denver, Colorado
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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32
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Beck D, Tatham AJ. Self-monitoring of intraocular pressure in glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1652093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daniel Beck
- Princess Alexandra Eye Pavilion, Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
| | - Andrew J. Tatham
- Princess Alexandra Eye Pavilion, Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
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33
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The role of self-dependent tonometry in improving diagnostics and treatment of patients with open angle glaucoma. OPHTHALMOLOGY JOURNAL 2019. [DOI: 10.17816/ov2019241-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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.
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Hassankarimi H, Noori SMR, Jafarzadehpour E, Yazdani S, Radinmehr F. Analysis of pattern electroretinogram signals of early primary open-angle glaucoma in discrete wavelet transform coefficients domain. Int Ophthalmol 2019; 39:2373-2383. [PMID: 30725244 DOI: 10.1007/s10792-019-01077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate discrete wavelet transform coefficients and identify descriptors of pattern electroretinogram (PERG) waveforms in order to determine PERG characteristics for optimizing the diagnosis of early primary open-angle glaucoma (POAG). METHODS Pattern electroretinogram was performed in 30 normal eyes and 30 eyes with primary open-angle glaucoma according to the ISCEV protocol. The check size was 0.8° and 16°, and the color was black/white in both groups. The results were analyzed in time domain (TD) and discrete wavelet transform (DWT) using the MATLAB software. The mean value, standard deviation, and relative energy of level 6 and 7 detail coefficients (d6, d7) and level 7 approximation coefficients (a7) of Daubechies 4 (db4), Daubechies 8 (db8), Symlet 5 (sym5), Symlet 7 (sym7), and Coiflet 5 (coif5) wavelets were calculated. In all the mentioned wavelets, DWT descriptors were extracted. Signals were reconstructed by inverse DWT. All data obtained by TD and DWT analyses were compared between the two groups. RESULTS In both check sizes, a significant attenuation of N95 amplitude was seen in the patient group. The relative energy of a7 of db8 increased significantly in the POAG group in the 0.8° check size. In larger check stimuli, the relative energy of d7 of coif5 decreased significantly and the standard deviation of d7 of sym7 increased markedly in glaucomatous patients (P < 0.05). In small stimuli, N95 descriptor (7N) of db8 had the highest value and showed a significant increase as compared to the POAG group. In the 16° check size, there was no significant difference. A strong correlation was seen between reconstructed signals and originals (r = 0.99). CONCLUSION The DWT can quantify PERG responses more accurately. In agreement with TD and wavelet coefficients domain results, 7N of db8 decomposition can be used as a good indicator for early detection of POAG.
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Affiliation(s)
- Homa Hassankarimi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Noori
- Departments of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jafarzadehpour
- Department of Optometry, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran. .,Department of Optometry, Faculty of Rehabilitation, Iran University of Medical Sciences, Shahnazary St., Mohseni Sq., Mirdamad Blvd., Tehran, Iran.
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Radinmehr
- Department of Optometry, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran
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35
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Cvenkel B, Velkovska MA, Jordanova VD. Self-measurement with Icare HOME tonometer, patients' feasibility and acceptability. Eur J Ophthalmol 2019; 30:258-263. [PMID: 30632407 DOI: 10.1177/1120672118823124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate and compare the accuracy of self-measurement of intraocular pressure using Icare Home rebound tonometer with Goldmann applanation tonometer and assess acceptability of self-tonometry in patients with glaucoma and ocular hypertension. METHODS In the study, 117 subjects were trained to use Icare Home for self-measurement. Icare Home tonometer readings were compared with Goldmann applanation tonometer, including one eye per patient. Agreement between the two methods of measurement was evaluated by Bland and Altmann analysis. Questionnaire was used to evaluate patients' perception of self-tonometry. RESULTS One hundred and three out of 117 patients (88%) were able to measure their own intraocular pressure and 96 (82%) fulfilled the requirements for certification. The mean (SD) difference Goldmann applanation tonometer minus Icare Home was 1.2 (2.4) mmHg (95% limits of agreement, -3.4 to 5.9 mmHg). The magnitude of bias between the two methods depended on central corneal thickness, with greater bias at central corneal thickness <500 µm. In 65 out of 96 subjects (67.7%), Icare Home results were within 2 mmHg of the Goldmann applanation tonometer. Seventy-three out of 93 (78.5%) felt that self-tonometry was easy to use and 75 patients (80.6%) responded that they would use the device at home. CONCLUSION Icare Home tonometry tends to slightly underestimate intraocular pressure compared to Goldmann applanation tonometer. Most patients were able to perform self-tonometry and found it acceptable for home use. Measurements using rebound self-tonometry could improve the quality of intraocular pressure data and optimize treatment regimen.
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Affiliation(s)
- Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | | | - Vesna Dimovska Jordanova
- University Eye Clinic, Skopje, Republic of Macedonia.,Saints Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Abstract
This review describes some of the most recent advances in the development and application of new technologies for detecting and managing glaucoma, including imaging, visual function testing, and tonometry. The widespread availability of mobile technology in the developing world is improving health care delivery, for example, with smartphones and mobile applications that allow patient data to be assessed remotely by health care providers.
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Affiliation(s)
- Ignacio Rodriguez-Una
- Glaucoma Department, Instituto Oftalmologico Fernandez-Vega, University of Oviedo, Oviedo, Spain
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37
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Razeghinejad MR, Lee D. Managing normal tension glaucoma by lowering the intraocular pressure. Surv Ophthalmol 2018; 64:111-116. [PMID: 30300624 DOI: 10.1016/j.survophthal.2018.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Daniel Lee
- Wills Eye Hospital, Glaucoma Service, Philadelphia, Pennsylvania, USA.
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38
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Abstract
The rebound tonometer has a unique mechanism for measuring intraocular pressure (IOP) and has become popular worldwide due to its ease of use. The most notable advantages are the lack of an air-puff and need for topical anesthesia, ease of operation and transport, and the ability to use it with children. Four rebound tonometers (Icare® TA01i, Icare PRO, Icare HOME, and Icare ic100) are currently available for clinical examination. It is important to understand the characteristics of each tonometer and select the most appropriate one because the IOP values and the purpose of measurement are different. In this review, with the goal of improving the understanding of a range of tonometers, the issues with each device are discussed.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji City, Japan,
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39
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The Influence of Corneal Biomechanical Properties on Intraocular Pressure Measurements Using a Rebound Self-tonometer. J Glaucoma 2018; 27:511-518. [DOI: 10.1097/ijg.0000000000000948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Abstract
PURPOSE OF REVIEW IOP is the only treatable risk factor contributing to glaucoma and most management and treatment of glaucoma is based on IOP. However, current IOP measurements are limited to office hours and control of glaucoma in many patients would benefit from the ability to monitor IOP diurnally so as not to miss abnormal pressures, which occur outside of office hours Consequently, to improve patient care, the ability to enable accurate and minimally disruptive diurnal IOP monitoring would improve caring for these patients. RECENT FINDINGS The studies we selected for this review can be divided into three categories: self-/home-tonometry, continuous invasive intraocular pressure measurements, and continuous noninvasive ocular measurements. SUMMARY The desire to obtain better insight in our patients' true diurnal IOP has led to the development of home-tonometers, in addition to extraocular and intraocular continuous pressure measurement devices. All of the devices have respective advantages and disadvantages, but none to date completely fulfills the goal of providing a true diurnal IOP profile.Video abstracthttp://links.lww.com/COOP/A27.
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41
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Tonometers-which one should I use? Eye (Lond) 2018; 32:931-937. [PMID: 29456251 DOI: 10.1038/s41433-018-0040-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/08/2022] Open
Abstract
Although several factors are known to play a role in the development and progression of glaucoma, intraocular pressure (IOP) remains the only modifiable risk factor. Medical and surgical treatments for glaucoma both aim to reduce IOP to minimize disease progression. Tonometry is therefore an essential element of the ophthalmological exam. There are several types of tonometers available currently. These range from well-established instruments that have been in clinical use for decades to new devices, which are the result of recent technological advances. The various instruments have advantages and disadvantages that affect their suitability for a given setting, purpose, and patient population. In this review, we aim to describe the most commonly available tonometers today along with their advantages, disadvantages, and applicability.
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Abstract
PURPOSE To highlight the effect of ascent to high altitude on intraocular pressure (IOP) in a patient with primary open-angle glaucoma, who had previously undergone trabeculectomy in 1 eye. METHODS Case report. RESULTS A 66-year-old mountaineer with primary open-angle glaucoma and previous right trabeculectomy performed self-tonometry using a rebound tonometer (Icare HOME) before and during an expedition in the Himalaya. In the nonoperated eye, there was a statistically significant increase in IOP as the patient ascended to 5000 m over 8 days (R=0.790, P=0.001), consistent with recent literature. IOP increased by 1.73 mm Hg with each 1000 m increase in altitude. In the trabeculectomized eye there was no significant increase in IOP (R=0.219, P=0.172). CONCLUSIONS Filtration surgery may be protective against IOP fluctuations associated with ascent to high altitude. Self-tonometry complements standard glaucoma care by providing opportunities for IOP monitoring outside office hours and in remote locations.
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