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Realini T, Halenda K, Palko J, McMillan B, Balasubramani GK. Test-Retest Reliability of Intraocular Pressure Measurements With Office-Based Versus Home-Based Rebound Tonometers. J Glaucoma 2024; 33:758-762. [PMID: 38814353 DOI: 10.1097/ijg.0000000000002441] [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: 01/18/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
PRCIS Intraocular pressure (IOP) measurements obtained with the HOME2 rebound tonometer are interchangeable with measurements obtained using the office-based IC100 and IC200 rebound tonometers, making characterization of circadian IOP achievable with no inter-device sources of variability. OBJECTIVE To evaluate test-retest reliability between IOP measurements obtained with a home rebound tonometer operated by patients and those obtained with office rebound tonometers operated by experienced clinical staff. METHODS After training and practice with a home rebound tonometer (iCare HOME2) in a randomly selected eye, patients with established or suspected open angle glaucoma underwent IOP measurement in the fellow eye as follows in randomized order: 3 good quality measurements with the iCare IC100 operated by experienced clinical staff, 3 good quality measurements with the iCare IC200 operated by experienced clinical staff, and 3 good quality measurements with the HOME2 operated by the patient. The Shrout-Fleisch intraclass correlation coefficient (ICC; 2,1) was the measure of reliability utilized based on the model using 2-way random effects, absolute agreement, and single measurement. RESULTS Thirty eyes of 30 patients were evaluated. The Pearson correlation coefficient ( r ) for IOP measurements taken with the IC100 and HOME2 was 0.97, with the IC200 and HOME2 was 0.96, and with the IC100 and IC200 was 0.97. Test-retest reliability between HOME2 and IC100 (ICC: 0.90), HOME2 and IC200 (ICC: 0.92), and IC100 and IC200 (ICC: 0.94) all reflected excellent test-retest reliability. CONCLUSION The test-retest reliability of IOP measurements taken by patients using the iCare HOME2 self-tonometer compared with IOP measurements taken by trained operators using the iCare IC100 and IC200 tonometers was uniformly excellent (ICCs all ≥0.9). These findings indicate that these three devices should be considered interchangeable for the clinical assessment of circadian IOP.
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Affiliation(s)
- Tony Realini
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Kevin Halenda
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Joel Palko
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Brian McMillan
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
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2
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Asrani SG, McGlumphy EJ, Al-Aswad LA, Chaya CJ, Lin S, Musch DC, Pitha I, Robin AL, Wirostko B, Johnson TV. The relationship between intraocular pressure and glaucoma: An evolving concept. Prog Retin Eye Res 2024; 103:101303. [PMID: 39303763 DOI: 10.1016/j.preteyeres.2024.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/22/2024]
Abstract
Intraocular pressure (IOP) is the most important modifiable risk factor for glaucoma and fluctuates considerably within patients over short and long time periods. Our field's understanding of IOP has evolved considerably in recent years, driven by tonometric technologies with increasing accuracy, reproducibility, and temporal resolution that have refined our knowledge regarding the relationship between IOP and glaucoma risk and pathogenesis. The goal of this article is to review the published literature pertinent to the following points: 1) the factors that determine IOP in physiologic and pathologic states; 2) technologies for measuring IOP; 3) scientific and clinical rationale for measuring diverse IOP metrics in patients with glaucoma; 4) the impact and shortcomings of current standard-of-care IOP monitoring approaches; 5) recommendations for approaches to IOP monitoring that could improve patient outcomes; and 6) research questions that must be answered to improve our understanding of how IOP contributes to disease progression. Retrospective and prospective data, including that from landmark clinical trials, document greater IOP fluctuations in glaucomatous than healthy eyes, tendencies for maximal daily IOP to occur outside of office hours, and, in addition to mean and maximal IOP, an association between IOP fluctuation and glaucoma progression that is independent of mean in-office IOP. Ambulatory IOP monitoring, measuring IOP outside of office hours and at different times of day and night, provides clinicians with discrete data that could improve patient outcomes. Eye care clinicians treating glaucoma based on isolated in-office IOP measurements may make treatment decisions without fully capturing the entire IOP profile of an individual. Data linking home blood pressure monitors and home glucose sensors to dramatically improved outcomes for patients with systemic hypertension and diabetes and will be reviewed as they pertain to the question of whether ambulatory tonometry is positioned to do the same for glaucoma management. Prospective randomized controlled studies are warranted to determine whether remote tonometry-based glaucoma management might reduce vision loss and improve patient outcomes.
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Affiliation(s)
- Sanjay G Asrani
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | | | - Lama A Al-Aswad
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig J Chaya
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Shan Lin
- Glaucoma Center of San Francisco, San Francisco, CA, USA
| | - David C Musch
- Department of Ophthalmology & Visual Sciences and Department of Epidemiology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Ian Pitha
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan L Robin
- Department of Ophthalmology & Visual Sciences and Department of Epidemiology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barbara Wirostko
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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3
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Kalantan H. Teleophthalmology in Saudi Arabia. Saudi J Ophthalmol 2023; 37:55-59. [PMID: 36968779 PMCID: PMC10032281 DOI: 10.4103/sjopt.sjopt_189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 01/22/2023] [Indexed: 03/12/2023] Open
Abstract
Teleophthalmology is the provision of ophthalmic care using digital medical equipment and telecommunications technology. While teleophthalmology has been practiced since the 1990s, it became a crucial medical service during the COVID-19 pandemic when doctors were required to make diagnoses from a distance. This was certainly the case in Saudi Arabia, a relatively large country with limited medical workforce to meet demands, yet a high prevalence of diseases such as diabetes, glaucoma, and cataracts which are considered leading causes of visual impairment. In response to the pandemic, Saudi Arabia's Ministry of Health issued scientific instruction manuals and guidelines for health-care providers which paved the way for increased use of digital technologies and solutions to mitigate the health and economic impacts of COVID-19. The pandemic served to accelerate the use of virtual ophthalmology in Saudi Arabia with the most common teleophthalmology applications being teleconsultation and disease-specific applications such as diabetic retinopathy and retinopathy of prematurity. Although some challenges relating to implementing teleophthalmology in Saudi Arabia remain, it is felt that there are great opportunities to expand the use of telemedicine in ophthalmology in this country.
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Yuen J, Pike S, Khachikyan S, Nallasamy S. Telehealth in Ophthalmology. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-telehealth-ophthalmology] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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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 PMCID: PMC8501148 DOI: 10.1016/j.ogla.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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 calculated to describe recurrent IOP spiking. RESULTS A total of 107 eyes from 61 patients were analyzed. Mean age was 63.2 years (standard deviation [SD], 14.0 years) and 59.0% were women. Mean clinic and home IOPs were 14.5 mmHg (SD, 4.7 mmHg) and 13.6 mmHg (SD, 5.1 mmHg). Home tonometry identified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than clinic tonometry (P < 0.001). Maximum daily IOP occurred outside of clinic hours (8 am-5 pm) on 50% of days assessed and occurred between 4:30 am and 8 am on 24% of days. Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mmHg, 5 mmHg, or 10 mmHg in 31%, 15%, and 6% of patients, respectively. Patient characteristics that predicted significant deviations between MDM and mean clinic IOP or target IOP in multivariate models included younger age, male gender, and absence of prior filtering surgery. CONCLUSIONS Self-tonometry provides IOP data that supplements in-clinic tonometry and would not be detectable over daytime in-clinic diurnal curves. A subset of patients in whom home tonometry was ordered by their glaucoma clinician because of suspicion of occult IOP elevation demonstrated reproducible IOP elevation outside of the clinic setting. Such patients tended to be younger and male and not to have undergone previous filtering surgery.
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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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Realini T, McMillan B, Gross RL, Devience E, Balasubramani GK. Assessing the Reliability of Intraocular Pressure Measurements Using Rebound Tonometry. J Glaucoma 2021; 30:629-633. [PMID: 34049350 DOI: 10.1097/ijg.0000000000001892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
PRECIS In a trio of prospective studies, the iCare rebound tonometer demonstrated significantly lower test-retest variability than Goldmann tonometry with good interoperator and interdevice reproducibility, supporting its value in monitoring intraocular pressure (IOP) changes over time. PURPOSE The purpose of this study was to characterize intraoperator and interoperator and interdevice reliability of IOP measurements with rebound tonometry (RT, ic100). METHODS Three prospective cross-sectional studies were conducted in distinct sample of adult patients with established glaucoma, suspected glaucoma, or no glaucoma at the West Virginia University Eye Institute. Participants in study 1 underwent 5 RT measurements in one randomly selected eye and 5 Goldmann tonometry measurements in the fellow eye by 1 operator; intraoperator variability was compared using the F test. In study 2, 3 operators each obtained 3 RT measurements in participants in randomized operator order. In study 3, a single operator collected 3 measurements each with 3 RTs in randomized device order. Between-operator and between-device reproducibility were characterized using intraclass correlation coefficients (ICCs). RESULTS Overall, 28, 19, and 25 subjects participated in the 3 respective studies. Within-subject variance across subjects was 0.757 in RT measurements and 2.471 in Goldmann measurements (P=0.0035). Interoperator reproducibility of RT measurements was good in both eyes [ICC for right eyes 0.78, 95% confidence interval (CI): 0.60-0.85; ICC for left eyes 0.75, 95% CI: 0.50-0.83]. Interdevice reproducibility of RT measurements was good approaching excellent (ICC for right eyes 0.87, 95% CI: 0.83-0.90; ICC for left eyes 0.89, 95% CI: 0.86-0.91). CONCLUSIONS The RT's lower measurement variability and good interoperator and interdevice reproducibility suggest that it can characterize IOP changes over time more robustly than Goldmann tonometry, aiding clinicians in assessing the effectiveness of glaucoma therapy and the consistency of IOP control.
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Affiliation(s)
- Tony Realini
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Brian McMillan
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | | | - Eva Devience
- Mid-Atlantic Permanente Medical Group, Baltimore, MD
| | - Goundappa K Balasubramani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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7
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Landers J. Selective laser trabeculoplasty: A review. Clin Exp Ophthalmol 2021; 49:1102-1110. [PMID: 34331388 DOI: 10.1111/ceo.13979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
Glaucoma is the second most prevalent cause of blindness worldwide, and the only effective management is the lowering of intraocular pressure (IOP). Selective laser trabeculoplasty (SLT) has become an essential part of glaucoma management since its commercial release in 2001. It has been an improvement from the previous argon laser trabeculoplasty (ALT), by using 1% of the laser energy, reducing the amount of anterior segment inflammation and minimising the degree of mechanical injury to the trabecular meshwork. There is now a large volume of work that demonstrates SLT is equally effective as ALT and topical medication in lowering IOP. It is simple to perform, with a well described side-effect profile, and is long-lasting and repeatable. This review will summarise the current literature on SLT for each of these topics.
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Affiliation(s)
- John Landers
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
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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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Abstract
Technological advances provide a number of options for glaucoma monitoring outside the office setting, including home-based tonometry and perimetry. This has the potential to revolutionize management of this chronic disease, improve access to care, and enhance patient engagement. Here, we provide an overview of existing technologies for home-based glaucoma monitoring. We also discuss areas for future research and the potential applications of these technologies to telemedicine, which has been brought to the forefront during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Inas F Aboobakar
- Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - David S Friedman
- Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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10
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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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Abstract
PURPOSE OF REVIEW For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for such popularity is that selective laser trabeculoplasty (SLT) is a therapy independent of patient adherence, which is typically low among glaucoma patients. Consequently, the number of studies on SLT has multiplied throughout the past years. This review provides an overview of studies on SLT from the last 12 months. RECENT FINDINGS The studies on treatment outcome show a wide range of success rates of SLT reaching between 18 and 88%; however, study designs differ and many studies are not directly comparable. The prospective laser trabeculoplasty for open-angle glaucoma and ocular hypertension (LiGHT) trial has demonstrated good efficacy of SLT - 75% of the eyes achieved their target pressure without drops and 58% after a single SLT. SUMMARY SLT has proven to be effective in lowering IOP with satisfactory success rates even after single SLT. SLT is repeatable independent of patient's adherence.
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12
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Mack HG, Fraser-Bell S. "COVID new normal" in ophthalmology: Implications for ophthalmologists, eye care, ophthalmic education and research. Clin Exp Ophthalmol 2021; 49:9-11. [PMID: 33462979 PMCID: PMC8013672 DOI: 10.1111/ceo.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Heather G Mack
- Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Samantha Fraser-Bell
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia.,Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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13
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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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14
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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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