Abstract
Purpose: To assess the effect of iCare HOME tonometry on the clinical management of glaucoma patients progressing with low in-office intraocular pressures (IOP).
Methods: Patients who were found to have progressive glaucoma by their glaucoma specialist were asked to record IOP at least four times daily using iCare HOME. Upon review of home tonometry readings, a decision was made on whether to advance therapy. IOP elevation was defined as a greater than 30% or 5mmHg increase of IOP from baseline. Primary outcome measures were therapy advancement and IOP profile.
Results: Eighty eyes of 41 patients with were enrolled during office visits. The average age of the patients was 60.6±14.2, and most of the cases were female (56.8%). most cases had moderate glaucoma (47.5%).Fifty eyes (62.5%) had changes in glaucoma management after a review of iCare HOME readings. Of these, 36(72%) changed medical therapy, 6(12%) underwent selective laser trabeculoplasty, and 8(16%) underwent surgery. Among all measurements, 724 elevations were detected in 55 eyes of 37 patients. The average elevation from baseline IOP was 8.17±4.47 mmHg, most of which occurred in the morning around 6AM and in the afternoon around 1PM. Only maximum home IOP was a significant predictor of therapy advancement (coefficient= 0.071, p=0.038). There was no significant association between the IOP profile before the home self-tonometry, visual field fast progression, number of IOP elevations, and therapy advancement between the two groups.
Conclusions: Home tonometry revealed significant IOP elevations beyond office IOP, and maximum home IOP was associated with therapy advancement.