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Home tonometry finds two daily IOP fluctuations
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Self-tonometry may contribute to better management of glaucoma patients and suspects through robust measures of diurnal IOP and detecting changes to IOP in response to treatment, according to researchers.
Researchers aimed to investigate the utility of rebound self-tonometry over several weeks in detecting diurnal IOP fluctuations in patients with newly diagnosed glaucoma and also untreated glaucoma suspects, according to the study.
Forty patients were recruited and trained with the iCare Home tonometer and directed to measure IOP while seated, four times a day, over 4 to 6 weeks.
Researchers found two dominant fluctuations: peak IOP upon awakening and at midday. Further, diurnal IOP measured in the first 7 days correlated to the diurnal IOP across the entire study period.
Of the 40 patients enrolled, 27 patients completed the trial, and nine of those were newly diagnosed and 18 were suspects.
Within 24 hours of beginning treatment with latanoprost 0.0005% ophthalmic solution, IOP reduced from 23.9 mm Hg to 16.1 mm Hg.
Mean IOP was 14.3 mm Hg for treated patients with glaucoma and 14.7 mm Hg for suspects, which researchers wrote was not significantly different. Mean central corneal thickness was also not significantly different, at 547 m for patients with glaucoma and 561 m for suspects.
“Examining intraocular pressure over several weeks allowed us to observe individual intraocular pressure diurnal patterns and more importantly establish that four measurements per day over 7 days can provide a robust estimation of these intraocular pressure patterns that would otherwise require several weeks of monitoring,” according to researchers. – by Abigail Sutton
In a patient satisfaction survey, they rated the instrument as easy to use, although difficulties with correct alignment were stated.
Disclosures: None of the authors reported any relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
During a recent glaucoma continuing education program, a participant asked why I started a normal-tension glaucoma patient on Alphagan (brimonidine tartrate solution, Allergan) rather than Xalatan (latanoprost, Pfizer) in 1998. Answer? At the time, research suggested that brimonidine might be neuroprotective.
Unfortunately, 20 years on we are still searching for a neuroprotective agent while diligently lowering IOP. It seems so old-fashioned, but it’s all we have. How will the Icare Home fit into our current care regimen?
Huang and colleagues suggest that this instrument is “a valuable tool for establishing diurnal IOP variations.” However, for new patients this is easily and more accurately done over several visits while collecting other pre-treatment data. For existing patients, IOP goals are empirically determined for each individual over time. Will this instrument find its way into my clinic? I doubt it. There may be a few patients where it could be helpful, but it’s hard to imagine it being worthwhile for most. It’s all I can do to encourage daily use of a single drop. Having patients test their own eye pressure at home might be difficult, and I’m not sure I trust most patients to do this accurately. In the meantime, where is that neuroprotective agent we’ve been waiting for?
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