Home tonometer proves reliable in most clinical settings
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Key takeaways:
- The iCare Home2 yielded similar results as the Goldmann applanation tonometer.
- Researchers recommend central corneal thickness measurements in patients who use the tool.
The self-measurement iCare Home2 tonometer may be reliable for most eyes and clinical settings, although central corneal thickness measurements are recommended before use, according to research published in the Journal of Glaucoma.
“Reliable IOP measurement is crucial for the management and prognostic implications for glaucoma patients,” Assaf Kratz, MD, from the department of ophthalmology at Soroka University Medical Center in Israel, and colleagues wrote. “Single IOP readings, once over a period of months and during office hours, yield very limited knowledge about a patient’s IOP levels in real-time. Home self-measurement would fill this defect.”
In a retrospective study of 135 eyes from 70 patients, randomly selected participants underwent a routine ocular examination, which included IOP measurements using the Goldmann applanation tonometer (GAT) and iCare Home2.
According to results, the average IOP was 16.3 ± 6.5 mm Hg using the GAT compared with 16.5 ± 7.3 mm Hg using iCare Home2 (P = .47).
The researchers noted a clinically insignificant proportional bias in which the iCare Home2 yielded slightly higher IOP readings for higher IOPs compared with the GAT. They also noted that the iCare Home2 underestimated IOPs with corneas thinner than 522 µm and overestimated IOPs with thicker corneas, prompting researchers to recommend central corneal thickness measurements in individuals who use the tool.
“[The] iCare Home2 measurements in the clinic correlated well with those from GAT,” Kratz and colleagues wrote. “The iCare Home2 underestimated IOPs lower than 15.1 mm Hg and overestimated IOPs above that point, the deviations being generally clinically insignificant.”
Perspective
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Tonometry plays a vital role in glaucoma risk evaluation and subsequent management. Unfortunately, the typical sampling of IOP data, regardless of which tonometer is employed, prior to or after treatment is severely lacking.
In an average year in which we physicians may measure 3 seconds worth of IOP on four different occasions throughout the year, we capture only 12 out of a potential 31,536,000 seconds worth of IOP. Given this current paradigm, we lack perspective on what IOP forces our patients’ respective optic nerves are actually exposed to.
As newer tonometry technologies emerge to help better inform our perspectives, it is important that they be consistent with legacy tonometry to avoid major disconnects that can confound their usefulness. This paper supports iCare Home2 having a strong correlation with GAT, with both devices susceptible to errors induced by central corneal thickness, a flaw of force tonometry that has been known since its development in the 1950s.
This positive correlation with GAT, coupled with the engineering and analytic improvements featured in the updated iCare Home platform, as highlighted in this paper, may compel the eye care community to embrace the need to acquire more IOP data. This shift from our currently underinformed paradigm would better inform our awareness of individual IOP dynamics and potentially our decisions in glaucoma diagnosis and management as a result.
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