OUR STUDYĪ recent study by our group at the University of Colorado validated the utility of the iCare Home for capturing treatment response. 4 Responses such as these may be missed if providers simply compare single in-office readings taken before and after treatment. Using home tonometry, Tong et al found that glaucoma patients who began therapy with IOP-lowering drops demonstrated different responses to treatment, including a reduction in mean IOP, reduction in peak IOP, and reduction in IOP fluctuation. This approach to evaluating treatment response can also fail to detect reductions in peak IOP and IOP fluctuations. If clinic visits before and after treatment fall at different points on this curve, a significant treatment response may be masked, or a poor response may be falsely inflated. Most people, however, have a diurnal rhythm to their IOP. 3Īnother issue is that providers typically judge treatment response based on a single IOP reading taken after several weeks of therapy and that they often compare this reading to a single pretreatment measurement. 2 Home tonometry can also detect fluctuations in IOP, which have been implicated as an independent risk factor for disease progression. 1 In a study of 18 patients with normal-tension glaucoma who experienced disease progression although their IOP appeared to be well controlled, six of the nine patients who required treatment adjustments had IOP spikes that were detected only by nocturnal measurements with home tonometry. This is especially worrisome because 24-hour IOP monitoring has shown that peak IOP often occurs outside of typical office hours. Given that much clinical decision-making in glaucoma is based on IOP, it seems surprising that, on average, providers rely on a handful of in-office IOP measurements obtained over the course of a year to determine IOP control. Currently, the iCare Home and recently cleared iCare Home2 (both from Icare USA) are the only devices available for this purpose. Home tonometry may be one way to address the challenge. Is this individual not responding to therapy, or did the single IOP measurement obtained in the clinic fail to capture the effect of treatment? These situations suggest a potential avenue for progress in the management of glaucoma: improved IOP monitoring. Is the IOP truly well controlled, or are spikes occurring outside of clinic hours? Another example is a patient who returns 6 weeks after starting a new drug with no change in IOP found. One example is a patient with seemingly well-controlled IOP whose structural and/or functional tests demonstrate disease progression. Glaucoma care can include many frustrating clinical scenarios.
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