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HomemiequipmentSelf-tonometry: Enhancing Outcomes

Self-tonometry: Enhancing Outcomes

Innovative glaucoma management solutions are being driven by the desire to improve outcomes with increasingly personalised glaucoma treatment regimens, along with virtual clinical care.

The iCare Home self-tonometer is one such solution that has gained wide-spread clinical recognition for its ability to offer both.

Diurnal variation in intraocular pressure (IOP) is well understood, yet glaucoma management is often based on single IOP measurements, taken in the clinic. With this in mind, iCare developed iCare Home, a self-tonometer that enables patients to measure their own IOP at home, both day and night, gaining real-world diurnal data.

The concept behind self-tonometry is that at-home measurements may help reveal IOP peaks that would not have been recognised, had measurements only been taken during office hours, at the clinic. Using this comprehensive, reliable information, clinicians may be able to finesse treatment decisions that further improve outcomes.

Importantly, the iCare Home tonometer is based on the widely patented iCare rebound tonometry principle. A tiny disposable probe is briefly bounced off the surface of the eye six times during an iCare measurement. The rebound measurement is barely noticed by the patient. As is the case for all iCare tonometers, measuring requires no anaesthesia, drops, air or other preparation.

iCare Home has been successfully used in Australian clinical research and treatment since 2014. Centre for Eye Health (CFEH) in Sydney and Flinders University in Adelaide have both integrated iCare Home into their glaucoma treatment protocols.

CFEH’s Dr Zangerl et al. found that the iCare Home was a valuable clinical tool for establishing diurnal IOP variations.According to their study, iCare Home can support the diagnosis and management of patients at risk of glaucoma by determining peak IOP and the extent and patterns of fluctuations, following seven days of patient self-monitoring.

USEFUL IN MULTIPLE ENVIRONMENTS

The iCare Home offers great potential for multiple clinical environments. For example, iCare Home can help compare the effects of various medications on IOP to find the optimum regime and instillation schedule for a specific patient. The IOP data can also reveal a need for surgery sooner. Post-surgery IOP monitoring can begin without delay, thanks to iCare’s gentle rebound tonometry technique.

In a recent article published by Sayoko E. Moroi, MD, PhD et al. iCare Home was used with two patients to assess the treatment efficacy of different medications.3 Both patients monitored their IOP at home for a one-week period, first with one set of medications and then another. The real-world data provided information about the IOP peaks that occurred outside of clinical hours.

The exfoliative glaucoma patient had IOP peaks of up to 28mmHg in the right eye and 43mmHg in the left eye, outside of clinical hours, with the first set of medication. After changing to the second set of medication, peak IOPs lowered to 19mmHg in the right eye and 17mmHg in the left eye.

The authors of the article concluded that the iCare Home tonometer can be used to evaluate IOP modulation under treatment and for changing treatment for patients with glaucoma.

Dr Jamie Craig’s research team from Flinders University, Adelaide, concluded in their study that iCare Home tonometry is clinically useful in following up on patients post- selective laser trabeculoplasty (SLT) and in monitoring the effectiveness of SLT on lowering IOP within hours of the procedure.3

iCare Home may also be the preferred method for facilitating safe IOP monitoring in elderly SLT patients or those residing in remote and rural areas, since it can assess the effect of SLT on lowering IOP without the need to attend a clinic.

TRANSFORMING TRADITION

In a recently published article, Dr Ike Ahmed et al. concluded that the iCare Home has demonstrated an excellent potential to transform the traditional approach to glaucoma diagnosis and management.4 According to their experience, iCare Home has been instrumental in patients who present with reasonable in-clinic IOP, but with uncertainty about whether their disease is controlled. It also assisted with pigment dispersion glaucoma patients, suspects of angle-closure glaucoma, and normal-tension glaucoma patients.

The authors suggested that iCare Home is an invaluable resource in these pandemic times, enabling clinicians to follow up on their glaucoma patients without the need to see them physically, in clinic. Additionally, the ability to deliver virtual clinical care is valuable in rural and remote settings, where patients may have difficulty accessing clinics.

ICARE HOME2: GREATER EASE AND SUPINE MEASUREMENT

The iCare Home2 introduces the next generation of iCare’s rebound selftonometer. Much emphasis has been put on ease of use in the development of this model, so that most patients can learn to use the device by themselves, just by watching a training video. This, in turn, means that busy eye care practitioners need to spend less time training patients.

The new Home2 also enables the measurement of IOP in the supine position, which is a significant improvement. Studies indicate that the IOP of glaucoma patients tends to be higher in the supine position.5,6 Night-time and early morning measurements, therefore, help obtain a full picture of IOP fluctuations.

The attending clinician can easily access the patient’s IOP data by using the secure cloud-based iCare Clinic software solution. Patients can follow the development of their IOP in a mobile application, iCare Patient2, which works on both Android and iOS platforms.

Importantly, this level of engagement in measuring and monitoring IOP at home can bring peace of mind to many glaucoma patients and increase patient compliance in taking topical medication. They can clearly see the effect that medication has on their own IOP measurement results.

Rebecca Huxstep qualified as an orthoptist from La Trobe University in Melbourne in 1999. Currently the Asia Pacific downstream marketing manager with iCare, she has worked in Australia and Asia as a clinical orthoptist and clinical educator. iCare Home is distributed in Australia by Designs for Vision, part of the Paragon Care group. 

References 

  1. Huang J, Katalinic P, Kalloniatis M, Hennessy MP, Zangerl B. Diurnal intraocular pressure fluctuations with selftonometry in glaucoma patients and suspects: a clinical trial. Optometry and Vision Science 2018;95(2):88-95. doi. org/10.1097/opx.0000000000001172 
  2. Awadalla MS, Qassim A, Hassall M, Nguyen TT, Landers J, Craig JE. Using Icare Home tonometry for follow-up of patients with open-angle glaucoma before and after selective laser trabeculoplasty. Clin Exp Ophthalmol. 2020 Apr;48(3):328-333. doi.org/10.1111/ceo.13686 
  3. Rojas CD, Reed DM, Moroi SE. The usefulness of Icare Home in Telemedicine Workflow to Detect Real- World Intraocular Pressure Response to Glaucoma Medication Change. Ophthalmol Glaucoma. 2020 Sep- Oct;3(5):403-405. doi.org/10.1016/j.ogla.2020.04.017 
  4. Liu J, De Francesco T, Schlenker M, Ahmed II. Icare Home Tonometer: A Review of Characteristics and Clinical Utility. Clin Ophthalmol. 2020 Nov 23;14:4031-4045. doi. org/10.2147/OPTH.S284844 
  5. Katsanos A, Dastiridou AI, Quaranta L, Rulli E, Riva I, Dimasi V, Tsironi EE, Weinreb RN. The Effect of Posture on Intraocular Pressure and Systemic Hemodynamic Parameters in Treated and Untreated Patients with Primary Open-Angle Glaucoma. J Ocul Pharmacol Ther. 2017 Oct;33(8):598-603. doi.org/10.1089/jop.2017.0030 
  6. Quaranta L, Katsanos A, Riva I, Dastiridou A, Oddone F, Roberti G, Konstas AG. Twenty-four-hour intraocular pressure and ocular perfusion pressure characteristics in newly diagnosed patients with normal tension glaucoma. Eye (Lond). 2016 Nov;30(11):1481-1489. dx.doi. org/10.1038%2Feye.2016.168

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