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Mona S Awadalla, Thi Thi Nguyen, Shahriar Amjadi, John Landers, Jamie E. Craig; The value of Icare HOME tonometry in detecting diurnal variation in IOP and its association with glaucoma progression. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2700. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the value of the clinical results of Icare HOME tonometry, and to elucidate possible roles in modifying glaucoma management plans.
Glaucoma participants were invited to perform home tonometry from a prospective study of glaucoma progression (PROGRESSA). Glaucoma progression was detected using optical coherence tomography of the retinal nerve fibre layer (RNFL). Patients were selected for IOP self-measurement, and were instructed on the use of the Icare HOME tonometer. Patients were asked to measure their eye pressure four times per day for 2 to 4 consecutive days including early morning and late evening timepoints.
202 patients were invited to the study. 20 patients declined to participate for logistic reasons. 182 (90.1%) were recruited and provided with education in the use of the Icare tonometer, of which 29 (15.9%) did not complete the measurements. 153 (84.1%) patients successfully completed the required measurements. 12 (7.8%) out of 153 patients had elevated IOP outside office hours not previously recorded before in the clinical setting (mean spike IOP of 35.6 ± 8.2 mmHg), which is higher than the mean IOP for these patients recorded in the clinic (21.4 ± 5.0 mmHg, p-value 0.0001). These twelve participants showed significant progression on retinal nerve fibre layer (mean RNFL GPA -3.9 ± 2.9 µm/year). The mean RNFL GPA of patients with no recorded elevated IOP was significantly lower -1.5 ± 1.8 µm/year (p-value of 0.0001). Examples of these patients will be presented to elucidate the role of Icare HOME tonometry in modifying their treatment plan.
Icare® HOME tonometry was feasible for most of our participants with suitable single session training (average 15 to 20 min). The unit documented higher IOP spikes in certain patients than those recorded within office hours. These results showed a possible link between elevated IOP outside office hours and rapid RNFL progression. It also provides early evidence of the importance of monitoring diurnal IOP in tailoring management to the individual.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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