Decision-Making Usefulness to Treat Glaucoma with a Combination of Water-Drinking Test and 24-Hour IOP curve with Icare Home.

Abstract

Purpose : The main risk factor for the development and progression of glaucoma is elevated intraocular pressure (IOP); thus, the mainstay of glaucoma treatment is to reduce IOP to a safe level. Measurement of IOP is crucial to the diagnosis and management of glaucoma. Alternative methods to measure IOP, as with the water-drinking test (WDT) and a 24-h profile of IOP (24HP), have been reported as useful ways to determine pressure control. The purpose of this study was to determine if a combination of a WDT and a 24HP of IOP with the device Icare Home, is a useful approach to make clinical decisions in regards of glaucoma management.

Methods : A retrospective study of 20 consecutive glaucoma patients who underwent an expanded profile of IOP (EPIOP) consisting of a combination of traditional WDT and a 24HP of IOP with Icare Home. IOP results for each test per eye were analyzed. Central corneal thickness, clinical examination data, including prior applanation IOP, were also assessed. The clinical impact for each test interpretation was determined.

Results : Patients had a mean age of 53.6 ± 14.3 years. A larger proportion of female patients (75%), with a primary open-angle glaucoma diagnosis (65%), and usage of antiglaucoma medication (55%) were observed. Mean previous highest IOP values were 14.4 ± 3.63 mm Hg (RE) and 14.1 ± 3.7 mm Hg (LE). Mean CCT values were 541.9 ± 35.9 microns (RE) and 540.7 ± 36.8 (LE). WDT abnormality was found in 60% of the RE and 65% of the LE. Mean IOP fluctuation was significantly different in both eyes (10.50 ± 4.55 mm Hg, RE; 11.05 ± 4.81mm Hg; P = 0.0001). Clinically significant results with the 24HP with Icare Home was obtained in 80% of both eyes. Integrated information with results derived from both tests supported the decision of starting antiglaucoma medications in 12 eyes, adding medications in 6 eyes, indicating SLT in 4 eyes, performing peripheral iridotomy in 2 eyes, and re-treating 1 eye with SLT.

Conclusions : An EPIOP (combined approach of WDT and a 24HP of IOP with the Icare Home device) seems to be a useful, although time-consuming, way to support the clinicians decision-making process in the management of glaucoma.

This is a 2021 ARVO Annual Meeting abstract.