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Nicholas O'Connor, Lauren E Hock, Aakriti Garg Garg Shukla, Natasha N Kolomeyer, Reza Razeghinejad, L. Jay Katz, Jonathan S Myers, Daniel Lee; Changes in Glaucoma Management Following Diurnal Home Tonometry. Invest. Ophthalmol. Vis. Sci. 2022;63(7):159 – A0352.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the effect of iCare HOME tonometry on clinical management of glaucoma patients who were progressing with low in-office intraocular pressures (IOP).
72 eyes of 36 patients with primary open-angle glaucoma (n=36 eyes), low-tension glaucoma (n=20), pigmentary glaucoma (n=6), pseudoexfoliation glaucoma (n=2), chronic angle-closure glaucoma (n=2), open-angle glaucomasuspects (n=2), and steroid response (n=2) were enrolled during office visits. Patients were asked to record IOP four times daily (around 8 am, 12 pm, 4 pm, and 8 pm) for 1 week using iCare HOME. Upon review of home tonometry readings, a decision was made whether to advance therapy. Home tonometry IOP mean, maximum, minimum, range, standard deviation, and coefficient of variation, as well as Goldman applanation tonometry (GAT) immediately prior to the home trial were compared retrospectively between patients who underwent changes in glaucoma therapy versus those whose management did not change.
42 eyes (58.3%) of 21 patients had changes in glaucoma management after review of iCare HOME readings. Of these, 30 (71.4%) changed medical therapy, 6 (14.3%) received selective laser trabeculoplasty, and 6 (14.3%) underwent surgery (Table 1). Patients for whom treatment was advanced demonstrated significantly greater maximum IOP (26.6 ± 10.5 mmHg vs 21.2 ± 7.3 mmHg, p = 0.01 and IOP range (17.6 ± 10.5 vs 12 ± 6.8, p = 0.01) than patients whose management was unchanged (Table 2). Mean IOP (15.3 ± 6.3 mmHg vs 14.1 ± 4.3 mmHg, p = 0.4) and GAT prior to the home trial (13.3 ± 4.2 mmHg vs 14 ± 3.3 mmHg, p = 0.4) were similar between the two groups.
The iCare HOME is a valuable tool for glaucoma specialists in determining whether to advance therapy among glaucoma patients who may be progressing despite meeting in-office IOP targets. Alternative iCare HOME testing may have value in assessing whether patients require additional treatment.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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