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Editors Selection IGR 8-4

Clinical Examination Methods: Self-tonometry and self-perimetry may comlement glaucoma monitoring in some patients

Comment by David Friedman on:

Berneshawi and colleagues evaluated home monitoring of glaucoma using the Icare Home tonometer and virtual reality perimetry (VRP) using the Olleyes device. Fifteen patients (28 eyes) were enrolled; however, only nine patients (16 eyes) completed the study. Six participants were unable to use the Icare device. In-office intraocular pressures (IOPs) ranged from 9 to 42 mmHg, and the mean deviation (MD) on Humphrey visual field (HVF) testing averaged -10 dB (range: -2 to -28 dB). Patients were instructed to perform VRP daily and Icare measurements four times per day over three consecutive days. Home IOP measurements correlated with in-office Goldmann IOPs, and the averaged VRP MD showed concordance with HVF MD.

This small study primarily confirms that VRP-derived MD correlates with HVF MD. Sectoral analysis revealed no correlation between VRP and HVF in the superonasal field, and only a weak correlation in the superotemporal field.

Sectoral analysis revealed no correlation between VRP and HVF in the superonasal field, and only a weak correlation in the superotemporal field

A larger sample is needed to determine whether these discrepancies reflect device limitations or variability due to the small and heterogeneous study population.

Importantly, not all patients were able to use the Icare tonometer, which in this study was an older-generation model. Despite training, several patients either failed to generate reliable values or could not operate the device. This limitation has been noted previously. A next-generation home tonometer requiring less user manipulation would be a welcome development for home monitoring. In sum, the authors show that select patients can measure IOP and perform perimetry at home. However, substantial work remains before this approach can be broadly integrated into clinical practice.

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