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Editors Selection IGR 11-1

Intraocular Pressure: iCare rebound tonometer

Comment by James Brandt on:

46454 Home tonometry for management of pediatric glaucoma, Flemmons MS; Hsiao Y-C; Dzau J et al., American Journal of Ophthalmology, 2011; 152: 470-478

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Glaucoma is notable among chronic diseases in that the major risk factor and treatment target (IOP) is measured only rarely over a patient's clinical course. In adults it is usually feasible to monitor the optic nerve and visual field in addition to IOP to track the disease. In children, visual fields and optic nerve imaging are rarely possible, and tonometry is challenging in the best of circumstances. Among children, tonometry is further confounded by anesthesia, crying and any number of other issues that limit the usefulness of the IOP measurements. Any technology that facilitates the acquisition of more IOP data in children, especially outside the operating room or office, will be a great help in caring for children with glaucoma. Flemmons et al. (1271) report on a pilot study using the iCare rebound tonometer in the home setting, with the parents of children with glaucoma trained to use the device. They report that the device was reliable and easily performed by caregivers. Furthermore, the device was well-tolerated and provided clinically useful IOP information.

Any technology that facilitates the acquisition of more IOP data in children, especially outside the operating room or office, will be a great help in caring for children with glaucoma

This is a small but helpful pilot project demonstrating the utility of rebound tonometry in a home setting. The company that manufactures the device (Icare Finland OY, Helsinki, Finland) has in development a home monitoring device that will record time-stamped IOP measure- ments for later analysis. That device should prove very helpful among both pediatric and adult patients in acquiring a clearer picture of diurnal fluctuations in IOP outside of office hours.

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