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Editors Selection IGR 16-4

Clinical Examination Methods: IOP: Self-tonometry

Comment by Kaweh Mansouri on:

74284 Measurement of Intraocular Pressure by Patients With Glaucoma, Pronin S; Brown L; Megaw R et al., JAMA ophthalmology, 2017; 135: 1-7

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Glaucoma specialists are in the constant pursuit of more IOP data for improved patient management. This study investigated the ability of patients to perform self-tonometry using the rebound tonometer (iCare HOME) in a consecutive cohort of 100 glaucoma patients with a mean age of 67.5 years.

Patient-obtained IOP measurements were reproducible and similar to physician-obtained ones

The authors found that patient-obtained IOP measurements were reproducible and similar to physician-obtained ones with an intraclass coefficient of 0.9. However, despite training by the study staff, not all patients were able to obtain accurate measurements: 27% of patients had values that deviated by more than 5 mmHg from the investigators' measurements and were therefore not included in the analysis. Patients were also given a short questionnaire about their acceptability of self-tonometry. Overall, 71% of patients believed the device was easy to use with 92% stating good comfort. Importantly, a similar proportion were willing to use the device again in future. In contrast, only 56% of measurements were within 5 mmHg of Goldmann applanation tonometry, a lower number than found in previous studies.

This study shows that a majority of patients were able and happy to use self-tonometry. It took an average of 20 minutes to teach patients to use the device. Given the potantial benefits of home-tonometry, this may be time well spent. This study was conducted at the investigators' office and did not evaluate actual home tonometry. Longitudinal data are necessary to study the continued interest and ability of patients to obtain home measurements over the long term and how the data would influence adherence with medications and other glaucoma outcomes. In the meantime, physicians are encouraged to make use of this technology and health systems to provide funding for it.

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