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Editors Selection IGR 25-2

Clinical Examination Methods: 24/7 IOP monitoring: suprachoroidal sensor proves safe long-term

Comment by Maria Chiara Rivolta & Alessandro Rabiolo on:

126464 Long-term Safety and Performance of a Suprachoroidal Pressure Sensor System: Results of the EYEMATE-SC Trial Follow-up Study, Micheletti E; Micheletti E; Mansouri K; Dick HB et al., Ophthalmology, 2025; 132: 775-784

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Intraocular pressure (IOP) remains the only established modifiable risk factor for glaucoma progression.¹ Conventional office-based tonometry provides only intermittent measurements and may fail to capture peaks outside office hours. In this context, Micheletti and colleagues present the 3-year follow-up of the multicenter EYEMATE-SC trial, assessing the safety and performance of a suprachoroidal telemetric sensor.

In this study, twenty-two patients underwent nonpenetrating glaucoma surgery (NPGS) with concurrent EYEMATE-SC implantation across five centers. Agreement between EYEMATE-SC and Goldmann applanation tonometry (GAT) remained within regulatory standards, with more than 85% of paired measurements differing by less than 5 mmHg. However, the 95% limits of agreement were relatively wide (−6.2 to +5.7 mmHg), indicating substantial variability between the two methods. Such wide limits mean that individual readings from the EYEMATE-SC could deviate from GAT by up to 6 mmHg in either direction.

Overall, these results confirm the technical feasibility of long-term continuous IOP monitoring. However, its clinical relevance remains uncertain, as the role of IOP fluctuation in glaucoma progression is still debated, and recent evidence does not consistently support diurnal or long-term IOP variability as independent predictors of disease progression.² Most available studies have relied on office-based tonometry, providing only sporadic IOP snapshots a few times per day, which may not accurately reflect the full dynamics of IOP. It remains unclear whether the finer-grained data provided by continuous monitoring would show any clinical value beyond conventional measurements.

From a clinical standpoint, the utility of the EYEMATE-SC for continuous IOP monitoring may be inherently limited by the context in which it is implanted. Because it is placed during glaucoma surgery such as deep sclerectomy, where IOP fluctuations are largely blunted by the surgical intervention itself,³ the clinical need to monitor IOP variability in this population is reduced. In contrast, continuous IOP monitoring may be more informative in medically treated patients undergoing routine procedures such as cataract surgery, as performed with the EYEMATE-IO, which however had worse agreement with GAT.⁴ Although the EYEMATE-SC could theoretically be implanted as a stand-alone procedure, its invasiveness and associated ethical and cost-effectiveness concerns make this approach impractical. Even for those who consider the assessment of IOP fluctuations clinically meaningful, the postoperative setting after glaucoma surgery may not be the most appropriate scenario in which to capture such variability.

Future investigations should move beyond technical validation to evaluate whether continuous telemetric monitoring translates into better patient management. At present, the EYEMATE-SC may hold greater promise in research by providing a better understanding of pressure dynamics than in routine clinical care, where functional outcomes remain the true benchmark.

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