12/17/2023 0 Comments Icare home tonometerTonometers that can accurately measure IOP at home without topical anesthetic are not common. Neither person would know anything had happened until the anesthetic wore off. Any physician will be reluctant to let a patient use an anesthetic at home, because if the eye is anesthetized for a home-based reading, there’s a risk that the person taking the pressure will injure the cornea. Most tonometers aren’t suited to home tonometry because they require anesthetizing the cornea. The first obstacle has only recently been overcome: Having available technology that can safely be used by patients at home. 20111)ĭespite the promise of home IOP monitoring, a number of obstacles have caused this idea to get off to a slow start. IOPs tended to be higher in the mornings and lower in the evenings for both normal and glaucoma patients. It’s helpful to measure a diurnal pressure curve over the course of a day in the clinic (if the patient can manage this), but some studies have shown that in adults the diurnal fluctuation may not be exactly the same from one day to the next. A single in-office diurnal curve measurement may not tell the whole story.For a patient measuring IOP at home, some office visits purely for IOP checks might actually be unnecessary. Patients who need to have their pressure checked sometimes can’t come to the office when, or as often, as we’d like. Fewer concerns about patients missing office visits.If IOP is being monitored at home during such high-risk times in vulnerable patients, we’ll know when there’s an abrupt pressure change that needs to be addressed. In the adult world, some MIGS procedures are also associated with pressure spikes. In the latter situation, the pressure may be very high until the stitch dissolves then it may drop very low. In the pediatric world, situations prone to such fluctuations might include doing angle surgery and having a little blood in the eye putting the child on steroids or putting in a Baerveldt drainage device where we purposely tie the tube off, knowing that it’s going to open when the stitch dissolves. Sometimes the treatments we pro-vide-including surgery-cause dramatic IOP fluctuations. Some fluctuations caused by surgery can be dangerous when they’re not carefully monitored. Measuring IOP over a larger range of time offers the possibility of catching those fluctuations. (This stands in contrast to patients whose IOPs are at target and stable.) We also know that pressure fluctuations can happen outside of office hours. It’s been shown that pressure fluctuations-even those measured during periodic office visits-are associated with progression in adult open-angle glaucoma. So it shouldn’t be a surprise-and it has been my experience-that multiple measurements taken outside of the office frequently reveal much higher pressures than we measured in the office. The variability of IOP over time sometimes surprises us occasionally, the pressure we measure in the office is very different from the previous visit.
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