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. 2017 Oct 1;135(10):1030-1036.
doi: 10.1001/jamaophthalmol.2017.3151.

Measurement of Intraocular Pressure by Patients With Glaucoma

Savva Pronin  1 , Lyndsay Brown  1 , Roly Megaw  1 , Andrew J Tatham  1
Affiliations

Measurement of Intraocular Pressure by Patients With Glaucoma

Savva Pronin et al. JAMA Ophthalmol. .

Abstract

Importance: The ability of patients to measure their own intraocular pressure (IOP) would allow more frequent measurements and better appreciation of peak IOP and IOP fluctuation.

Objective: To examine whether patients with glaucoma can perform self-tonometry using a rebound tonometer and examine patient acceptability.

Design, setting, and participants: An observational study in which IOP was assessed using Goldmann applanation tonometry and a rebound tonometer. Consecutive patients were provided with a patient information sheet and those consenting to take part in the study received standardized self-tonometry training and were then instructed to measure their own IOP under observation. This study was conducted at a glaucoma clinic at a university hospital from March 1, 2016, to December 30, 2016, and included both eyes of 100 patients with glaucoma or ocular hypertension.

Main outcomes and measures: The percentage of patients who could successfully perform self-tonometry. Complete success was defined by a good technique and an IOP reading within 5 mm Hg of that obtained by a clinician using the same device. A 3-item questionnaire was used to examine perceptions of self-tonometry among patients.

Results: Among the 100 patients, the mean (SD) age was 67.5 (10.9) years (53% female). A total 73 of 100 patients (73%) met the complete success criteria. An additional 6 patients could use the device but had IOP readings greater than 5 mm Hg different from those obtained by the clinician. On average, IOP by the rebound tonometer was 2.66 mm Hg lower than Goldmann applanation tonometry (95% limits of agreement, -3.48 to 8.80 mm Hg). The IOPs with the rebound tonometer were similar whether obtained by self-tonometry or investigator, with excellent reproducibility with an intraclass correlation coefficient of 0.903 (95% CI, 0.867-0.928). A total of 56 of 79 successful or partially successful patients (71%) felt self-tonometry was easy, with 73 of 79 (92%) reporting self-tonometry to be comfortable, and a similar number happy to perform self-tonometry in the future.

Conclusions and relevance: Most patients could perform self-tonometry and the method was acceptable to patients. Self-tonometry has the potential to improve patient engagement, while also providing a more complete picture of IOP changes over time.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Brown undertook this research as part of the third year of the MSc in primary care ophthalmology, University of Edinburgh’s Edinburgh Surgical Sciences Qualification. In the last 3 years, Dr Tatham has received travel grants from Thea and speaker fees from Allergan and Alcon. No other disclosures were reported.

Figures

Figure.
Figure.. Participant and Investigator Icare HOME Readings and Goldmann Applanation Tonometry (GAT)
A, Scatterplot of Icare HOME readings obtained by self-tonometry (successful and partially successful participants) and by the investigators. B, Scatterplot of Icare HOME readings obtained by self-tonometry vs GAT readings. The solid lines represent the reference line of perfect agreement and the dashed lines, 5 mm Hg limits of agreement. IOP indicates intraocular pressure.
See this image and copyright information in PMC

Comment in

  • Home Tonometry-Can We? Should We?
    Muir KW. Muir KW. JAMA Ophthalmol. 2017 Oct 1;135(10):1036. doi: 10.1001/jamaophthalmol.2017.3194. JAMA Ophthalmol. 2017. PMID: 28859198 No abstract available.

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