#Icare home tonometer how to

When that happens, we need to monitor and change the patientвЂ™s medications. Because the tube typically doesnвЂ™t start working fully until four to six weeks after surgery, itвЂ™s important to know when the pressure drops. Herndon: It's important after tube shunt surgeries to be able to monitor a patientвЂ™s pressures.

#Icare home tonometer how to

Q: How is home tonometry beneficial before or after glaucoma surgery?ДЇreedman: ItвЂ™s invaluable in childhood glaucoma management in a couple of scenarios: 1) when we suspect ongoing optic nerve and vision damage is occurring, but we are just not getting the high IOP readings in the office to justify doing surgery 2) the second and perhaps the most helpful is to help us decide how to manage an eye with glaucoma just after surgery, when the IOP may fluctuate widely and we would like to be able to adapt the medication schedules accordingly without making the patient return over and over to the office at short time intervals. Although the ICare tonometer has been shown to be reliable in several studies (some done here at Duke), many clinicians feel that too much data might actually be detrimental to their management of the glaucoma patient, especially if that patient is also able to track his/her IOP. Many of my patients donвЂ™t see the added value of making an expensive purchase such as a home tonometer when they feel the every three to four months that they go into the office to be checked is adequate. I think that in selected adult patients the same will be true, but there is some groundwork to be done to make it more widely applicable.

I have no question that in selected pediatric patients it makes a huge difference in terms of allowing the physician to tailor and improve clinical management. The reason I think home tonometry has perhaps made more progress in the pediatric glaucoma area is that it's a rarer disease in children than in older adults. Q: Why has home tonometry been slow to be studied for adults?ДЇreedman: The adult glaucoma world hasnвЂ™t jumped on this technology because clinicians would be overwhelmed with data, and thereвЂ™s no good study that correlates home IOP readings with actual glaucoma outcomes. Freedman has already done this to some degree in the pediatric population, but we've been talking about scaling this up to our adult population. WeвЂ™re considering setting up a program where we can rent tonometers to patients. Herndon: The Icare devices have been around for awhile, and several of my adult patients have purchased them.

Being able to evaluate IOPs taken at home over extended hours provided additional data that sometimes changed our decisions about glaucoma medications and management. We found that having families measure a childвЂ™s IOP at home often revealed fluctuations that were not вЂњcaughtвЂќ during office visits. As part of a clinical study, we began loaning Icare tonometry devices (Icare, Helsinki, Finland) to families.

Rebound tonometers donвЂ™t require an anesthetic eye drop, and can be used on babies and young children in the office, so we decided to see whether parents could use a rebound device on their childrenвЂ™s eyes at home. The gold standard has always been the Goldmann applanation tonometer (Haag-Streit UK, Essex, England), but there has long been interest in other ways to check IOP. Q: What has DukeвЂ™s experience been with home tonometry for glaucoma care?ДЇreedman: Most IOP-measuring methods, including non-contact or air puff tonometry, require the cornea to be anesthetized. Herndon Jr.,В MD, and pediatric glaucoma specialist Sharon F.В Freedman, MD, share their experiences and thoughts on home tonometry. In this Q&A, Duke glaucoma specialist Leon W. Because IOP fluctuates significantly, obtaining multiple measurements outside the clinic setting can reduce the number of office visits and facilitate immediate changes in medications for patients when indicated.Д«ut home tonometry devices produce large amounts of data for each patient that can be challenging to collect and analyze for follow-up, and most tonometers arenвЂ™t suited for home use because they require anesthetizing the cornea. Technology has made it possible for patients to self-monitor their intraocular pressure (IOP), but there are challenges to overcome before it becomes widely applicable.