Home iCare – What we already know

The only known modifiable risk factor for the development and progression of glaucoma is an increased intraocular pressure (IOP). Current follow-up with Goldmann applanation tonometry (GAT) constitutes a suboptimal approach, given out-of-office IOP peaks and fluctuations will not be exposed. Self-tonometry in the home environment could address this unmet need, detecting uncontrolled disease and potentially impacting further therapeutic management. Since recently, iCare HOME was developed as a handheld rebound tonometer for this purpose. The aim of this literature review is twofold. First, the accuracy of iCare HOME compared to GAT will be assessed, including evaluation of the influence of corneal characteristics and the mean IOP. Second, an overview of the reported feasibility and acceptance on the use of iCare HOME will be presented. The literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature was searched on Medline (via Pubmed), Embase, Cochrane Library, and Web of Science (Core Collection) on April 10, 2023. A total of 187 records were identified after deduplication, of which 20 articles were included after full evaluation of their suitability. This study reported that iCare HOME has a moderate to good accuracy compared to GAT and a tendency to underestimate GAT, with a median underestimation of 1 mmHg, ranging from 2.66 mmHg underestimation to 2.08 mmHg overestimation. Success rates ranged between 67.5% and 100% with a median rate of 82.5%. Sufficient acceptance was demonstrated. In conclusion, self-tonometry with iCare HOME constitutes an accurate, feasible, and accepted method for home monitoring of glaucoma, providing additional out-of-office IOP-data, and increasing patient empowerment.