Home tonometry and glaucoma – patient and provider perspectives on indications, benefits, and barriers to wider implementation

Glaucoma is the second leading cause of blindness globally. It is a degenerative condition that commonly results in elevated intraocular pressure (IOP), which, in turn, damages the eye's optic nerve. Glaucoma is an irreversible condition with no cure, but there are treatments available to manage and monitor glaucoma. These treatments primarily focus on reducing IOP. Therefore, monitoring IOP in eyes with suspected and documented glaucoma is pivotal in the management of this disease. For patients with glaucoma, the measurement of IOP is currently performed almost exclusively in the clinic using a tonometer. However, IOP is known to fluctuate widely in some patients with glaucoma, often showing IOP peaks outside traditional clinical office hours (Konstas et al, 2018). Home tonometry, which enables patients to self-monitor IOP, is a more recently introduced practice than home blood pressure monitoring or home blood glucose monitoring. The FDA approved the first tonometer for home use in 2017 (Liu et al., 2020). Despite its adoption by some eye care physicians and their patients, much remains to be learned regarding what factors lead physicians to be more likely to prescribe home tonometry for their glaucoma patients. Past research has found that home tonometry helps make more informed treatment decisions, particularly with regards to medical treatment (usually eyedrops) and surgery (Mali et al., 2018). However, home tonometry is still used by a minority of glaucoma patients. There remain real and perceived barriers to wider spread use of home tonometry, both from the provider and the patient. This study aims to better understand the factors which influence the practice of home tonometry in glaucoma management using a survey-based approach towards understanding attitudes and perspectives of both glaucoma patients and glaucoma specialists. Survey questions target perspectives on home tonometry, as well as barriers to its use. The survey results offer insights on home tonometry in adult glaucoma management, by querying both those who prescribe home tonometry for their patients, and those patients who have used home tonometry themselves. We found that patients’ use of home tonometry seemed to mirror provider-reported recommendations for home tonometry in terms of glaucoma severity, duration and frequency of measurement. We found a psychological benefit for many patients, where 69% of patients reported having moderate to severe anxiety surrounding their glaucoma and 47% of patients reported a reduction in anxiety about their condition after using home tonometry. However, most providers were concerned about an increase in patient stress as a reason not to prescribe home tonometers to their patients. The greatest perceived barrier for all survey participants was device cost. We expect this study to facilitate further uptake in home tonometry by glaucoma specialists and their patients in managing this prevalent and chronic disease.