Home Rebound Tonometry for Detecting Diurnal Intraocular Pressure Response to Selective Laser Trabeculoplasty: A Comparative Cohort Study

collection-are increasingly advocated in longitudinal research to improve the precision of phenotypic estimates.5 The advent of rebound home tonometry (iCare HOME) has made this highdensity monitoring feasible, allowing for the rigorous assessment of diurnal fluctuation in a real-world setting.6 Validation studies have consistently demonstrated strong agreement between iCare HOME measurements and the gold-standard Goldmann applanation tonometry (GAT), with high reproducibility of patient self-administered readings.7,8 IntroductIon Primary open-angle glaucoma (POAG) is a chronic, progressive optic neuropathy in which elevated intraocular pressure (IOP) remains the sole modifiable risk factor proven to slow disease progression.While reducing mean IOP is the established gold standard for preserving visual function, landmark randomized controlled trials, such as the Early Manifest Glaucoma Trial (EMGT), 1 have demonstrated that a sustained 25% IOP reduction significantly delayed progression.The Advanced Glaucoma Intervention Study (AGIS) 2 suggests that long-term IOP fluctuation (variability between visits) is an independent predictor of visual field progression, distinct from the mean IOP level.Similarly, large diurnal fluctuations (variability within a day) are identified as an independent risk factor in patients with glaucoma.3 Clinicians increasingly recognize that the traditional paradigm of glaucoma care, which relies heavily on static, sporadic officehour measurements, is insufficient for capturing the dynamic physiological reality of the eye.Studies utilizing continuous monitoring via contact lens sensors or 24-hour phasing in sleep laboratories have demonstrated that single office measurements may miss up to 80% of peak IOP events, which often occur outside standard business hours.4 To address this critical sampling error, "measurement burst" designs-short periods of intensive high-frequency data