The impact of iCare HOME tonometry on clinical decision-making in glaucoma management: a retrospective observational study

Abstract Purpose To evaluate the impact of iCare HOME tonometry on clinical decision-making in the management of glaucomatous eyes with acceptable office IOPs but high-risk clinical features. Methods This retrospective study includes 82 eyes from 46 patients that had iCare HOME tonometry between 2020 and 2023. Patient demographics, ocular characteristics, iCare HOME data, prior surgical interventions and baseline medications, and changes to glaucoma management were collected. “IOP spike” was defined as any elevated iCare HOME measurement 5 mm Hg greater or 30% greater than the baseline office IOP. Physician impressions of visual field testing and optical coherence tomography imaging were also recorded to determine whether eyes had evidence of “glaucoma progression” prior to home tonometry. Statistical analyses were conducted to evaluate the factors influencing clinical decision making. Results The 82 eyes in this study had generally normal office IOP and high-risk features on pre-home tonometry examination. 72% (59 eyes) of eyes demonstrated IOP spikes on home tonometry. Of eyes with home IOP spikes, 50.8% (30 eyes) had changes in their management. Eyes with management changes had higher trough home IOP (OR = 1.27 [1.04, 1.55], p = 0.017), better LogMAR BCVA (OR = 0.09 [0.02, 0.44], p = 0.003), and higher odds of glaucoma progression (OR = 2.59 [1.01, 6.61], p = 0.047). Among eyes without evidence of “glaucoma progression” but an “IOP spike” on home tonometry, a higher proportion of eyes did not have changes to their management (65.5% vs. 34.5%). Conclusion Our study found that 72% of eyes experienced a home IOP spike despite acceptable office IOPs, with roughly half of patients with home IOP spikes undergoing management changes. Among eyes with home IOP spikes but no evidence of glaucoma progression, a greater proportion had no management changes. These findings indicate that home IOP spikes are interpreted in the context of other clinical indicators, such as structural and functional imaging studies.