Chatter: Leveraging Home Tonometry in Modern Glaucoma Care
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12 months ago
david 4.2k
@david_fe

Intraocular pressure (IOP) is the most important medically treatable risk factor in glaucoma. However, it is an ever-changing variable, shifting between doctor visits, throughout different times of day, and even in response to everyday activities. It is becoming abundantly clear that measuring IOP a few times a year, in the artificial setting of the clinic, is woefully inadequate for proper glaucoma management.

The more IOP data everyone has (you, your physician, glaucoma researchers and related scientists), the more comprehensive our collective understanding of glaucoma becomes -- and the more likely we are to achieve better clinical results today, as well as achieve research breakthroughs tomorrow. The massive data generated by home tonometry has the power to accelerate research breakthroughs dramatically.

Knowing your IOP fluctuations and your peak IOP are both critical on many levels. Glaucoma researchers suspect that the extent of these fluctuations could be an independent risk factor for glaucoma damage, separate from maximum IOP. Both are important. I would argue that home IOP monitoring is the single most empowering thing a person living with glaucoma can do for themselves. At the same time it generates data that allows doctors to make better treatment decisions.

Limitations of Current Approaches

Traditionally, doctors acquire this crucial IOP data by assessing your eye pressure at limited times during office hours in the clinic. However, doctors are likely missing the maximum IOP in most patients. Emerging evidence reveals that these peaks often occur outside regular clinic hours, potentially influenced by real-world activities and conditions, akin to the effects we observe with blood pressure and glucose levels.

Historically, ophthalmologists have observed that IOP often reaches its zenith during morning clinical visits. But recent research, enabled by home IOP monitoring, indicates that the pressure actually peaks even earlier – during the earliest waking hours. In fact, the best way to check your early morning IOP is to check it while you are still in bed. The moment you get out of bed, your IOP has changed. Home monitoring is the only way to collect this all-important information. No matter who quickly you could get to a clinic to have your IOP checked, it will be substantially different from your upon-awakening IOP by the time you even get dressed, much less arrive at the clinic.

Now, with the FDA-approved iCare HOME2 device -- built on the same technology used by professionals -- home IOP monitoring has become a practical reality. A home tonometer enables doctors to gather valuable additional data to enhance our patient care. Potentially even more important, the device allows patients to become engaged in the management of their own eye health. See this related post:

Do NOT Do These Things If You're Living with Glaucoma | AskGlaucoma

Home Tonometers Are Available Now

Even a brief period, such as a week or two of home IOP monitoring (available for rent through Enlivened.com), can offer a more holistic view of IOP trends, potentially unmasking spikes or variations that are invisible with clinic-based measurements alone.

Enlivened.com allows patients, at their own option, to upload their IOP data to a secure cloud database, where they can access the results easily. At the patient's option, their IOP data can be shared with their physicians.

This IOP information is invaluable to physicians, but it is often the patients who spend the time required to discover the real-life factors that significantly impact their own IOP. Patients empowered with IOP data can make the physician's job of managing glaucoma a lot easier.

Physicians can leverage IOP data not only for diagnosis, but also for managing patients whose glaucoma progresses despite showing “controlled” pressures during office visits. The observed IOP patterns are invaluable for making important medical decisions.

Given the challenges of glaucoma (for which medicine has no cure at this time) and with doctors only seeing patients every 3 to 6 months, what could be more important than home IOP monitoring? Home monitoring provides an optimized and more complete method to measure IOP than the common practice employed today. Whenever you get a new glaucoma eye drop or any other treatment change that necessitates IOP monitoring, the additional data gathered outside the clinic can prove invaluable to your doctor.

A Home Tonometer Could Save Your Eyesight

Over the last 16+ years of managing an online glaucoma community, I know many stories of home tonometers saving people's eyesight. Here's one story.

One FitEyes member was in the habit of checking his IOP each day when he got home from work. He could predict what it would be each day because he had been checking it regularly. However, he kept up that habit and checked it just a few times a day. (There is nothing obsessive about this for a glaucoma patient, just like there is nothing obsessive about a diabetes patient checking their blood glucose. It's smart and it indicates you care about your health.) However, one Friday this person got home from work and discovered that his IOP was extremely high -- near 50 mmHg. He got in touch with his doctor and had emergency surgery over the weekend. He was incredibly thankful he was in the habit of checking his IOP each day. Without that, by his next office visit, he may not have had any vision left. Having a tonometer saved his eyesight.

Apart from emergencies, the routine data collected through home IOP monitoring enhances patient management and care, while providing doctors with a more comprehensive understanding upon which to make the best treatment decisions for each patient.

Patient Rights

All patients should be presented with the opportunity to monitor their IOP at home. It should be a patient's right. Unfortunately, the change will take time. I've been advocating for self-tonometry since 2006. But much like blood glucose monitoring, more data equates to better outcomes, and progress cannot be stopped. Side effects and complications from diabetes have been dramatically reduced and patient quality of life dramatically improved since home glucose monitoring became widely utilized. For the last 16+ years, I've seen the same kind of radical improvement in the lives of people living with glaucoma when they get home tonometers.

Glaucoma specialists have a single risk factor to manage -- IOP. Since treatment decisions hinge on this all-important single parameter, shouldn't everyone have a complete understanding of that parameter? Checking it a few times a year is an entirely outdated practice.

Empowering Patients

Home monitoring not only empowers patients, but it also fosters education. Patients gain insight into their disease progression and can observe the impact of therapies on their IOP. A widespread increase in access to home IOP monitoring would be a game-changer in eye care.

Home monitoring plays a pivotal role in educating and empowering patients. It provides a real-time insight into IOP management and the effect of different therapies or lifestyle factors. Enabling more widespread access to home IOP monitoring would represent a significant advancement in patient-centric glaucoma care.

Home IOP monitoring is a revolution in glaucoma, one that respects the reality of the disease's chronic nature and its variability. If we all, patients, physicians and researchers, embrace this advance we can change the reality of everyone living with glaucoma very quickly.

Home IOP monitoring is a new and indispensable tool, not only in improving our understanding of glaucoma but also in enhancing patient engagement, resulting in better outcomes for all. It's a promising development in glaucoma, and it's only the beginning of what's possible with this technology. The future of glaucoma care is here, and it's in the patient's hands.

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