Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Reliability of remote patient training for home tonometry

To the Editor:

Thank you to the authors, Catriona C. Barbour-Hastie & Andrew J. Tatham, for their interesting article entitled “Teaching home tonometry using a remote video link” [1]. This article provides promising results for the future of remote patient training for home intraocular pressure (IOP) measurement to better track glaucoma progression and response to treatment. Home tonometry allows patients to reduce office visits, saving them time and minimizing their risk of COVID-19 infection [2].

However, it is worth addressing the reliability of the remote training used by the authors in their study. While patients were trained to use the ICare HOME device by a licensed optometrist and were required to fulfill a remote training course, there was very little follow-up to confirm the consistency of individual patient IOP measurements. The 16 IOP measurements by each patient over the 2-day period were not shown, further questioning the consistency of IOP measurements made during the study period. In addition, no attempt was made to confirm the reliability of the home IOP measurements through comparison to more standardized methods, i.e., Goldman applanation tonometry (GAT) or Tonopen (Reichert). The authors address this concern in their article by referring to the fluctuating nature of IOP. Although there are daily fluctuations in IOP [3], taking IOP measurements around the same time every day, or an average of the daily measurements for each patient can control for these differences. Furthermore, the majority of clinical decisions to adjust medication, intervene medically to lower IOP, or intervene surgically are often based on IOP measurements taken during office hours, which have been shown to produce minimal variation [4].

Although the reliability of GAT and ICare HOME has been shown [5], no comparison between the two modalities were made in this study, which would strengthen the reliability of the remote training used. Feedback from patients on the remote training was overall positive, suggesting that the training was patient-friendly. However, if the efficacy of the remote training is in question, the ICare HOME IOP measurements should be tracked for consistency and be compared directly to GAT.

References

  1. Barbour-Hastie CC, Tatham AJ. Teaching home tonometry using a remote video link. Eye. 2022.

  2. Mansouri K, Kersten-Gomez I, Hoffmann EM, Szurman P, Choritz L, Weinreb RN. Intraocular Pressure Telemetry for Managing Glaucoma during the COVID-19 Pandemic. Ophthalmol Glaucoma. 2021;4:447–53.

    Article  Google Scholar 

  3. Kim JH, Caprioli J. Intraocular Pressure Fluctuation: Is It Important? J Ophthalmic Vis Res. 2018;13:170–4.

    Article  Google Scholar 

  4. Colombo L, Fogagnolo P, Montesano G, De Cillà S, Orzalesi N, Rossetti L. Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours. BMC Ophthalmol. 2016;16:15.

    Article  Google Scholar 

  5. Dabasia PL, Lawrenson JG, Murdoch IE. Evaluation of a new rebound tonometer for self-measurement of intraocular pressure. Br J Ophthalmol. 2016;100:1139–43.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

MO was responsible for the conception of the correspondence and writing and revising of the paper.

Corresponding author

Correspondence to Marko Oydanich.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Oydanich, M. Reliability of remote patient training for home tonometry. Eye (2022). https://doi.org/10.1038/s41433-022-02099-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41433-022-02099-y

Search

Quick links