Patient-administered tonometry can identify tube openings and alarming intraocular pressure (IOP) readings in childhood glaucoma patients with Baerveldt implants, researchers from Duke University and the Medical University of South Carolina report.

The investigation was part of an ongoing prospective study involving home-based tonometry, where the families of young patients with the implants were trained to use an Icare rebound tonometer. The families documented IOP, relevant symptoms and ocular medication changes outside of the clinic setting. The study also evaluated clinician response to IOP fluctuations detected by home tonometry.

The investigation included 19 patients who had a Baerveldt implantation from 2015 to 2018 by one attending physician. Researchers found home tonometry detected spontaneous tube openings 92.3% of the time, which occurred at approximately six weeks. Using home tonometry, the study reported mean IOP decreased 32.7% (24mm Hg vs. 15mm Hg). Additionally, the five-day IOP fluctuation decreased from 15mm Hg pre-operatively to 8mm Hg after a tube opening.

The study also noted home tonometry resulted in 94 medication changes and one surgical decision among 14 patients.

Home tonometry can help physicians, patients and families react appropriately and quickly to IOP fluctuations that may be missed in the clinic, researchers Sharon Freedman, MD, and Michelle Go, MD, both of the Department of Ophthalmology at Duke University Medical Center, noted.

 Future studies should address obstacles to more widespread acceptance and availability of home tonometry such as cost, lack of reimbursement for services provided and inefficiencies in IOP data management, the study suggested.

Go MS, Barman NR, House RJ, Freedman SF. Home tonometry assists glaucoma drainage device management in childhood glaucoma. J Glaucoma. July 5, 2019. [Epub ahead of print].