Bringing IOP Measurements Home

Interview with Barbara Wirostko, MD, FARVO

Glaucoma Today – September/October 2021

GT: Can you tell us about MyEyes and its founding?
Dr. Barbara Wirostko:MyEyes was founded by three individuals passionate about glaucoma: a patient, a glaucoma specialist (myself), and an ophthalmic technician. We saw how information about IOP fluctuations could inform clinical decision-making and quickly direct a change in disease management. We recognized the need to enable patients to measure and monitor their IOP outside of office visits.

The main objective of MyEyes is to help patients gain access to the iCare Home, an FDA-cleared prescription tonometer device that allows users to measure their IOP at home at various times of the day and/or night. Given the cost and the short-term needs of some patients, we offer the iCare Home tonometer as a rental or for purchase. The device provides critical information on IOP variability, which may help patients and their physicians tailor therapy to reduce fluctuations and spikes.

GT: How does the rental process work for the patient and the physician?
Dr. Wirostko:Patients and physicians have provided positive feedback on the ease of use and the support available through MyEyes and iCare USA. Physicians need only to provide a prescription, which patients can upload on the MyEyes website, make a payment, and have the home tonometer device shipped to them within a few days. We offer access to teaching videos, instructional information, and one-on-one tutorials to facilitate the device’s usability. The device requires no anesthetic, and sterile probes are provided. Once the rental period ends, patients return the device in a prepaid box.

GT: Is 24-hour IOP monitoring beneficial for all patients with glaucoma?
Dr. Wirostko:Measuring IOP at different times of day and night can be very beneficial. This was part of the reason for founding MyEyes—I saw nighttime IOP rise significantly in a few patients with advanced and “controlled” normal-tension glaucoma, which led to changes in treatment and surgery sooner. We are seeing trends in IOP control depending on the surgical procedure used. However, not all patients experience significant IOP fluctuations, so their management plan might remain adequate.

GT: How has monitoring IOP over 24 hours made a difference in glaucoma care?
Dr. Wirostko:In my practice, 24-hour IOP measurement over 1 or 2 weeks have significantly impacted glaucoma care. For instance, Rojas et al. reported a case where a patient experienced an IOP spike into the high 40s mm Hg during the night, leading to a medication adjustment. Although not all patients may experience this, it raises concerns about how many patients could be progressing due to undetected IOP spikes.

Recent investigations have focused on the 24-hour variability in IOP, especially in patients with normal-tension glaucoma. While the iCare Home tonometer does not perform continuous monitoring, it can indicate trends toward elevated IOP—a key modifiable risk factor. I compare the iCare Home ocular tonometer to a glucose monitor or a home blood pressure monitor. These measurements help identify fluctuations that could impact disease progression.

GT: What would you say to anyone on the fence about implementing an iCare Home IOP-measurement program using a home tonometer device?
Dr. Wirostko:There are few to no downsides to this approach. The prescription from the physician is all that’s needed, and having a graph of IOP measurements could provide critical data points that might save vision. Numerous studies have shown IOP variability, especially at night. The iCare Home tonometer is a simpler and more cost-effective way to capture these data, providing trends that inform treatment decisions.

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