How Home Monitoring Changes Treatment Decisions
Real cases from published research show how continuous IOP data leads to better surgical timing, earlier medication adjustments, and more personalized glaucoma care.
Beyond the Office Visit
Glaucoma treatment decisions are traditionally based on periodic IOP measurements taken during office visits. But IOP is a dynamic measurement that changes throughout the day and night — and the data that matters most may be occurring when no one is looking.
Research from Johns Hopkins found that peak IOP occurred outside of office hours on 50% of the days measured.[1] For patients whose glaucoma is progressing despite apparently controlled in-clinic IOP, home monitoring can reveal the pressure spikes and fluctuations that explain why.
The following case examples, drawn from a published case series by physicians at the University of Utah Moran Eye Center and Johns Hopkins Wilmer Eye Institute, illustrate how home IOP data directly influenced treatment decisions.[2]
When Data Changes the Plan
In each of these published cases, home tonometry data revealed IOP behavior that was not visible during clinic visits — and directly informed the next treatment step.
Revealing Hidden IOP Spikes Before Surgery
A 74-year-old man with primary open-angle glaucoma had in-clinic IOP that appeared controlled. Home tonometry revealed variable IOP with readings reaching 25-26 mmHg — prompting surgical intervention that significantly reduced his peak pressures and IOP fluctuation.
IOP peaks and fluctuation reduced after surgery, guided by home monitoring data.
Tracking Post-Surgical Recovery at Home
A 67-year-old man underwent combined phacoemulsification and Hydrus placement in both eyes. Home tonometry showed the preoperative IOP spikes and mean IOP of 15.8 mmHg decreased to 12.5 mmHg post-operatively — with early morning spikes also reduced.
Home data confirmed surgical success and guided the next intervention.
Detecting When Treatment Wears Off
Following a bimatoprost intracameral implant (Durysta), home monitoring tracked IOP control over months. At approximately 6 months, the patient noticed home readings beginning to climb during the day — allowing the physician to adjust medications before the next scheduled clinic visit.
Medication adjusted proactively based on home data, avoiding vision loss between visits.
Confirming the Need for Further Intervention
A 75-year-old man with dense central visual field loss had in-clinic IOP of only 11 mmHg. Home tonometry revealed IOP variability up to 25 mmHg. After an initial procedure showed persistent home spikes to 26 mmHg, the data guided the decision to proceed with a more definitive surgical intervention.
Home data prevented false reassurance from low in-clinic readings.
Case details adapted from Levin AM, McGlumphy EJ, Chaya CJ, Wirostko BM, Johnson TV. Am J Ophthalmol Case Rep. 2022.[2]
A Patient's Perspective
In a published roundtable discussion in Glaucoma Today, retired aerospace engineer Dorian De Maio described his experience using the iCare HOME over 1.5 years as a long-time glaucoma patient.[3]
His pressures appeared generally controlled during daytime office visits. But visual field testing showed his better-seeing eye was beginning to deteriorate. His physician suspected nighttime IOP spikes — and home monitoring confirmed it. That finding led to surgery, and afterward, home monitoring continued to track his recovery and guide further treatment.
When a subsequent treatment (a bimatoprost intracameral implant) was expected to last about 6 months, De Maio monitored carefully at home. Almost right on schedule, his readings began to climb — and his physician adjusted his medication regimen immediately, without waiting for the next scheduled appointment.
“From a patient point of view, when you go to the clinic on a periodic basis and know that your pressures may vary according to the day, you feel a bit hopeless and like you have no control. With the iCare Home, you can build a closer relationship with your provider and feel like you are part of the treatment, or at least like you can have an impact on the treatment plan.”
— Dorian De Maio, glaucoma patient, Glaucoma Today, 2022
For Clinicians: Peri-Interventional Monitoring
Levin et al. (2022) proposed home tonometry as a clinical decision-making adjunct across the surgical timeline. Their 12-case series demonstrated value in several contexts:[2]
- Pre-surgical workup: Establishing baseline IOP patterns and identifying nyctohemeral fluctuations not captured in clinic
- Post-operative recovery: Tracking treatment response with higher temporal resolution than periodic follow-up visits
- Medication titration: Identifying when a treatment is wearing off before the next scheduled appointment
- SLT and MIGS follow-up: Monitoring procedure efficacy over weeks and months
Berneshawi et al. (2024) further demonstrated in a Stanford pilot study that at-home tonometry yielded statistically higher maximum IOP values than in-clinic measurements — consistent with prior findings that home data captures IOP behavior not evident during office hours.[4]
The Bigger Picture
The evidence tells a consistent story. Landmark trials like CIGTS show that aggressive IOP lowering matters for preserving vision.[5] Self-monitoring studies show that office visits miss a substantial portion of IOP behavior.[1] And case studies demonstrate that when clinicians have home monitoring data, it directly changes treatment decisions for the better.[2]
As Turner and Ou wrote in their 2022 editorial: home IOP monitoring technology is ready, and it provides data that can meaningfully improve glaucoma care.[6] The question is no longer whether home monitoring is useful — it's how to make it accessible to every patient who could benefit.
Always Consult Your Ophthalmologist
Home monitoring is a tool to complement your clinical care, not replace it. Work with your doctor to determine the right monitoring plan and treatment approach for your specific situation.
Start Making Better-Informed Decisions
Whether you're considering a rental for a specific monitoring period or ongoing monitoring with a purchased device, our team is here to support you.
References
- McGlumphy EJ, Mihailovic A, Ramulu PY, Johnson TV. Home self-tonometry trials compared with clinic tonometry in patients with glaucoma. Ophthalmology Glaucoma. 2021;4(6):569-580. doi:10.1016/j.ogla.2021.03.017
- Levin AM, McGlumphy EJ, Chaya CJ, Wirostko BM, Johnson TV. The utility of home tonometry for peri-interventional decision-making in glaucoma surgery: case series. Am J Ophthalmol Case Rep. 2022;28:101689. doi:10.1016/j.ajoc.2022.101689
- Kahn R, De Maio D, Wirostko B, Chaya C. Remote diagnostics for closer clinical teamwork [roundtable]. Glaucoma Today. March/April 2022.
- Berneshawi AR, Shue A, Chang RT. Glaucoma home self-testing using VR visual fields and rebound tonometry versus in-clinic perimetry and Goldmann applanation tonometry: a pilot study. Transl Vis Sci Technol. 2024;13(8):7. doi:10.1167/tvst.13.8.7
- Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK; CIGTS Study Investigators. Visual field progression in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology. 2009;116(2):200-207. doi:10.1016/j.ophtha.2008.08.051
- Turner M, Ou Y. At-home glaucoma monitoring: is it ready for prime time? [editorial]. Ophthalmology Glaucoma. 2023;6(2):117-119. doi:10.1016/j.ogla.2022.08.009