APUP Community Workshop with MyEyes | IOP & Home Tonometry

Why One Office Reading Is Never Enough

In this 63-minute APUP community workshop, Hillary Golden — founder of Glaucoma Coach and a normal-tension glaucoma patient herself — and Ericka Shepard, MyEyes Vice President of Patient Success and a glaucoma patient, explain why the single IOP reading taken during a quarterly office visit captures a snapshot of seconds in an entire year. IOP fluctuates with time of day, body position, hydration, medications, exercise, stress, and sleep. Patients whose office pressures appear stable may still be progressing because the spikes and dips driving damage happen when no clinic is open to measure them. Home tonometry with the iCare HOME2 fills that gap by enabling patients to capture dozens of readings across their daily routine and build a diurnal curve their doctor can use to personalize treatment.

Hillary's Diagnosis Story: Normal-Tension Glaucoma

Hillary was diagnosed with normal-tension glaucoma after imaging revealed she had already lost 40% of her vision — despite IOP readings of only 13–14 mmHg. Her pressures looked "normal" by textbook standards, yet damage was accumulating silently. She describes the fear and helplessness of waiting months between appointments with no way to know whether her drops were working. After starting home tonometry, she could see her own numbers, track patterns, and share objective data with her specialist. The device gave her something the disease had taken away: a sense of control.

How the iCare HOME2 Works

The iCare HOME2 uses rebound tonometry, a technology where a tiny magnetized sensor bounces off the surface of the cornea so gently that most patients don't feel it at all — no numbing drops, no puff of air. The measurement takes about 30 seconds per eye. Patients align their eye in a viewfinder, press a button, and the device captures six micro-measurements and averages them into a single IOP reading. Studies comparing the HOME2 to Goldmann applanation tonometry (the clinical gold standard) show it tracks within 1–2 mmHg across the normal range. The device stores up to 100 paired readings and transmits data via Bluetooth to the MyEyes app for PDF report generation.

When and How Often to Monitor

Hillary and Ericka recommend taking readings at different times of day to build a complete diurnal curve — early morning upon waking, midday, evening, and before bed. Patients recovering from surgery or adjusting medications may monitor more frequently. Ericka explains that MyEyes offers guided monitoring schedules during onboarding and that patient ambassadors — all glaucoma patients themselves — call every rental customer to walk them through the device, answer questions, and help with any troubleshooting during the monitoring period.

Pricing, Insurance, and Getting Started

MyEyes offers three rental options: the Diagnose plan at $249 for the first week with additional weeks at $149, the Aftercare subscription at $299 per month (3-month minimum) for patients managing ongoing treatment or surgical recovery, and outright purchase at $2,999 with payment plans available. All plans are HSA and FSA eligible. While Medicare does not yet reimburse for home tonometry, MyEyes provides superbills with the proper diagnosis and DME codes so patients can submit claims to private insurers, and a growing number are receiving partial or full reimbursement. To start, patients need only a prescription from any optometrist or ophthalmologist — MyEyes handles device shipping within 24 hours, onboarding, and report delivery back to the prescribing provider.

Mary Lou's Rural Access Story

Mary Lou Iverson, a patient living in rural Montana 140 miles from her nearest glaucoma specialist, shares how home monitoring transformed her care. Traveling to the doctor meant a full-day commitment, and appointments were limited to a few per year. With the HOME2, she discovered that her blood pressure medication was causing IOP spikes, and that over-the-counter Zyrtec was raising her pressure — findings her doctor never would have detected from quarterly office visits alone. Mary Lou was able to bring data showing these patterns to her appointment, leading to a medication adjustment. She describes the device as giving her "eyes and ears" between visits and emphasizes how critical it is for rural patients who cannot easily access specialists.

Contraindications and Limitations

The presenters note that the HOME2 is not suitable for patients with certain corneal conditions including active corneal infections, significant scarring, or recent corneal transplant. Patients with nystagmus or those who cannot hold the device steady may also have difficulty obtaining accurate readings. Ericka emphasizes that MyEyes screens for these contraindications during onboarding and will work with the prescribing doctor if questions arise about patient suitability.

Q&A with Dr. Rathi

During the audience Q&A, ophthalmologist Dr. Rathi addressed several patient questions. On smoking: nicotine causes blood vessel constriction that can affect IOP and optic nerve blood flow — cessation is strongly recommended for all glaucoma patients. On sleep apnea: untreated sleep apnea is associated with increased glaucoma risk due to intermittent hypoxia and elevated intracranial pressure during apneic episodes — treatment with CPAP may help. On altitude: moving to higher elevations can temporarily affect IOP, and patients relocating should monitor with HOME2 to establish their new baseline. On whether home readings replace office visits: they do not — home data supplements clinical examination including visual fields, OCT imaging, and gonioscopy, giving the doctor a more complete picture to guide treatment.