What is the iCare HOME and how does it work?

The iCare HOME is an FDA-cleared, handheld rebound tonometer that patients use at home to measure their intraocular pressure. It requires no anesthetic drops, uses a tiny probe that touches the eye for a millisecond, and automatically uploads readings to the cloud for your doctor to review.

When is the best time to measure IOP at home?

Research shows the highest IOP readings typically occur in the early waking hours between 4:30 and 8:00 a.m. Dr. Wirostko recommends setting an alarm one to two hours before your usual wake-up time to capture the peak. The device can measure IOP while sitting up or lying down.

How long should I monitor my IOP at home?

A 7- to 10-day monitoring period is recommended. Research from the Moran Eye Center and Wilmer Eye Institute found that 24 hours is not enough to capture the full range of IOP variability. Seven to ten days provides the data needed to identify meaningful patterns and pressure spikes.

Does Medicare or insurance cover home tonometry?

Medicare does not currently cover the iCare HOME because there is no HCPCS code assigned to the device. However, some secondary insurance plans and even workers' compensation have covered part or all of the cost. MyEyes helps patients with insurance paperwork and reimbursement submissions.

How much does it cost to rent or buy the iCare HOME through MyEyes?

The purchase price is approximately $3,000. Rentals start at about $300 for the first week, with the cost decreasing for longer rental periods. Replacement probes come in boxes of 40 for about $55. All shipping is included.

What if my doctor won't prescribe the home tonometer?

Dr. Wirostko suggests educating your doctor by sharing published research on the importance of IOP fluctuation. MyEyes can provide documentation and references you can present to your physician. More and more leading ophthalmologists at institutions like Wilmer, Moran, Duke, and Harvard are adopting home tonometry into their practice.

Can two family members share one device?

The device data is linked to the machine, not the patient. If you own it, you could theoretically share it, but you would need to carefully track who used it at what time because the cloud system cannot differentiate between users. For rentals, each device is assigned to one patient.

Is there a connection between sleep apnea and glaucoma?

Emerging research suggests yes. Dr. Wirostko presented data showing patients with sleep apnea tend to have greater IOP fluctuation, and treating sleep apnea in one patient reduced his IOP spikes enough to avoid surgery. A prospective study is underway at the Moran Eye Center to further investigate this link.

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Webinar Recap · For Glaucoma Patients

Home IOP Tonometry: Improving Patient Care with Better Management and Empowerment

Dr. Barbara Wirostko explains why IOP fluctuations outside the clinic are a hidden driver of glaucoma progression, and how home tonometry with the iCare HOME empowers patients and physicians to detect dangerous pressure spikes and take action before vision loss occurs.

Recorded

Tuesday, March 17, 2026
11:00 PM UTC

Run time

51 minutes

Speakers

Dr. Barbara Wirostko, Elena Sturman

Summary

What was covered

A written overview of the full discussion for quick reference.

Why Traditional IOP Measurement Falls Short

Glaucoma is a slowly progressive optic neuropathy and the leading cause of irreversible blindness worldwide. While intraocular pressure (IOP) remains the only modifiable risk factor, the way IOP has traditionally been measured presents a fundamental limitation. A clinic visit captures just a few seconds of IOP data, yet there are over 31 million seconds in a year during which pressure fluctuates continuously. Dr. Wirostko emphasized that clinicians have long relied on these isolated snapshots to make treatment decisions — a practice she compares to managing diabetes with a single annual blood glucose reading rather than continuous monitoring.

The Science Behind IOP Fluctuation

IOP is a dynamic physiologic parameter influenced by body position, cortisol levels, pain, exercise, blood pressure, nitric oxide, and sleep quality. Research dating back to the 1970s has shown that endogenous cortisol rises in the early waking hours, followed approximately three hours later by a corresponding spike in IOP. More recent studies from 2009 and 2011 have established that IOP fluctuation — independent of mean IOP — is a significant predictor of visual field progression. This means patients can have "normal" pressures in the office while experiencing damaging spikes at home that go entirely undetected.

Landmark Findings from Home Tonometry Research

A pivotal study from the Wilmer Eye Institute led by Professor Tom Johnson examined 61 patients (107 eyes) and found that 44% had mean daily home IOP readings that exceeded their clinic measurements. The highest pressures consistently occurred in the early waking hours between 4:30 and 8:00 a.m. Based on joint research between Wilmer and the Moran Eye Center involving thousands of patients, Dr. Wirostko now recommends a 7- to 10-day monitoring period to capture meaningful variability, noting that 24 hours is insufficient to establish a reliable IOP profile.

How Home Tonometry Changes Treatment Decisions

Dr. Wirostko shared several compelling patient cases illustrating the clinical impact of home IOP data. One patient appeared controlled at 15 mmHg in office visits but was spiking to 28 mmHg in the early morning hours. A 72-year-old surgeon with exfoliative glaucoma showed pressures of 16–17 during clinic hours but reached 48 in the early waking hours — a finding that prompted a medication change which flattened his IOP curve. Another patient, an 84-year-old cardiologist afraid of cataract surgery after previous post-operative IOP spikes, used the iCare HOME to monitor before and after his procedure, giving him the data and peace of mind he needed.

Not All Treatments Are Equal for IOP Fluctuation

An important finding discussed during the webinar is that not all glaucoma treatments control IOP equally well throughout the day and night. While prostaglandins work effectively at night, timolol and brimonidine do not. This insight allows physicians to tailor medication regimens based on a patient's specific IOP fluctuation patterns. Among surgical options, trabeculectomies and PreserFlo appear most effective at completely eliminating IOP fluctuation. The landmark LiGHT trial from Moorfields showed that SLT resulted in less visual field loss over 6 years compared to eye drops, even though mean IOPs were similar — likely because SLT reduces IOP spikes more effectively.

The Connection Between Sleep Apnea and Glaucoma Progression

Among the most intriguing areas of emerging research is the link between sleep apnea, circadian rhythm disturbances, and IOP fluctuation. Dr. Wirostko described a patient with pigmentary glaucoma who was scheduled for surgery but saw his IOP fluctuation decrease significantly after being diagnosed and treated for sleep apnea. Preliminary data from the Moran Eye Center comparing glaucoma patients with and without sleep apnea suggests those with sleep apnea experience greater IOP fluctuation. A prospective study is planned to further investigate this relationship.

Accessing Home Tonometry Through MyEyes

Dr. Wirostko founded MyEyes to make the iCare HOME tonometer accessible to patients nationwide. The service works through a simple prescription from the patient's ophthalmologist, after which the device is shipped directly to the patient's home. Patient ambassadors — many of whom are glaucoma patients themselves — provide onboarding support, achieving a 97–98% success rate regardless of patient age. The device can be rented (starting at approximately $300 per week) or purchased (approximately $3,000). While Medicare does not currently cover the device due to the lack of a HCPCS code, some secondary insurance plans and workers' compensation have provided reimbursement, and MyEyes assists patients with the paperwork.

The Future of IOP Monitoring

Multiple IOP monitoring technologies are in development, including implantable sensors (IMDA), smart contact lenses, and intravitreal sensors (InjectSense), though none are yet commercially available. MyEyes is also developing a web-based app that will allow patients to track not only their IOP data but also medications, exercise, diet, and other interventions alongside their pressure readings. Research partnerships with academic centers including Wilmer, Moran, Duke, Harvard, Bascom Palmer, and the University of Michigan continue to advance understanding of IOP fluctuation patterns, phenotyping, genetic risk scoring, and the relationship between sleep disorders and glaucoma.

Key Takeaways

What you’ll learn

Share these highlights with your care team or fellow patients.

IOP spikes happen outside the clinic

Research shows that 44% of glaucoma patients have higher IOP readings at home than in the clinic, with peak pressures occurring between 4:30 and 8:00 a.m. A single office reading captures just seconds out of 31 million seconds in a year, making it an unreliable snapshot of true IOP behavior.

IOP fluctuation drives vision loss

Studies dating back over a decade demonstrate that IOP fluctuation — not just average IOP — is an independent risk factor for visual field progression. Even patients with "controlled" pressures in the office can be losing vision due to undetected spikes at home.

Home tonometry enables proactive, personalized care

By monitoring IOP at home over 7–10 days, physicians can identify dangerous pressure patterns, adjust medications based on when spikes occur, and intervene before irreversible damage occurs. This represents a shift from reactive to proactive glaucoma management.

Sleep apnea may be linked to greater IOP fluctuation

Emerging research suggests patients with sleep apnea and circadian rhythm disturbances experience more IOP fluctuation. In one case, treating a patient's sleep apnea reduced his IOP spikes enough to potentially avoid surgery. Prospective studies are underway at the Moran Eye Center.

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Timestamp	Segment	Notes
00:00	Welcome and introduction	Elena Sturman, President and CEO of The Glaucoma Foundation, welcomes the audience and introduces Dr. Barbara Wirostko, highlighting her credentials and the iCare sponsorship.
02:26	Why IOP matters in glaucoma	Dr. Wirostko explains why IOP is the only modifiable risk factor in glaucoma, why patients still progress despite treatment, and how IOP fluctuates with positioning, cortisol, exercise, sleep, and more.
07:17	The case for monitoring IOP fluctuation	Studies dating back to 2009–2011 show visual field progression is linked to IOP fluctuation, not just mean IOP. The analogy to glucose monitoring in diabetes is drawn.
10:37	IOP monitoring devices: what exists today	Overview of devices in development (IMDA, Smart Lens, IOP Connect) vs. what is cleared and available now, including Triggerfish/Sensimed and the iCare HOME tonometer.
13:10	Clinical evidence: peak IOP outside the office	Research from Wilmer Eye Institute (Prof. Tom Johnson) found that 44% of patients had higher IOP at home than in clinic, with peaks between 4:30–8:00 a.m. A 7–10 day monitoring period is recommended.
17:08	Clinical use cases and patient stories	Real patient cases demonstrating how home tonometry detected dangerous spikes missed in office visits, guided medication changes, monitored post-surgical IOP, and provided peace of mind.
22:34	Research: SLT, sleep apnea, and IOP fluctuation	SLT was shown to reduce IOP spikes (not just mean IOP), which may explain its superiority over drops. Early research links sleep apnea and circadian rhythm disturbances to greater IOP fluctuation.
27:34	MyEyes: how it works and getting access	Dr. Wirostko explains how MyEyes enables patient access to the iCare HOME through a simple prescription, onboarding by patient ambassadors, and a 97–98% success rate. Rental and purchase options, insurance reimbursement, and contact info are shared.
32:09	Audience Q&A	Elena and Dr. Wirostko field audience questions on getting a prescription, Medicare coverage, device sharing, IOP measurement technique, dry eye, nitric oxide, device cost, calibration, and post-surgical use.
49:26	Closing remarks	Elena thanks Dr. Wirostko and the audience. Webinar recording will be available on The Glaucoma Foundation website and YouTube channel.

FAQ

Common questions from the webinar

Answers drawn directly from the discussion and Q&A.

What is the iCare HOME and how does it work?: The iCare HOME is an FDA-cleared, handheld rebound tonometer that patients use at home to measure their intraocular pressure. It requires no anesthetic drops, uses a tiny probe that touches the eye for a millisecond, and automatically uploads readings to the cloud for your doctor to review.
When is the best time to measure IOP at home?: Research shows the highest IOP readings typically occur in the early waking hours between 4:30 and 8:00 a.m. Dr. Wirostko recommends setting an alarm one to two hours before your usual wake-up time to capture the peak. The device can measure IOP while sitting up or lying down.
How long should I monitor my IOP at home?: A 7- to 10-day monitoring period is recommended. Research from the Moran Eye Center and Wilmer Eye Institute found that 24 hours is not enough to capture the full range of IOP variability. Seven to ten days provides the data needed to identify meaningful patterns and pressure spikes.
Does Medicare or insurance cover home tonometry?: Medicare does not currently cover the iCare HOME because there is no HCPCS code assigned to the device. However, some secondary insurance plans and even workers' compensation have covered part or all of the cost. MyEyes helps patients with insurance paperwork and reimbursement submissions.
How much does it cost to rent or buy the iCare HOME through MyEyes?: The purchase price is approximately $3,000. Rentals start at about $300 for the first week, with the cost decreasing for longer rental periods. Replacement probes come in boxes of 40 for about $55. All shipping is included.
What if my doctor won't prescribe the home tonometer?: Dr. Wirostko suggests educating your doctor by sharing published research on the importance of IOP fluctuation. MyEyes can provide documentation and references you can present to your physician. More and more leading ophthalmologists at institutions like Wilmer, Moran, Duke, and Harvard are adopting home tonometry into their practice.
Can two family members share one device?: The device data is linked to the machine, not the patient. If you own it, you could theoretically share it, but you would need to carefully track who used it at what time because the cloud system cannot differentiate between users. For rentals, each device is assigned to one patient.
Is there a connection between sleep apnea and glaucoma?: Emerging research suggests yes. Dr. Wirostko presented data showing patients with sleep apnea tend to have greater IOP fluctuation, and treating sleep apnea in one patient reduced his IOP spikes enough to avoid surgery. A prospective study is underway at the Moran Eye Center to further investigate this link.

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