Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmol Glaucoma. 2021 Nov-Dec;4(6):569-580. doi: 10.1016/j.ogla.2021.03.017. Epub 2021 Apr 9.
This study examined characteristics of intraocular pressure (IOP) as measured during home tonometry in comparison with in-clinic tonometry in patients with glaucoma.
Retrospective cross-sectional study of glaucoma patients who completed 1 week of self-tonometry at a single academic center.
Patients with glaucoma who completed home tonometry trials with the iCare HOME tonometer (iCare USA) for any reason.
Home IOP measurements were compared with in-clinic tonometry performed during the 5 visits preceding home tonometry. Maximum daily IOP was correlated to time of day. Generalized estimating equations were used to evaluate patient characteristics and clinic-derived variables that predicted differences between home and clinic IOP.
IOP mean, maximum, minimum, range, standard deviation and coefficient of variation were compared between clinic and home tonometry. IOP mean daily maximum (MDM) and mean daily range were calculated to describe recurrent IOP spiking.
A total of 107 eyes from 61 patients were analyzed. Mean age was 63.2 years (standard deviation [SD], 14.0 years) and 59.0% were women. Mean clinic and home IOPs were 14.5 mmHg (SD, 4.7 mmHg) and 13.6 mmHg (SD, 5.1 mmHg). Home tonometry identified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than clinic tonometry (P < 0.001). Maximum daily IOP occurred outside of clinic hours (8 am-5 pm) on 50% of days assessed and occurred between 4:30 am and 8 am on 24% of days. Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mmHg, 5 mmHg, or 10 mmHg in 31%, 15%, and 6% of patients, respectively. Patient characteristics that predicted significant deviations between MDM and mean clinic IOP or target IOP in multivariate models included younger age, male gender, and absence of prior filtering surgery.
Self-tonometry provides IOP data that supplements in-clinic tonometry and would not be detectable over daytime in-clinic diurnal curves. A subset of patients in whom home tonometry was ordered by their glaucoma clinician because of suspicion of occult IOP elevation demonstrated reproducible IOP elevation outside of the clinic setting. Such patients tended to be younger and male and not to have undergone previous filtering surgery.
本研究比较了青光眼患者家庭眼压测量与临床眼压测量的特点。
在单一学术中心进行的青光眼患者回顾性横断面研究，这些患者完成了一周的家庭眼压测量。
因任何原因完成家庭眼压测量试验的青光眼患者，使用 iCare HOME 眼压计（iCare USA）。
将家庭眼压测量值与家庭眼压测量前 5 次就诊时进行的临床眼压测量值进行比较。最大日眼压与时间相关。使用广义估计方程评估预测家庭和诊所眼压差异的患者特征和临床衍生变量。
比较诊所和家庭眼压测量的眼压平均值、最大值、最小值、范围、标准差和变异系数。计算眼压日均值最大（MDM）和眼压日均值范围，以描述复发性眼压峰值。
共分析了 61 例患者的 107 只眼。平均年龄为 63.2 岁（标准差 14.0 岁），59.0%为女性。平均诊所和家庭眼压分别为 14.5mmHg（标准差 4.7mmHg）和 13.6mmHg（标准差 5.1mmHg）。家庭眼压测量值显著高于诊所眼压测量值，最大眼压更高，最小眼压更低，眼压范围更大（P<0.001）。最大日眼压 50%发生在评估日的诊所时间（8 am-5 pm）以外，24%发生在 4：30 am-8 am。44%的患者的平均日最大眼压超过了最大诊所眼压，31%、15%和 6%的患者的平均日最大眼压分别超过了目标眼压 3mmHg、5mmHg 和 10mmHg。多元模型中预测 MDM 与平均诊所眼压或目标眼压显著偏差的患者特征包括年龄较小、男性和无既往滤过性手术史。
自我眼压测量提供了补充临床眼压测量的眼压数据，并且在日间临床昼夜曲线中无法检测到。一小部分患者因怀疑存在隐匿性眼压升高而由青光眼临床医生安排家庭眼压测量，这些患者在诊所外出现可重复的眼压升高。这些患者往往更年轻、更男性，并且没有接受过先前的滤过性手术。
