A handheld device that allows patients to track their eye pressure at home is transforming care and research.
Glaucoma is a chronic, incurable, insidious blinding eye disease.
People often lose vision before receiving a diagnosis since its main symptom—increased intraocular pressure (IOP)—usually does not cause any pain or discomfort. Once a diagnosis is made, fluctuations in IOP reveal whether the disease is progressing or a treatment is working.
Like early coal miners who once relied on canaries to warn of toxic gases, ophthalmologists have long relied on pressure checks at clinic appointments to monitor IOP. The problem: These checks provide only a brief snapshot of a patient’s condition every few months.
“Our research has shown IOP can spike early in the morning or late at night—times that patients are not typically seen,” said Barbara Wirostko, MD, FARVO, a glaucoma researcher at the Moran Eye Center’s Alan S. Crandall Center for Glaucoma Innovation. “There is a need to monitor eye pressure more continuously, similar to monitoring blood sugar or blood pressure.”
Enter the iCare HOME2—a compact, handheld device that allows patients to easily measure their eye pressure at home without the need for numbing eyedrops.
“This technology is like a better canary in the coal mine,” said Wirostko. “It helps us detect dangerous pressure changes we might not be seeing in the office before they cause permanent damage. It’s also a valuable new tool for research, helping us to learn more about the underlying pathophysiology of glaucoma as well as comorbidities and associations.”
“There is a need to monitor eye pressure more continuously, similar to monitoring blood sugar or blood pressure.”
RIDING THE TREATMENT ROLLERCOASTER
Like many patients, John Sharkey was surprised by his glaucoma diagnosis. He sought the help of Wirostko several years into his glaucoma treatment journey.
By the time he retired from his law practice 25 years ago, Sharkey had already cycled through different glaucoma therapies, beginning with eye drops before progressing to laser eye surgery. Wirostko introduced him to the iCare HOME2.
“I liked having the feedback—not just an absolute pressure number—but how it changes,” said Sharkey. “My results showed quite a bit of variability during the day even with treatment.”
The handheld device, known as a tonometer, has built-in sensors that help the patient make subtle adjustments to match the contours of their face and align the device with their eye. As with many routine tests during an eye exam, the patient looks at a light in the device while it captures pressure readings.
“It wasn’t hard,” said Sharkey. “It was how I found out one of my surgeries had failed. I was able to get back on medication and schedule the next surgery rather than waiting for more progression to occur.”
iCare HOME2 takes six measurements in rapid succession, eliminating the lowest and highest numbers and logging an average of the remaining readings.
The data, which is displayed graphically and in a table, also includes metadata, such as the date and time when the measurement was taken. The data is downloaded wirelessly to a secure cloud server that the patient and doctor can access.
Like Sharkey, Justin Wilson was surprised by his glaucoma diagnosis.
“Your biggest fear is the fear of the unknown,” he said. “Now I can be proactive, not reactive, in my care. Daily monitoring allows me to be immediately aware of any IOP issues and not have to wait for biannual office visits—a true game changer.”
Wilson also began his therapy with eye drops, but after each new treatment failed to lower his eye pressure, he turned to more invasive therapies. Wilson also sought treatment from Wirostko and found that the Moran Eye Center treated him as an individual, not another number walking through the door.
“Eyes are not a cookie-cutter or one-size-fits-all business,” Wilson said. “At the Moran Eye Center, they look at you as an individual, and they treat your individual problem.”
Understanding Glaucoma
Glaucoma is a group of eye diseases that damages the optic nerve, the part of the eye that carries information defining what you see to the brain. The brain then turns the information into images. Although there are probably several factors that contribute to glaucoma, the best understood is eye pressure. Increased pressure damages the optic nerve over time. Without treatment, optic nerve damage can lead to vision loss and, ultimately, blindness.
NEW STUDY USING ICAREHOME2 AND GENETIC TESTING
Genetics influence how likely you are to develop a host of diseases, and glaucoma is no exception. Doctors can use a measure called a polygenic risk score (PRS), which measures the combined effects of several genes, to assess a person’s risk for developing glaucoma.
Wirostko and her Crandall Center colleagues are launching a study with glaucoma patients who have used or are currently using the iCare HOME2 to monitor their IOP daily.
The study aims to determine if higher PRS scores are associated with elevated IOP and greater and more frequent IOP fluctuations. The answers could help patients, their family members, and doctors make better treatment decisions to manage IOP.
“If we find a correlation, this could be a game-changer for glaucoma patients and even their loved ones,” said Wirostko. “We want to have the best information possible to customize care to each patient and control both high IOP and IOP fluctuations before our patients lose vision. So often we treat after there is already vision loss.”
Participating patients will complete a saliva test to determine their PRS, which will then be compared to their IOP records.
Australian researchers conducted a similar study, published in 2020, involving 239 participants with open-angle glaucoma who used the iCare HOME. The study found that those in the highest PRS quintile were 5.4-fold more likely to show early morning IOP spikes (4-6 a.m. on average) than those in the lowest quintile.
“Much of this groundbreaking work is already happening around the world,” said Wirostko. “Here at the Moran Eye Center, we can help lead the U.S. in this field to learn more about patterns and associations of IOP with a PRS score.”
Support the Research
Donors are needed to help fund saliva testing for the PRS study. Why? The out-of-pocket test cost is $350, which is a barrier for some patients to participate. Data collected from this initial study will be used to secure grants to fund additional research.
Faculty leading the study include:
- Ike Ahmed, MD, FRCSC
- Craig J. Chaya, MD
- Ian F. Pitha, MD, PhD
- Barbara Wirostko, MD, FARVO
