Performance of home-based self-tonometry (iCare HOME (TA022)) for measuring intraocular pressure among healthy and glaucoma patients.

Introduction: The purpose of this study was to compare iCare HOME (TA022) with Goldmann applanation tonometer and to evaluate the self-tonometry measurements among the Indian population. Methods: Eligible patients underwent iCare HOME training through guided demonstration (verbal, pictorial, video) and practised self-tonometry measures using iCare HOME. Certification for independent iCare HOME measure was provided if first iCare HOME intraocular pressure (IOP) measurement fell within ± 5 mmHg of Goldmann applanation tonometer (GAT) measurement which was measured by the trained clinician (principal investigator). Certified participants underwent simulated home self-tonometry measurements using iCare HOME, and agreement with GAT IOP measurements was assessed. Results: Seven of 83 participants (8.43%) failed to complete the study due to difficulty in performing the task, leading to non-certification. Patients who could use the iCare HOME had a mean age of 53 ± 15.55years (53% males; 46% females). Only one in 12 subjects did not qualify to use iCare HOME. The overall mean difference between iCare HOME and GAT was 0.83 mmHg (95%, 3.92 and -2.25). At various pressure ranges, 7-16 mmHg, 17-23 mmHg and >23 mmHg, the mean difference between iCare HOME and GAT was 1.22 mmHg (95%, 4.32 and -1.86), 0.77 mmHg (95%,3.69 and -2.19), -0.11 mmHg (95%, 2.52 and -2.74) respectively. The intra-class correlation coefficient of the iCare HOME device was 0.997(95% CI,0.995-0.998). Conclusions: Patients were able to perform self- tonometry using iCare HOME with good reliability and safety. iCare HOME can be used to address the issue of difficulty in acquiring frequent and diurnal IOP measurements by patients doing self-tonometry from home.

Glaucoma and its association with obstructive sleep apnea: A narrative review.

Obstructive sleep apnea (OSA) is one of the systemic risk factors for glaucoma which causes irreversible visual field (VF) damage. We reviewed the published data of all types of studies on the association between these two conditions and papers regarding functional and structural changes related to glaucomatous damage using Scopus, web of science, and PubMed databases. There is evidence that the prevalence of glaucoma is higher in OSA patients, which independent of intraocular pressure (IOP). Studies have reported thinning of retinal nerve fiber layer (RNFL), alteration of optic nerve head, choroidal and macular thickness, and reduced VF sensitivity in patients of OSA with no history glaucoma. A negative correlation of apnea-hypopnea index with RNFL and VF indices has been described in some studies. Raised IOP was noted which is possibly related to obesity, supine position during sleep, and raised intracranial pressure. Diurnal fluctuations of IOP show more variations in OSA patients before and after continuous positive airway pressure (CPAP) therapy when compared with the normal cases. The vascular factors behind the pathogenesis include recurrent hypoxia with increased vascular resistance, oxidative stress damage to the optic nerve. In conclusion, comprehensive glaucoma evaluation should be recommended in patients with OSA and should also periodically monitor IOP during CPAP treatment which may trigger the progression of glaucomatous damage.

Structure-Function Relationship in Glaucoma Using Ganglion Cell-Inner Plexiform Layer Thickness Measurements.

PURPOSE: To evaluate the structure-function relationship between ganglion cell-inner plexiform layer (GCIPL) thickness at the macula and 10-2 standard automated perimetry (SAP) in glaucoma and to evaluate the relationship using a recently proposed linear model. METHODS: In a cross-sectional analysis, structure-function relationship was determined in 50 glaucomatous eyes (40 patients, mean deviation: -15.4 ± 7.5 dB) and 21 control eyes (13 subjects, mean deviation: -3.4 ± 3.0 dB), which had undergone 10-2 SAP and GCIPL imaging on the same day. Functional loss was derived from total deviation numerical values on 10-2 SAP and calculated on both a linear (reciprocal of Lambert) and a decibel scale after accounting for the retinal ganglion cell displacement at the macula. Strength of relationship was reported as coefficient of determination (R2) of the linear regression models fitted to the data separately for different sectors. The relationship was also evaluated using a linear model. RESULTS: The R2 for the associations between GCIPL thickness sectors and the corresponding sector SAP total deviation values ranged from 0.19 (for superonasal GCIPL sector) to 0.60 (for average GCIPL thickness) when functional loss was calculated on the decibel scale and 0.16 (for superonasal sector) to 0.54 (for inferior sector) on the linear scale. All associations were statistically significant (P < 0.05). The linear model fitted the data reasonably well. CONCLUSIONS: Significant structure-function associations were found between GCIPL thickness measurements at the macula and the functional loss measured on 10-2 SAP in glaucoma. Best fit was found for the inferior and average GCIPL sector thickness. The linear model was useful to study the structure-function relationship.

Comparing the Structure-Function Relationship at the Macula With Standard Automated Perimetry and Microperimetry.

PURPOSE: To compare the structure-function relationship between ganglion cell-inner plexiform layer (GCIPL) thickness measurements using spectral-domain optical coherence tomography (SDOCT) and visual sensitivities measured using standard automated perimetry (SAP) and microperimetry (MP) at the macula in glaucoma. METHODS: In a prospective study, 45 control eyes (29 subjects) and 60 glaucoma eyes (45 patients) underwent visual sensitivity estimation at the macula (central 10°) by SAP and MP, and GCIPL thickness measurement at the macula by SDOCT. Structure-function relationships between GCILP thickness and visual sensitivity loss with SAP and MP at various macular sectors were assessed using the Hood and Kardon model. To compare structure-function relationship with SAP and MP, we calculated the number of data points falling outside the 5th and the 95th percentile values of the Hood and Kardon model with each of the perimeters. RESULTS: The number of points falling outside the 5th and 95th percentile values of the Hood and Kardon model ranged from 28 (superior sector) to 48 (inferonasal sector) with SAP and 33 (superior sector) to 49 (inferonasal sector) with MP. The difference in the number of points falling outside the 5th and 95th percentile values with SAP and MP was statistically insignificant (P > 0.05, χ(2) test) for all the sectors. CONCLUSIONS: Visual sensitivity measurements of both SAP and MP demonstrated a similar relationship with the GCIPL measurements of SDOCT at the macula in glaucoma.