At-Home Glaucoma Testing Devices Approved by Patients, Survey Shows

Glaucoma care may soon include more metrics derived from at-home monitoring, an Ophthalmology Glaucoma publication suggests. The research reviewed 2 technologies for monitoring these patients — home tonometry and virtual reality visual field testing. The study included a small cohort of motivated participants, but researchers say it shows the technologies were acceptable and feasible. 

“Patients were able to perform these tests proficiently at home, and they were generally enthused to obtain more data about their intraocular health, as it allowed them a heightened sense of security and insight about their chronic disease, as well as a reduction in foreseeable barriers to care,” the study authors report.

Between July 2021 and October 2021, the prospective feasibility and acceptability study enrolled 39 eyes from 20 patients (mean age 55.4 years, age range 25-83 years, 13 women, 7 men) who had primary open angle glaucoma, ocular hypertension, or suspected glaucoma. Participants were instructed and trained to bring 2 devices home for 1 week and use the tonometer 4 times a day for 4 days, and the virtual reality visual field test 3 times total for 1 week. To measure acceptability, the researchers administered 35-item satisfaction surveys and conducted semi-structured qualitative interviews with thematic analysis. They evaluated feasibility by device usage and quality of tests. 

According to the researchers, 73.7% of patients felt that the tonometer was easy to use and 100% of patients felt that the VT device was easy to use. A total of 100% of patients obtained an acceptable intraocular pressure (IOP) and finished a VF test at home. The team identified 4 key themes with 33 subthemes. 

The key themes were:

1. Benefits of home monitoring.
2. Problems with home monitoring.
3. Future considerations in home monitoring. 
4. The glaucoma patient experience.

Study limitations include possibility of bias measurements due to patients being highly engaged in their eye care, failure to evaluate factors such as socioeconomic status, health literacy, and education, failure to incorporate a screening process to identify reliable visual field test-takers during the recruitment process, and the inability to gauge longitudinal adherence patterns for patients with home monitoring. Further, patients were allowed troubleshooting assistance from a research assistant, but other patients may not receive the same level of support in the wider application of these tests. 

“Home monitoring could allow for better appraisal of disease management, especially through longitudinal data,” according to the study authors. “The additional data gained from home monitoring could allow for more personalized care.”

Reference

Hu GY, Prasad J, Chen DK, et al. Home monitoring of glaucoma using a home tonometer and a novel virtual reality visual field device: acceptability and feasibility. Ophthalmol Glaucoma. Published online May 14, 2022. doi:10.1016/j.ogla.2022.05.001