Home tonometry readings above target tracked field loss when clinic pressures did not

Design

Retrospective longitudinal cohort

Population

94 treated open-angle glaucoma patients (150 eyes) using home tonometry

Primary outcome

Association of pressure metrics with visual field progression rate

Effect

Home average IOP excess over target β −0.34 (P = .003); no in-office metric associated

A retrospective analysis in Ophthalmology (30 September 2026) studied 94 treated glaucoma patients (150 eyes) who used a home rebound tonometer for at least seven days and had at least three reliable visual fields. Researchers compared standard pressure measures with new ones capturing how often, and by how much, readings exceeded each patient's target.

Mean pressure was about 13 to 14 mmHg at home and in clinic. No standard measure, from either setting, was associated with the rate of field loss. But the average and total excess of home readings above the patient's own target were associated with faster progression; the same measures from clinic readings were not.

The numbers are small and retrospective, and patients prescribed home tonometry may be those already causing concern. Still, it suggests that clinic snapshots miss the pressure peaks that matter, and that a target is most useful when you can see how often it is breached.

• Consider home tonometry for patients who progress despite clinic pressures at target.
• Look at how often and by how much home readings exceed the target, not just the average.
• Set and record an individual target pressure for every glaucoma patient.
• Do not rely on a single in-clinic pressure to judge control in a progressing patient.

Why it matters

It suggests the pressure that drives progression may happen at home, outside the clinic snapshot.

Don't overread it

A small retrospective association; it does not show that acting on home readings slows progression.

The statistics, in plain English

The regression coefficients (around −0.3 dB a year) describe how much faster the field mean deviation fell for each unit of pressure excess. With 94 patients and several metrics tested, some associations could arise by chance, which is why the authors call for prospective validation.

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