- Design
- Retrospective longitudinal cohort
- Population
- 94 patients (150 eyes) with treated open-angle glaucoma using home tonometry
- Primary outcome
- Association of pressure metrics with visual field progression (dB/year)
- Effect
- Home average IOP excess β -0.34 (p=0.003); clinic metrics not associated
A retrospective study in Ophthalmology (30 September 2026) analysed 150 eyes of 94 patients with treated open-angle glaucoma who used home rebound tonometry for at least seven days, alongside clinic pressures and at least three reliable visual fields.
Mean pressure was similar at home and in clinic (13-14 mmHg), and no standard pressure measure - mean, peak, range or variability - was associated with field progression. But two new home-derived measures of how much pressure exceeded the patient's individual target (average and total excess) were associated with faster mean deviation loss (for example, absolute average excess β -0.34, p=0.003). Clinic-derived equivalents showed no association.
This suggests a normal clinic pressure can hide repeated spikes above target. It is a small, selected group of patients already chosen for home monitoring, so the new metrics need prospective testing, but it supports home tonometry for patients progressing despite apparently controlled pressure.
- Consider home tonometry when fields progress despite pressures at target in clinic
- Set and record an individual target pressure for every glaucoma patient
- Look at how often home readings exceed target, not just the average
- Treat these new metrics as research tools until validated prospectively
Why it matters
It challenges the reliance on a handful of daytime clinic readings to judge pressure control.
Don't overread it
Retrospective, 94 patients, many metrics tested - not yet a basis for new treatment targets.
The statistics, in plain English
A negative β means a steeper decline in visual field mean deviation as pressure excess rises. Several metrics and thresholds were tested, so some significant results may be chance; the consistent direction across the target-based measures is reassuring but not conclusive.
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