- Design
- Retrospective longitudinal cohort
- Population
- 150 eyes of 94 patients with treated open-angle glaucoma using home tonometry
- Primary outcome
- Association of pressure metrics with visual field progression rate
- Effect
- Home average excess over target β −0.34 (p=0.003); clinic equivalents not associated
This retrospective study analysed 150 eyes of 94 patients with treated open-angle glaucoma who were prescribed at least seven days of home rebound tonometry. It compared standard pressure metrics and new threshold-based measures, describing how often and by how much pressure exceeded a target, from home and clinic readings against the rate of visual field loss.
Mean pressure was about 13 to 14 mmHg on both home and clinic readings. No standard metric, including mean, peak or fluctuation, was associated with field progression. Home-derived measures of average and total excess above each patient's own target pressure were associated with faster progression (for example, absolute average excess β −0.34, p=0.003). The same measures from clinic readings were not.
The finding suggests clinic pressures can look controlled while pressure at home repeatedly rises above target. It supports considering home tonometry for patients who progress despite apparently good clinic pressures. The study is small, retrospective and limited to patients already selected for home monitoring, so it is a reason to test the approach prospectively, not to change monitoring for everyone.
- Consider home tonometry for patients whose fields progress despite clinic pressures at target.
- Set and record an individual target pressure for every glaucoma patient.
- Look at how often home readings exceed target, not just the mean pressure.
- Continue regular visual field testing; home pressure data complement it and do not replace it.
Why it matters
It suggests the pressure that matters may be happening between clinic visits, where a single office reading cannot see it.
Don't overread it
A small retrospective cohort cannot show that acting on home readings slows field loss.
The statistics, in plain English
A negative β here means more pressure excess went with a steeper fall in mean deviation, that is, faster field loss. Several related measures were tested, which raises the chance that some associations are false positives. With 150 eyes from 94 people, the estimates are imprecise.
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