Defining the optimal duration of remote home tonometry for accurate characterization of intraocular pressure fluctuation

This is the authors' abstract. We don't add key points for this paper.

PURPOSE: To determine the minimal duration of remote intraocular pressure (IOP) monitoring needed to yield accurate IOP fluctuation metrics in patients. DESIGN: Secondary modeling analysis of retrospective data, validated with a large national database. PARTICIPANTS: database who utilized an iCare HOME/HOME2 tonometer and recorded ≥3 measurements throughout each day over several consecutive days. METHODS: Bootstrapped progressive day-censorship analyses and exponential decay modeling were used to estimate the number of monitoring days required to achieve 95% of the maximal model-based reduction in error for IOP metrics, including mean, maximum, range, and standard deviation (SD). Ground truth for each metric was defined using all available measurements within each eye-specific monitoring period. Sensitivity analyses assessing the effects of diagnosis, treatment, and three daily IOP measurements were also completed. MAIN OUTCOME MEASURES: Mean absolute error (MAE) and mean relative error (MRE) for IOP mean, maximum, range, and SD; the number of monitoring days required to achieve 95% of the maximal model-based reduction in error. RESULTS: Across both datasets, approximately 6-7 monitoring days were required to achieve 95% of the modeled reduction in error for daily mean, maximum, range, and SD of IOP in the primary analysis. Sensitivity analyses demonstrated longer monitoring requirements in primary open-angle glaucoma (9.1-10.0 days) compared with glaucoma suspects (5.5-6.7 days), secondary open-angle glaucoma (6.4-8.0 days), and primary angle-closure glaucoma (7.8-8.3 days). Monitoring durations remained relatively consistent before and after selective laser trabeculoplasty (8.4-9.0 days) and Hydrus microstent implantation (6.0-6.8 days). Restricting measurements to only three daily IOP recordings throughout the day extended monitoring duration to approximately 10 days in the Moran/Wilmer dataset and longer in the MyEyes dataset. Additionally, 74.1% of peak IOP measurements occurred outside typical clinic hours. CONCLUSIONS: Remote tonometry provides clinically meaningful characterization of IOP metrics beyond traditional office-based measurements. Depending on the clinical context, seven to ten consecutive monitoring days consisting of measurements across each day are needed to represent a patient's true IOP pattern.