Beyond the Clinic: Home-Based Monitoring Strategies in Glaucoma Care

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Qualitatively described as 'good agreement' for tonometry and 'comparable repeatability and sensitivity' for visual field testing — no pooled effect size or Bland-Altman limits of agreement are reported in the abstract

• Primary Outcome: Agreement between home self-tonometry (iCare HOME, iCare HOME2) and Goldmann applanation tonometry, and comparability of home-based visual field testing with standard automated perimetry in terms of repeatability and sensitivity

• Nnt Or Sensitivity: Sensitivity and repeatability of home visual field platforms described as comparable to standard automated perimetry; specific sensitivity/specificity values and repeatability coefficients are not quantified in the abstract

• Confidence Interval: Not reported

Clinical Application

Technically feasible based on reviewed evidence; iCare HOME devices are anesthesia-free and designed for unsupervised use. Tablet-based and VR-based perimetry platforms are accessible via consumer hardware. However, real-world implementation is constrained by device cost, patient training requirements, data integration with electronic health records, and variable compliance with testing schedules — all of which require health system-level solutions before widespread adoption. The iCare HOME tonometer has TGA registration in Australia (ARTG listed as a Class IIa medical device). It is not currently listed on the Pharmaceutical Benefits Scheme (PBS), and device costs (approximately AUD 800–1,200 for the iCare HOME) represent a significant out-of-pocket expense for patients. Medicare Benefits Schedule (MBS) item numbers do not currently support reimbursement for home tonometry data review or remote monitoring consultations in glaucoma outside of specific telehealth frameworks. The RACGP and Optometry Australia have not yet issued formal guidelines on home glaucoma monitoring integration into primary care. Australian glaucoma specialists (via RANZCO) may find this review useful for informing future guideline development, particularly given Australia's ageing population and the high prevalence of glaucoma in Indigenous Australians and those in rural/remote settings where clinic access is limited. Home monitoring could address geographic health equity gaps, but cost and digital access barriers must be addressed. Adults with established glaucoma (particularly those with documented or suspected diurnal IOP fluctuation, rapid progressors, or those with limited clinic access) who are motivated and have sufficient dexterity and digital literacy for self-monitoring. Patients in early-to-moderate disease stages may derive the greatest benefit from increased visual field testing frequency for progression detection.

Abstract

Glaucoma is a chronic and progressive optic neuropathy, necessitating lifelong monitoring for affected individuals. Traditional surveillance of the disease relies on evaluation of intraocular pressure (IOP), optic nerve anatomy, and visual function at the physician's office, which only provides limited snapshots of a disease characterized by dynamic physiological variation. Developments in portable ophthalmological technologies and digital health platforms have enabled home monitoring of glaucoma. This review synthesizes current evidence on the home monitoring of glaucoma, with a focus on self-tonometry and home-based visual field testing. Handheld tonometers such as iCare HOME and iCare HOME2 allow repeated, anesthesia-free self-measurement of IOP in a real-world setting. These devices have demonstrated good agreement with Goldmann applanation tonometry, the gold standard. Home tonometry captures diurnal variations of IOP, thus providing relevant insights for diagnosis and therapeutic decision-making. Home-based visual field testing (eg, tablet-based platforms, virtual reality-based testing) enables frequent, unsupervised functional assessment with repeatability and sensitivity comparable to standard automated perimetry. Increased testing frequency may facilitate earlier detection of rapid progression, particularly in the early stages of disease. Collectively, evidence suggests the feasibility and clinical relevance of these home monitoring modalities. However, patient compliance with testing schedules and cost-effectiveness remain as challenges.

References

1. 1.Kamdar, A., & Swaminathan, S. S. (2026). Beyond the clinic: Home-based monitoring strategies in glaucoma care. International Ophthalmology Clinics. Advance online publication. https://doi.org/10.1016/j.ogla.2025.10.008