Innovation in tonometry for glaucoma monitoring

Discussing the role of tonometry in glaucoma diagnosis, Adrian Richards, sales director for Mainline Instruments, suggested: “It’s not the only thing that has to be considered when you’re diagnosing, but it’s an indicator and certainly important.”

Mainline Instruments distributes iCare tonometers in the UK, which utilise rebound tonometry to read intraocular pressure (IOP) without the need for anaesthetic drops.

Technological advancements have meant the iCare IC200 handheld tonometer can take measurements from a patient at any angle – sitting, standing, and lying down – making it beneficial for clinics where patients may struggle to sit up at a slit lamp.

Further enhancements to the tonometers have included alignment functions which ensure the device is appropriately aligned to take measurements from the apex of the cornea.

At-home monitoring

The iCare Home2 tonometer has been designed to allow patients to take pressure readings themselves. The device records the date, time, intraocular pressure, and which eye the measurement is for, and the results can be downloaded through an app or to clinic software.

Richards explained: “Some hospitals now loan the devices out to patients with glaucoma so they can use it at home for a few days.”

This means that, instead of taking one pressure reading, multiple readings can be gathered at different times over the course of several days, providing more data and opportunities to spot patterns in increases and decreases of pressure.

This can be particularly helpful for patients with borderline readings, Richards said, who may find their pressures are higher in the mornings after waking.

“That could be doing damage to the eye if the pressure is too high. The increased pressure kills off cells within the eye and those aren’t repairable,” he emphasised.

Over time, patients have shown an increasing interest in their own health, Richards said, adding: “They are very aware that taking a pressure reading can be critical.”

At-home blood pressure monitors are allowing people to take regular readings, and this could be the direction of travel for intraocular pressures. Richards suggested: “I think that’s the way technology will go. It will lead people into more self-monitoring and providing more information for better management of their problems.”

“There’s more to glaucoma diagnosis and management than just pressure, but it’s certainly a good indicator as to how your eye is performing,” he added.

Practice efficiency

Optical supplier, Grafton Optical, has been partnered with AMETEK Reichert Technologies for more than 40 years.

David Thickens, CEO of Grafton Optical, explained: “The demand for reliable and user-friendly tonometry solutions has grown significantly, particularly within High Street optometry practices where efficiency and accuracy are paramount.”

Dave Taylor, director of marketing and business development at AMETEK Reichert Technologies, highlighted the need for tonometry to be easy-to-use and objective, so clinicians can be confident in the results.

Handheld tonometers are gaining popularity particularly due to space constraints in practice and the efficiency of the technology, Taylor added.

Reichert solutions include the Ocular Response Analyser (ORA) G3 and the recently-introduced Tono-Vera Handheld Tonometer.

The ORA G3 offers benefits for risk stratification in glaucoma, providing accuracy in IOP measurement and incorporating corneal hysteresis to support predictions of glaucoma progression, Thickens explained.

“This allows clinicians to make more informed decisions about patient management and treatment plans,” he said.

Taylor suggested that ORA is especially useful for clinicians who see a high number of patients with suspected and confirmed glaucoma, sharing: “It really helps refine who needs to be seen more frequently and possibly treated more aggressively.”

The Tono-Vera Handheld Tonometer features the ActiView alignment system to ensure measurements are taken at the corneal apex for objective and repeatable assessments.

Taylor said: “It takes the guesswork out of the measurement and provides IOP results that the clinician can trust.”

Advancing services

Discussing tonometry technology, Thickens told OT: “These advancements are crucial as optometry practices increasingly adopt a broader range of clinical services within the community.”

“By providing tools that enhance the accuracy and reliability of glaucoma management, we are supporting optometrists in delivering high-quality care to their patients,” he added.

With the technology already advancing, what could be next for tonometry?

“Home measurement of IOP by the patient is already here, but it is quite rare,” Taylor told OT. “This will expand in the future once we better understand how the increased frequency of IOP data can help us better detect and manage glaucoma.”

“Beyond that, implantable IOP devices are on the horizon that will provide 24-hour IOP data. One day we may manage glaucoma more like diabetes, where we have a feedback mechanism that can help us tailor the treatment to the individual eye more so than we are doing today,” he suggested.