Intraocular Pressure Telemetry for Managing Glaucoma during the COVID-19 Pandemic

Glaucoma Home Self-Testing Using VR Visual Fields and Rebound Tonometry Versus In-Clinic Perimetry and Goldmann Applanation Tonometry: A Pilot Study

Purpose

This pilot study aimed to assess the feasibility, accuracy, and repeatability of unsupervised, at-home, multi-day glaucoma testing using the Olleyes VisuALL Virtual Reality Platform (VRP) and the iCare HOME handheld self-tonometer.

Methods

Participants were trained to use two U.S. Food and Drug Administration-registered or approved devices before conducting self-tests at home over 3 consecutive days. The iCare HOME intraocular pressure (IOP) measurements were collected four times daily per eye, and VRP visual field tests were performed once daily. The results were compared with one in-clinic Humphrey Field Analyzer (HFA) visual field test performed on the day of device training, iCare HOME measurements by the trainer, and the last five Goldmann applanation tonometer (GAT) results.

Results

Of 15 enrolled participants, nine of them (60%) completed the study. The six excluded participants could not self-measure using iCare HOME. There was significant correlation between the average mean deviation (MD) values of the at-home VRP tests and in-clinic HFA test (r2 = 0.8793, P < 0.001). Additionally, the average of the sensitivities in five of six Garway-Heath sectors were significantly correlated. VRP test duration was also shorter than in-clinic HFA testing (P < 0.001). Finally, at-home tonometry yielded statistically similar values compared to trainer-obtained iCare HOME values. The mean and range of at-home tonometry were also statistically similar to those for in-clinic GAT, but at-home tonometry demonstrated higher maximum IOP values (P = 0.0429).

Conclusions

Unsupervised, at-home, multi-day glaucoma testing using two devices resulted in the capture of higher maximum IOPs than in the clinic and good MD correlation of VRP with HFA. However, 40% of participants could not self-measure IOP using iCare HOME.

Translational Relevance

The study findings suggest that at-home remote glaucoma monitoring correlates with in-office testing and could provide additional information for glaucoma management, although patients had more difficulty with the iCare HOME than the VRP.

Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review

Glaucoma, marked by its intricate association with intraocular pressure (IOP), stands as a predominant cause of non-reversible vision loss. In this review, the physiological relevance of IOP is detailed, alongside its potential pathological consequences. The review further delves into innovative engineering solutions for IOP monitoring, highlighting the latest advancements in wearable and implantable sensors and their potential in enhancing glaucoma management. These technological innovations are interwoven with clinical practice, underscoring their real-world applications, patient-centered strategies, and the prospects for future development in IOP control. By synthesizing theoretical concepts, technological innovations, and practical clinical insights, this review contributes a cohesive and comprehensive perspective on the IOP biosensor's role in glaucoma, serving as a reference for ophthalmological researchers, clinicians, and professionals.

EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure

PURPOSE

Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS).

DESIGN

Prospective, multicenter, open-label, single-arm, interventional clinical trial.

PARTICIPANTS

Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy).

METHODS

An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors' IOP measurements at all postoperative visits through 12 months.

MAIN OUTCOME MEASURES

Device position and adverse events.

RESULTS

Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], -5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was -0.2 mmHg (95% CI of LoA, -4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT.

CONCLUSIONS

The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Mental health and social support among glaucoma patients enrolled in the NIH All of Us COVID-19 Participant Experience (COPE) survey

BACKGROUND

The COVID-19 pandemic created many challenges for our society. In this study, we explore how measures of mental health, coping strategies, and social support during the pandemic varied by glaucoma status.

METHODS

A cohort of patients aged 40 and over enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, who answered the COVID-19 Participant Experience (COPE) survey was obtained. We analyzed several measures of mental health, coping strategies, and social support used during the early stages of the COVID-19 pandemic. Surveys were recurring and answered from May 2020 to February 2021. Demographics and the most recently answered survey responses were obtained and stratified by glaucoma status. Pearson's Chi-squared tests and multivariable logistic regressions adjusting for age, gender, race, ethnicity, and income were used to generate p-values, odds ratios (ORs) and 95% confidence intervals (CIs) between outcome measures and glaucoma status.

RESULTS

Of 42,484 patients who responded to All of Us COPE survey items, 2912 (6.9%) had a diagnosis of glaucoma. On Pearson's Chi-squared tests glaucoma patients were less likely to report drinking alcohol (P = 0.003), eating more food than usual (P = 0.004), and using marijuana (P = 0.006) to cope with social distancing than those without a diagnosis of glaucoma. Further, glaucoma patients had lower rates of probable mild, moderate, or severe depression as calculated by Patient Health Questionnaire-9 (PHQ-9) scores (P < 0.001) and had lower rates of reporting some or a lot of stress from social distancing (P < 0.001). However, glaucoma patients were less likely to report having someone to help prepare meals (P = 0.005) or help with daily chores (P = 0.003) if they became sick with COVID-19. In multivariable logistic regression analyses adjusting for confounding factors, no differences were found for measures of mental health or social support.

CONCLUSIONS

Glaucoma patients did not fare worse on many measures of mental health and coping strategies during the early stages of the COVID-19 pandemic compared those without glaucoma. However, a substantial proportion of glaucoma patients still endorsed stress, social isolation, and probable depression, representing challenges for disease management.

Detailed intraocular pressure curve by telemetric tonometry with an implanted pressure sensor before and after PreserFlo® MicroShunt implantation: a case report

Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo^® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo^® MicroShunt to significantly reduce IOP fluctuations.

Patients' Perception of COVID-19 Preventive Measures in Ophthalmology: Satisfaction and Impact on Glaucoma Care and Follow-up

PURPOSE

In response to the spread of COVID-19 in Switzerland, ophthalmology practices implemented a variety of preventive measures in order to minimise the risk of contamination to their patients and staff. Yet, some studies suggested that over a quarter of all glaucoma patients never returned to the clinic after the first lockdown eased. This raises the question of the factors influencing Patients' likelihood to keep their appointments in this COVID-19 era. The aim of this study was therefore to assess ophthalmology Patients' perception of COVID-19 preventive measures, as well as their impact on glaucoma Patients' clinic attendance and follow-up.

METHODS

This was a prospective study based on primary data collected from 12 private ophthalmology clinics in French-speaking Switzerland. A web-based patient experience questionnaire was designed to assess Patients' appreciation of the preventive measures in place at their eye care provider as well as their intention to attend further follow-up appointments. These measures were made on modified 10-point Likert scales. Every patient who attended an appointment at one of the participating clinics on randomly selected dates in October 2020 was offered voluntary enrolment into the study.

RESULTS

In all, 118 surveys were completed and analysed. The mean age of respondents was 57.8 ± 18.0 years, 59.3% were female, and 71.2% were Swiss nationals. Fifty-four (45.8%) of them suffered from glaucoma. Overall, patients were highly satisfied with the measures in place to safeguard them from COVID-19 infection, with a mean score of 9.29 ± 1.35. This was higher amongst Swiss nationals (9.55 ± 0.77) than foreigners (8.65 ± 2.09). On average, responders expressed a 90.2 ± 17.5 percent likelihood to keep their follow-up appointment. The figure went down to 88.5 ± 19.9 percent amongst glaucoma patients (p = 0.58), and 86.3 ± 22.1 percent amongst glaucoma patients aged 65 and over (p = 0.29). Interestingly, older glaucoma Patients' satisfaction with preventive measures in place strongly correlated with their likelihood to keep follow-up appointments (r = 0.72). The correlation was moderate amongst all glaucoma patients (r = 0.46) and weak amongst all respondents (r = 0.38) and those over 65 (r = 0.44).

CONCLUSIONS

The present research highlights the importance of Patients' perception on COVID-19 preventive measures in place in ophthalmology clinics, which was directly associated with their likelihood to keep follow-up appointments. Vulnerable subgroups of patients were more likely to miss their follow-up appointments altogether, and their decision to attend was more strongly influenced by their perceived risk of contracting COVID-19. This suggests a role for telemedicine in more vulnerable patients suffering from progressive diseases such as glaucoma.

[Telemedical applications in ophthalmology in times of COVID-19]

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic access to and utilization of ophthalmologic healthcare providers was partially restricted.

OBJECTIVE

This article provides an overview of already available tele-ophthalmologic applications for better care during the pandemic as well as those still under development.

MATERIAL AND METHODS

The study included an analysis of current scientific publications, analysis of unrestricted screening applications in smart device app stores as well as telemetric medical products specifically designed for home monitoring and discussion of the requirements of an integrated ophthalmologic video consultation.

RESULTS

There is significant interest in tele-ophthalmologic applications and devices as evidenced by a rise in the number of relevant publications. Freely available screening tests for smart phones and tablets are as a rule currently not validated and show significant discrepancies from established standard tests. Telemetric medical devices show great potential for home monitoring in chronic ophthalmologic diseases but must first become established in the clinical routine.

CONCLUSION

There is an unmet need for systematic analysis, development and validation of telemedical applications and medical products for ophthalmology in order to advantageously utilize the potential of telemedicine and to incorporate this into an ophthalmologic video consultation.

Intraocular Pressure Monitoring Using an Intraocular Sensor Before and After Glaucoma Surgery

PURPOSE

Intraocular pressure (IOP) is the only modifiable risk factor for glaucoma, with evidence from landmark randomized controlled trials demonstrating visual field preservation with IOP reduction. Over recent years, the use of remote sensors has formed an increasingly important component of the management of chronic diseases. During the COVID-19 pandemic, the ability to remotely monitor IOP proved particularly useful when public stay at home orders have been in place.

PATIENTS AND METHODS

This report describes the first case of glaucoma surgery in a patient who had previously received an eyemate-IO implant. The eyemate-IO (Implandata Ophthalmic Products) is an implant for intraocular pressure (IOP) monitoring placed in the ciliary sulcus during cataract surgery.

RESULTS

Remote IOP monitoring enabled the clinician to identify sustained high IOP readings and the need for glaucoma surgery. Post-operatively, response to treatment could be monitored to ensure sufficient long-term IOP control.

CONCLUSIONS

The eyemate-IO implanted during cataract surgery in this patient provided valuable remote continuous IOP information that guided timely glaucoma surgical interventions for poorly controlled IOP.