title: Home tonometry for management of pediatric glaucoma.
abstract: OBJECTIVE
  To use iCare rebound tonometry in the home setting for documentation of diurnal intraocular pressure (IOP) fluctuations in children.
  
  
  METHODS
  Nonrandomized, prospective clinical study.
  
  
  METHODS
  Pediatric ophthalmology clinic patients were recruited between October 2009 and February 2010 who were able to cooperate with IOP measurement by iCare rebound tonometry and whose caregiver was willing and able to obtain iCare measurements at home. The child's IOP was measured first by iCare tonometry followed by a second method (Goldmann applanation [GAT]). The caregiver was instructed on the use of the iCare tonometer. The subject's IOP was measured by the caregiver at home at designated time periods for at least 2 consecutive days.
  
  
  RESULTS
  Seventeen children (17 eyes) with known or suspected glaucoma and 11 normal children were included. Excellent reliability was obtained by caregivers in 70% of iCare measurements. Mean difference between iCare and GAT in clinic was 2.0 ± 4.0 mm Hg, P = .08. Daily IOP fluctuation occurred in both subjects with glaucoma and normal subjects. In children with known or suspected glaucoma, relative peak and trough IOPs occurred in the early morning (45%) and late evening (43.5%), respectively. Comparison of the peak IOP measured at home vs in the clinic was >6 mm Hg in 5 of 16 subjects (31%) and affected glaucoma management in several subjects.
  
  
  CONCLUSIONS
  In selected children with glaucoma, home tonometry by iCare rebound tonometry was reliable, easily performed by caregivers, and well tolerated, and offered IOP information valuable in clinical management.
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Meghan S
authors.initials: MS
authors.lastname: Flemmons
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Ya-Chuan
authors.initials: YC
authors.lastname: Hsiao
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dzau
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Asrani
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jones
authors.affiliation: Duke Eye Center, Durham, North Carolina. Electronic address: sharon.freedman@duke.edu.
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology*; D006699:Home Care Services; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D018670:Monitoring, Ambulatory; D009798:Ocular Hypertension / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D014065:Tonometry, Ocular / Q000295:instrumentation* / Q000379:methods
chemical_list: D000959:Antihypertensive Agents