Dr Malvika Gupta explains why the iCare EIDON Ultra-Widefield fundus camera is a “jack of all trades and master of many” – and why that makes it a necessity in practice, even if it’s not a billable item.

Eye care professionals are well aware of the need to visualise the peripheral retina when diagnosing and managing retinal disease. With the evolution of new technology, this is becoming easier to do and the details provided are increasingly revealing. Devices like iCare’s EIDON Ultra-Widefield, with TrueColor confocal technology, are also providing valuable opportunities to educate patients about their disease states, in the first instance and as time goes by.

For ophthalmologist Dr Malvika Gupta from Eastern Eye Specialists in Melbourne, having “fought to invest in the iCare EIDON for three years at the Sunbury practice” this device has become a clinical necessity that she wouldn’t be without. “I’m a pioneer in wanting to provide good patient education and I knew that this device would enable me to do exactly that. It provides a platform from which you can literally share information you see with your patient – you can show them what you are talking about. “And it’s also an extra safeguard. In busy retinal practices you can easily miss things you’re not looking for when you’re viewing a cataract, the optic disc, and the macula, so having a fundus camera is a safeguard against that – even a tiny spot is visualised under magnification – right there in your face,” she told mivision.

Getting from A to B

With an expanded field of view of the retina up to 200°, iCare’s Ultra-Widefield imaging technology provides more information about the signs of pathologies in the periphery. Besides the TrueColor  confocal images, it enables the acquisition of Ultra-Widefield infrared, autofluorescence, and  fluorescein angiography images. Dr Gupta said many eye care professionals will be hesitant to invest in the device because “it is not a billable item” and therefore there is “no financial or economic reason to have the device”. However, for her, the benefits it delivers far outweigh the costs. “It’s like buying a car. Any car will get you from A to B, so buying a luxury car is not a necessity – you don’t have to pay for one, but having invested in one will bring in more ease and make the experience more enjoyable and worthwhile. “As ophthalmologists, we spend two thirds of our lives at work, we’re workaholics, so why not pay more attention to the experience and spend a little more on the devices that enhance our clinical experience and the experience for our patients.”

Encouraging compliance

Dr Gupta said the device can be invaluable when getting patients onboard with their recommended treatment plan. Using the Eidon’s images, she can now show patients the true picture, literally and then over time, demonstrate the change being achieved.

“Communication flows easily when you can highlight their own pathology and compare it with another image, showing normal or far advanced disease,”

“The images are crystal clear, with perfect contrast, and a high degree of peripheral visualisation – it’s easy to show the normal and the abnormal, which makes it easy for patients to understand complex messages,” she said. When a patient is being treated with anti-VEGF for a macular haemorrhage for instance, she shows them, over time, how it disappears following injection therapy. “Otherwise, they come in, have an injection and they don’t see what’s going on. It is very rewarding and includes patients in their own care.

“Similarly, I can show them a scar and they can see what it looks like. When a patient’s life is going to change based on a diagnosis, their ability to see it and come to terms with it visually is comforting for them and satisfying for me as a clinician.  “So, I feel it’s a necessity – there’s comfort in sharing complex clinical information with the patient and them being able to have that same realisation as I do.”

Of greatest value is explaining eye disease to patients who have few symptoms. “There are patients with poor vision, and they will be motivated to come on board with treatment to recover what vision they’ve lost, or at least maintain the vision they have. “The more challenging patients are those who have reasonably good vision – and this is where the motivation is important.

“Someone with 6/7.5 vision, who is not particularly symptomatic, has their diabetes reasonably under control, yet may be developing worsening eye disease. I pick up early signs but because they’re not noticing any change, they can’t comprehend why I want them to see me more regularly. It’s hard for them to fathom the reality of disease severity and progressive nature. she explained. “With the camera, I can show a patient their leaking microaneurysms and proximity of the exudates to the foveal centre. This makes the threat real and motivates them to manage their systemic diseases, like diabetes and hypertension, better and be more compliant to frequent visits. They will come back every three months and, with fundus  imaging,  together we can monitor the change and manage as needed.”

Dr Gupta said it’s also helpful when you want to reassure a patient that treatment is not necessary. “I had a patient with a microaneurysm. They often rupture and spontaneously heal but if leaking into the macula persists, treatment is probably needed. “Rather than telling the patient, I was able to show them that the microaneurysm was located away from the fovea, with no immediate threat of leakage into the macular centre or line of sight. This helped explain why I didn’t feel the need to treat them. That was immediately reassuring for the patient. Sharing imagery of the disease signs helps justify a treatment plan so much more effectively than a one-sided didactic conversation.”

Connected devices

Having had the iCare EIDON Ultra-Widefield for a year now, Dr Gupta said it has been a worthwhile investment and, despite a few teething issues, a “set and forget”. “There have been a few teething issues – something as simple as patients wearing masks while doing the scans caused the lenses to fog. We were getting really poor scans and we couldn’t figure out why. The Designs for Vision) rep suggested the patients take their masks off and life changed. The machine did not know that (mask wearing) would ever be a challenge, and we were not aware of the possibility. “Another issue that took us by surprise was the impact of lighting – we had to place the camera in a brightly lit area, and we couldn’t dim the lights enough to enable good images. The rep suggested a veil over the device when taking the pictures, which worked brilliantly. So, you have to provide the right circumstances for the camera to be able to function. “We’re amazed by the picture quality, we make montages all the time – it’s beautiful – you’re taking the pictures, auto fluorescein images, angiograms, and creating montages, all from one device, which makes it more useful. “Some might say that the iCare EIDON must be a ‘jack of all trades, master of none’ but I don’t believe in that – if you want to specialise in one thing you can, but is that what’s really needed; what you will actually use day-to-day? Just because this device does five things, that does not mean it’s not going to be good enough. I’d suggest those people with doubts try it. I think it is ‘jack of all trades – and master of many!”

With cloud connectivity and devices increasingly integrated from clinic to operating theatre, Dr Gupta said she strongly feels the equipment and diagnostics she invests in must have the potential to talk to each other – if not now, then in the near future.

With this in mind, she’s decided that it makes sense to “keep it in house” by buying from one supplier who will be able to assist with upgrades, software, and the integration of devices into one platform. “Communication flows easily when you can highlight their own pathology and compare it with another image, showing normal or far advanced disease”

The post Luxury vs Necessity, Finding the Balance in an iCare EIDON appeared first on iCare.

Rebound self-tonometry has revolutionized glaucoma care over the last two decades. iCare HOME tonometers empower patients to take self-measurements and offer accurate real-world IOP data, that can support medical practitioners in their clinical decisions. Recent scientific publications attest to the convenience, reliability, and value of iCare HOME tonometers in modern-day glaucoma care.

The role of self-measurements in confirming the IOP-lowering effect of a medication regimen

Research by Mizohata et al¹ observed that thanks to frequent IOP measurements, which can be done by the iCare HOME tonometer, even a small change in IOP can prove statistically significant.

The motivation for the study was that it is difficult to follow changes in IOP in glaucomatous eyes comprehensively because of the limited number of outpatient examinations. The findings were reported in a case of a 50-year-old patient with normal tension glaucoma (NTG) and a nasal step visual field defect in his right eye.

To evaluate the IOP-lowering effect of different medications, the patient was instructed to self-measure his IOP using the iCare HOME tonometer twice a day. The patient was treated using only 0.005% LAT ophthalmic solution in the first treatment period, then using a LAT and carteolol fixed combination (LCFC) for the second treatment period and finally using a brimonidine and brinzolamide fixed combination (BBFC) together with an LCFC ophthalmic solution.

Comparisons of the IOPs between the different treatment periods showed that the reductions in the IOP were significant. The authors concluded that by performing a large number of IOP measurements, even a small change in IOP of about 1-2 mmHg can be determined to be statistically significant and can confirm the significant IOP-lowering effect of a specific medication regimen.

Frequent measurements for more comprehensive data: The study cites research to point out that while Goldmann Applanation Tonometry (GAT) is the most widely accepted method of measuring IOP², it’s not the most convenient or time efficient.

To measure IOP by GAT, patients need to come to the clinic, be topically anesthetized, and have the IOP measured by a trained doctor or technician. In addition, to follow the course of the IOP changes accurately, frequent measurements need to be made in the clinic.

The iCare HOME tonometer overcomes these problems by enabling measurements without anesthesia — patients can be trained to record their IOPs accurately and safely³ and self-measurements can be performed by the patient daily to obtain a more detailed evaluation of the diurnal and daily fluctuations in the IOP^4-7.

Measuring IOP at home can reveal patterns not apparent during in-clinic measurements

A study by A.M. Levin et al ⁸  describes 12 cases (18 eyes) of patients who underwent IOP-lowering interventions for primary or secondary glaucoma. They used iCare HOME devices to measure their IOP before and after the interventions to gain a better understanding of individual diurnal and nocturnal IOP fluctuations.

The study found that home tonometry can reveal patterns that are not apparent during in-clinic measurements, particularly when in-clinic IOP appears stable. Higher peaks and greater fluctuations have been identified by home IOP monitoring outside of clinic hours than by in-clinic tonometry.⁹

Prior studies have not extensively explored the utility of home tonometry in monitoring response to interventions. The authors noted that postoperatively, home IOP monitoring may help the surgeon gain a better understanding of the impact of the procedure more quickly than would otherwise be obtained by consecutive clinic visits.

Through reliable data, home tonometry offered a better understanding of the response to the intervention, which was sometimes sub-optimal and required further intervention at early time points. The authors point out that many other studies have demonstrated that iCare HOME measurements are accurate and reproducible.^9-12

Offering convenience to patients and professionals: The study highlighted that home monitoring has the potential to reduce the number of in-person clinic visits scheduled solely for IOP monitoring, which could be an inconvenience for the patient as well as potentially delay earlier intervention.

The cases in the study demonstrate how home tonometry can augment clinical decision-making and evaluate the impact of IOP-lowering interventions. The authors propose that home tonometry has the potential to be a useful tool that can positively impact the care of glaucoma patients.

Self-tonometry with iCare HOME — a valuable method to complement traditional glaucoma care

A doctoral thesis by Laurence Quérat¹³ that studied the self-monitoring of intraocular pressure and its clinical application attests to the significant role a device like the iCare HOME tonometer could play in glaucoma care.

The thesis included five papers:

• Paper I: Self-tonometry as a complement in the investigation of glaucoma patients ¹⁴
• Paper II: Monitoring daily intraocular pressure fluctuations with self-tonometry in healthy subjects. ¹⁵
• Paper III: Home vs. Goldmann applanation tonometry: Agreement of methods and comparison of inter-observer variation at a tertiary eye centre. ¹⁶
• Paper IV: Impact of self-tonometry on glaucoma treatment decision. ¹⁷

The findings highlighted the feasibility and reliability of self-tonometry, the usefulness of monitoring different IOP patterns from day to day, and the presence of IOP peaks outside office hours. In Papers I and II, more than 60% of glaucoma patients had their highest IOP levels in the morning.

The authors found that more than 85% of the study participants were able to perform self-tonometry (Papers I, II, and III). Overall, approximately 70% of the measurements made with iCare self-tonometers were within 3 mmHg of GAT measurements. Tonometry with iCare HOME used by the patients themselves had less inter-user variation compared with GAT measured by healthcare professionals. In paper III, the inter-user agreement between the users was excellent with iCare HOME, at 0.903 (95% CI 0.880–0.959), and good with GAT, at 0.741 (95% CI 0.558–0.849).

The thesis also found that high IOP measurements collected during IOP phasing with self-tonometry could motivate additional treatment.

Self-tonometry provided clinicians with a solid basis on which to make their decisions and avoid a possible under or over-treatment for the benefit of patients. The paper concluded that self-tonometry with iCare HOME appears to be a valuable complement to traditional glaucoma care — the measurements taken by patients played an important role in the clinicians’ decisions.

¹ Mizohata H, Ikesugi K, Kondo M. Frequent self-monitoring of intraocular pressure can determine effectiveness of medications in eyes with normal tension glaucoma: A case report. Medicine 2022;101:52(e32478).

² Zeppieri M, Gurnani B. Applanation tonometry. In: StatPearls. Treasure Island (FL): StatPearls Publishing LLC.; 2022. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK582132/

³ Takagi D, Sawada A, Yamamoto T. Evaluation of a new rebound self-tonometer, Icare HOME: comparison with Goldmann applanation tonometer. J Glaucoma. 2017;26:613–8.

⁴ Scott AT, Kanaster K, Kaizer AM, et al. The utility of iCare HOME tonometry for detection of therapy-related intraocular pressure changes in glaucoma and ocular hypertension. Ophthalmol Glaucoma. 2022;5:85–93.

⁵ Tong J, Huang J, Kalloniatis M, et al. Clinical trial: diurnal IOP fluctuations in glaucoma using latanoprost and timolol with self-tonometry. Optom Vis Sci. 2021;98:901–13^.

⁶ Rosenfeld E, Rabina G, Barequet D, et al. Role of home monitoring with iCare ONE rebound tonometer in glaucoma patients management. Int J Ophthalmol. 2021;14:405–8.

⁷ Qassim A, Mullany S, Awadalla MS, et al. A polygenic risk score predicts intraocular pressure readings outside office hours and early morning spikes as measured by home tonometry. Ophthalmol Glaucoma. 2021;4:411–20.

⁸ Ariana M. Levin, et al. The utility of home tonometry for peri-interventional decision-making in glaucoma surgery: Case series. American Journal of Ophthalmology Case Reports 28 (2022) 101689

⁹ Tatham AJ, Young SL, Chew E, Brown L. A comparison of short-term intraocular pressure fluctuation with office-based and home tonometry. Ophthalmol Glaucoma. Published online August 17, 2020. doi:10.1016/j.ogla.2020.08.005.

¹⁰ McGlumphy EJ, Mihailovic A, Ramulu PY, Johnson TV. Home self-tonometry trials compared with clinic tonometry in patients with glaucoma. Ophthalmol Glaucoma. 2021;4(6):569–580. https://doi.org/10.1016/j.ogla.2021.03.017.

¹¹ Ogle JJ, Soo Hoo WC, Chua CH, Yip LWL. Accuracy and reliability of self-measured intraocular pressure in glaucoma patients using the iCare HOME tonometer.  J Glaucoma. 2021;30(12):1027–1032. https://doi.org/10.1097/IJG.0000000000001945.

¹² Mudie LI, LaBarre S, Varadaraj V, et al. The iCare HOME (TA022) study: performance of an intraocular pressure measuring device for self-tonometry by glaucoma patients. Ophthalmology. 2016;123(8):1675–1684. https://doi.org/ 10.1016/j.ophtha.2016.04.044.

¹³ Laurence Quérat. Self-monitoring of intraocular pressure and its clinical application. Thesis for doctoral degree (Ph.D.). Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 2022.

¹⁴ Chen E, Quérat L, Åkerstedt C. Self-tonometry as a complement in the investigation of glaucoma patients. Acta Ophthalmol. 2016 Dec;94(8):788-792. doi: 10.1111/aos.13129. Epub 2016 May 26. PMID: 27227556.

¹⁵ Quérat L, Chen E. Monitoring daily intraocular pressure fluctuations with selftonometry in healthy subjects. Acta Ophthalmol. 2017 Aug;95(5):525-529. doi: 10.1111/aos.13389. Epub 2017 Mar 14. PMID: 28296082.

¹⁶ Quérat L, Chen E. iCare Home vs. Goldmann applanation tonometry: Agreement of methods and comparison of inter-observer variation at a tertiary eye centre. Eu Ophthalmol. May 2022. doi:10.1177/11206721221099252.

¹⁷ Quérat L, Chen E. Impact of self-tonometry on glaucoma treatment decision. Accepted for publication. Acta Ophthalmol. 2022 Sep

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Any ophthalmic practice can benefit from tools that are reliable and accurate. But when the patients in question are young children, patient-friendly medical devices that promise speed and efficiency can make all the difference in helping eyecare professionals offer a smooth and comfortable patient experience.

“50% of my patients are children and some of them are very young — they don’t always cooperate,” explains Dr. Mario Angi, an ophthalmologist based in Padua, Italy where he sees about 100–120 patients per week.

The doctor mainly deals with cases of myopia and astigmatism, but in some cases, also rarer syndromes, congenital disorders, or optic nerve head diseases in children.

“Our workflow usually starts with a visual acuity test and in some cases, a video refractometer. We check the patient to examine the fundus of the eyes and check the intraocular pressure (IOP) if needed. Sometimes, we take a retinal image to document anomalies like congenital deformation, infections, or rare cases of retinal diseases in children,” Dr. Angi explains.

The biggest challenge of a primarily pediatric practice is to be able to test a child’s eye painlessly, accurately, and most importantly, quickly.

“I use iCare’s IC100 tonometer and the EIDON fundus camera in my practice and I appreciate how truly user-friendly and practical they are. They make my work faster and more efficient,” Dr. Angi adds.

Discover how rebound tonometry compares with Goldmann applanation tonometry in recent research.

Quick, accurate, and painless — iCare devices simplify diagnostic testing in young patients

All iCare’s tonometers, including the iCare IC100, use patented rebound technology, which allows painless and hygienic IOP measurement without the need for anesthetic drops or any special preparation.

“Traditional tonometers that require you to administer an anesthetic to children are not the best choice in private practice. I use the iCare tonometer with every single child effortlessly and get accurate results with great speed,” Dr. Angi says.

According to Dr. Angi, who has over 40 years of experience in the field, efficient documentation plays a very important role in helping with diagnosis.

“iCare devices consistently and reliably provide very high-quality images and accurate test results that support me in my diagnostic work.”

Read more about iCare’s range of cutting-edge fundus imaging devices that provide unique confocal-based technology and capture ultra-high-quality, detail-rich images.

Building trust with the help of intuitive and user-friendly technology

The advanced technology combined with the intuitive user interface of iCare devices can significantly help cut down test times, which not only optimizes clinical workflows but is also reassuring to patients, especially the youngest ones.

“Our patients appreciate how easy the devices are to use. Measurements can be taken easily when the child is seated on a parent’s lap, and they don’t feel any pain during the procedure. With our youngest patients, I create moments of play around measuring the IOP. The tests go by quickly and the whole experience helps us build trust with the parents,” Dr. Angi says.

On the other side of the table too, operating the device requires minimal staff training, bringing speed, precision, and efficiency to the eyecare practice.

“Each one of my three assistants uses an iCare tonometer. They are authorized to check the optical nerve and visual field of the eye if they observe high IOP. The IC100 has a handy green light feature that indicates correct positioning. The smart features of the EIDON make it easy for my staff to take a picture of the exact spot I indicate in the retina,” Dr. Angi says.

By the time the doctor receives the patient, the images are already in an easily accessible database.

“The Remote Viewer feature is pretty useful. The patients are also happy that I can explain their situation to them using the high-quality images on my screen.”

Read more about our user-friendly Remote Viewer feature that enables data access and data analysis on multiple review stations here.

Dr. Angi also outlines the benefits of using iCare devices during large-scale screening when time and accuracy are of the essence.

“The sterile tips can be changed easily and the speed with which you can conduct a test is impressive. I extensively used the iCare tonometers when I was in Africa working for the Christian Blind Mission. The devices are excellent for screening in every space of the world,” he adds.

Find out which of the iCare tonometers is best suited for your practice.

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With many years of experience developing retinal imaging devices, iCare is highly ranked for scientific excellence and well known for providing ophthalmic imaging devices that help doctors diagnose and monitor eye disorders, retina diseases, and glaucoma with high accuracy. Following the success of the iCare DRS, the iCare team has carefully crafted the iCare DRSplus – a new imaging device that combines the best of fundus imaging technology with TrueColor Confocal technology to provide a new gold standard for retinal imaging.

iCare DRSplus confocal fundus imaging system uses white LED illumination that produces 45° detail-rich images and up to 80° mosaic images with greater resolution and contrast compared with traditional fundus camera imaging devices. Clarifying visualization further, red-free filtering is used to enhance the detail of retina vasculature, blue images provide a clearer image of the nerve fiber layer, and the red channel allows light to penetrate deeper into the retina. The confocal technology is also able to scan through cataracts and can therefore lead to clearer diagnosis and documentation of ocular disease in these patients.

Efficient but patient friendly

Alongside producing high-quality images, the iCare DRSplus provides a comfortable patient experience. The reduced flash intensity has a softer effect on the pupil and the non-mydriatic device permits imaging through pupils as small as 2.5mm – negating the need for dilating drops and dark environments. The quick and easy patient positioning paired with a quick examination period, ensures that the device is both comfortable and adept.

With a focus on automated capabilities – including auto-alignment, auto-focus, auto-exposure, and auto-capture – the intuitive imaging
system requires minimal staff training. Offering live IR preview and filtering options that make image post-processing simpler, the device ensures a more consistent and efficient workflow. Reviewing retinal images is also made easier by the touch screen that allows for easy magnification – and the remote viewer feature allows access to remote data from multiple review stations.

Championing a spirit of innovation, creativity, and exceptional expertise, iCare continues to shape products in collaboration with customers, industry leaders, and world-class researchers. This latest innovation simplifies the current standard of retinal imaging and paves a new pathway for the future of imaging devices.

The post Why the iCare DRSplus raises the retinal imaging benchmark appeared first on iCare.

Jose Maria Martínez de la Casa, Professor of Ophthalmology at the Hospital Clínico San Carlos, Universidad Complutense in Madrid, Spain, explains his reliance on iCare rebound tonometers

At my practice, I see approximately 50 to 60 private and public patients – most with glaucoma – every day. Ergonomics plays a huge role for both me and my patients. And maintaining quality while efficiently managing time is also crucial. In short, I need a streamlined practice that allows me to see all my patients in a comfortable setting, with enough time to discuss the important aspects of their disease, treatment options, and other elements.

Measuring IOP is a fundamental part of my practice – and of any ophthalmic examination – so when planning the workflow, I consider the points above about comfort and time carefully. The patient is usually seated when their IOP is being measured; but occasionally, for example, with bedridden patients or examinations of children under general anesthesia, measurements must be taken with the patient lying down, which presents additional challenges.

For my practice, I chose versatile rebound technology tonometers – currently the iCare IC200. We were certainly early adopters of this technology, but only because I was convinced of its utility the moment it became available. Over the years, the iCare tonometers have been modified to improve their use, with additional features like indicators of correct alignment, where a green light shows when the tonometer is correctly aligned with the corneal apex (a red light comes on when it is not). Also, the corneal distance indicator shows whether the tip of the probe is too close or too far from the cornea. All of these optimizations give me a high level of trust in the reliability and accuracy of any measurements taken.

We currently work interchangeably with iCare’s IC100 and IC200 tonometers, and we also have patients using the iCare HOME2 model that allows them to monitor their IOP remotely. All these models perform well in our workflow and they are very reliable under all circumstances.

Reliant rebound

Automatic calibration of the tonometer and reliability in measurement indicators make the process very simple – and that means measurements can be made by a range of healthcare professionals (ophthalmologists, residents, optometrists, and others) with different levels of experience, improving the workflow and taking pressure off an already busy ophthalmologist. The fact that no anesthetic or fluorescein is required gives the tonometer a broad spectrum of use.

There are many situations where my team only uses rebound tonometry. In my opinion, these devices are good substitutes for the Goldmann tonometer, yielding similar results, and they have a clear advantage over air-puff tonometry: namely, portability. I have noticed small differences when comparing measurements with those from applanation tonometers, but I believe they may be the result of poor Goldmann tonometer calibration rather than the inaccuracy of the rebound tonometer. In any case, these differences are usually consistent, so it is easy to predict the Goldmann pressure based on the rebound tonometer measurement.

Over the years, I have found iCare tonometers to be reliable, very fast, and especially useful for some patients, such as postoperative cases where contaminated fluorescein drops can cause infections. They have also changed our management of pediatric patients, with or without glaucoma, as it is much easier to obtain a measurement than with applanation tonometry. We can now measure IOP in children as young as a few months, without the need for examination under anesthesia – that’s in stark contrast to applanation tonometers that demand the instillation of a drop or the opening of eyelids.

Improving eye care

The risk of cross-contamination has always been a problem with applanation tonometers, notably, the disposable probes of iCare tonometers completely eliminate any such risk. The distance between the examiner and the patient is also increased when using rebound tonometers, which further decreases the risk of viral infection transmission. With COVID-19 still being a global health concern, this advantage cannot be taken as lightly as it perhaps was in the past! During the hardest times of the COVID-19 pandemic, rebound tonometry was an important ally in our practices. And in their guidelines for safe practice during the easing of COVID-19 control measures, Spanish ophthalmology societies recommended that air-puff tonometers should not be used to avoid the formation of aerosols that could potentially spread the disease; applanation tonometry was also not suitable due to the contact with the corneal surface and the close proximity to the patient (1).

Final words

I wholeheartedly recommend iCare tonometers to my colleagues; I think they are essential in our practices today. I encourage everyone to try them – for I am sure that they will not look back!
Perhaps more important than my own personal view is that patients are happy with my team using iCare tonometers, which offer quick and painless measurements without the need for anesthetic. Moreover, it is possible to show the patient their pressure, which really helps strengthen the doctor-patient relationship and can improve compliance and adherence.

Cutting Out COVID-19 Cross-Contamination

iCare rebound tonometers enable measuring IOP in a way that is free from air puffs, microaerosol drop formation, and anesthetic drops, which greatly reduces the risk of cross-contamination – no mean feat during a pandemic. iCare’s tonometers are also one of the only handheld tonometers that use safe, disposable probes, protecting patients from transmitting infectious diseases. These single-use, hygienic probes are individually packed and allow for dropless IOP evaluation, protecting patients from contamination. They are also very easy to use for eye care professionals.

Reference

1. JA Gegúndez-Fernández, “Spanish Ophthalmology Societies. Recommendations for ophthalmologic practice during the easing of COVID-19 control measures,” Acta Ophthalmol, 99, e973 (2021). PMID: 33433050.

The post Tonometry Technology Growing in Leaps and Rebounds appeared first on iCare.

iCare’s first patented rebound tonometer revolutionized the world of tonometry in 2003. Today, iCare tonometers are available in over 100 countries and more than 100 000 devices have been sold globally.

Distinguished reliability in IOP measurement proven in over 200 clinical studies

iCare’s handheld rebound tonometers have been heavily researched by the scientific community. According to several recent studies*, iCare’s rebound tonometry offers excellent reliability and demonstrates the capability to portray changes in intraocular pressure (IOP) more robustly than Goldmann applanation tonometry.

Combined with an enhanced user experience for eye care professionals and patients alike, this presents a noteworthy challenge to the gold standard of IOP measurement.

Read an overview on recent scientific publications comparing rebound tonometry and Goldmann applanation tonometry.

Innovative rebound technology enables safe, hygienic, and patient-friendly IOP measurement

iCare’s rebound technology is based on a simple, effective principle: the lightweight, single-use probe makes quick contact with the cornea and rebounds back. This applanation-free method allows painless and hygienic IOP measurement without the need for topical anesthetic or calibration. The safe and gentle measurement technique also enables measuring during and immediately after surgery.

Discover the benefits of rebound tonometry during times of heightened hygiene requirements and the COVID-19 pandemic.

200 degrees of positional freedom with the iCare IC200 tonometer

Usability and performance have always been at the heart of iCare’s tonometers, and recent developments have taken these aspects even further. The iCare IC200 tonometer offers a full 200 degrees of positional freedom, making it possible to measure IOP accurately in supine, reclined, and sitting positions. This is especially useful in clinical, surgical, or emergency settings.

The alignment assistant makes it quick and easy to achieve accurate results. A high-visibility indicator confirms the correct position for reliable measurement with a green light.

20 years of experience in versatile clinical tonometers

During the past 20 years, iCare has launched an assortment of rebound tonometers for different uses, from the most versatile clinical tonometer with positional freedom to the world’s first self-tonometer for 24-hour IOP monitoring by patients themselves.

“The difference between readings we obtain in the office and the data from the iCare HOME is like the difference between a single snapshot and a continuous movie of a patient’s daily life.”
– Ike K. Ahmed, MD, FRCSC
(Mapping Diurnal IOP Fluctuations at Home, Insert to Glaucoma Today | September/October 2018)

All iCare tonometers deliver accurate results and are exceptionally fast and easy to use. The ergonomic handheld devices require only minimal training and help to maintain an efficient patient flow.

Learn more about the features of the different iCare tonometer models.

* Realini T., McMillan B., Gross R. L., Devience E., Balasubramani G.K. Assessing the Reliability of Intraocular Pressure Measurements Using Rebound Tonometry. Journal of Glaucoma. May 27, 2021 – Volume Online First – Issue – doi: 10.1097/IJG.0000000000001892

Gómez-Gómez A., Talens-Estarelles C., Alcocer-Yuste P., Nieto J.C. Reliability of iCare ic100 Rebound Tonometry and agreement with Goldmann Applanation Tonometry in Healthy and Post-myopic LASIK Patients. Journal of Glaucoma. May 12, 2021 – Volume Online First – Issue -doi: 10.1097/IJG.0000000000001878

Nakakura S., Asaoka R., Terao E., Nagata Y., Fukuma Y., Oogi S., Shiraishi M., Kiuchi Y. Evaluation of rebound tonometer iCare IC200 as compared with IcarePRO and Goldmann applanation tonometer in patients with glaucoma. Eye and Vis 8, 25 (2021). doi: 10.1186/s40662-021-00249-z

Badakere S.V., Chary R., Choudhari N.S., Rao H.L., Garudadri C., Senthil S. Agreement of Intraocular Pressure Measurement of Icare ic200 with Goldmann Applanation Tonometer in Adult Eyes with Normal Cornea. Ophthalmol Glaucoma. 2021 Jan-Feb;4(1):89-94. Epub 2020 Aug 13. Erratum in: Ophthalmol Glaucoma. 2021 Mar-Apr;4(2):234. PMID: 32801019. doi: 10.1016/j.ogla.2020.08.004

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Dr. Mario Economou, glaucoma specialist at Sophia hemmet and Ögonläkargruppen Praktikertjänst in Sweden, and his patient, Mr. Tor Wådell, a glaucoma patient, give high praise to iCare HOME and HOME2 tonometers.

Doctors benefit from engaging patients with home measurements

“As a doctor, I find it a significant advantage when my patients have more knowledge and are interested and involved in the management of their eye pathology. Measurements with the iCare HOME and HOME2 tonometers are reliable, and the data helps us to better assess the status of any glaucoma present,” Dr. Economou states.

“Intraocular pressure (IOP) is the only clinical parameter that we ophthalmologists can influence with treatment. Therefore, it is very important to get a comprehensive view of diurnal IOP patterns over time,” he emphasizes.

Comprehensive IOP data provides better insight into the progression of glaucoma

Typically, ophthalmologists meet their glaucoma patients 2–3 times a year, during office hours, and take a single IOP measurement at each visit. Without self-tonometry, it is impossible to monitor short-term IOP fluctuations and adequately understand how the pressure behaves in between visits to the clinic.

“The iCare HOME2 tonometer provides valuable continuous IOP information. The data tells us how the pressure is affected for 24 hours when we change medication, do a laser treatment, or an operation. This way we have better control over the development of glaucoma and can better monitor the situation, even at a distance,” explains Dr. Economou.

Go deeper into why comprehensive diurnal IOP profiles are key in ensuring that glaucoma patients receive the most appropriate care, according to recent research.

Home IOP measurements helped to save Tor Wådell’s sight

Glaucoma patient Tor Wådell had pressure-lowering surgery and monitored his IOP at home with the iCare HOME tonometer.

“If I had not had the possibility to use the first version of iCare HOME at that time, the vision impairment in one eye could have been severe today”, Wådell explains.

Since the second surgery, Wådell has been using his iCare HOME2 tonometer to keep his eye pressure in check and his vision has stabilized. Wådell praises the iCare tonometers: “It is an incredible development to have a device at home that is so accurate. They are also very easy to use, and easy to set up, so that the handheld tonometer is in the right position.”

Read more about easy and accurate IOP self-measurement with the iCare HOME2 tonometer.

Close IOP monitoring provides security and reassurance for both the doctor and the patient

For Tor Wådell, the ability to keep track of his eye pressure independently affords a great sense of security.

For Dr.Economou, the benefits are obvious as well: “Home measuring involves patients in the management of their own glaucoma. The patient is much more cognizant of their situation, and it is easier for them to accept any changes in therapy or even decisions to undergo surgery, if needed.”

Contemplating further, he says: “In addition to monitoring patients’ IOP in relation to surgery, it would be very helpful to more closely monitor patients who are in a so-called risk zone. In these cases, the patient’s glaucoma is progressing, even though their in-office IOPs are within the target range. This particular profile gives us reason to suspect that short-term pressure variations should be monitored and held in check, with the help of self-tonometry.”

Clinical findings show that the iCare HOME self-tonometer demonstrates excellent potential to transform glaucoma diagnosis and management. Read more!

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By Kaweh Mansouri, MD

Visual field testing to identify functional damage is an essential component of the diagnostic evaluation for glaucoma detection and monitoring. Full threshold testing with automated perimetry is the gold standard for identifying and quantifying glaucoma-related functional damage and can be done using different perimeters that are based on various technologies.

Combining perimetry, fixation loss correction, and confocal TrueColor fundus imaging with patient- and technician-friendly features, the COMPASS Automated Perimeter with active Retinal Tracking (Centervue Spa, a company of iCare Finland Oy; Vantaa, Finland) is a unique tool that takes visual field testing and interpretation to a higher level.

iCare COMPASS functions and features

Visual field testing

Automated perimetry with COMPASS is fully compatible with standard 24-2, 30-2 and 10-2 visual field testing containing age-matched databases of retinal sensitivity in normal subjects. In addition, COMPASS offers SupraThreshold and Quick SupraThreshold testing for rapid visual field loss screening. Done using the standard 24-2 test grid, the SupraThreshold test takes approximately 2 to 3 minutes per eye. The Quick SupraThreshold test using an optimally reduced 24-2 grid is even faster, taking just 30 to 90 seconds per eye and allowing testing of both eyes sequentially using the “OU” option.

Visual field testing with COMPASS is done using Active Retinal Tracking. During the examination, continuous and automated tracking of eye movements by infrared scanning of the retina provides real-time compensation for fixation losses and assures that the stimulus position is correct. Perimetric stimuli are automatically repositioned prior to and during projection based on the current eye position. Stimuli lost due to blinking are automatically repeated and do not interrupt the test.

TrueColor confocal imaging

COMPASS generates 60° confocal images of the retina in three modalities: TrueColor, infrared and red-free. By combining a confocal engine with a white light LED source to illuminate the retina, COMPASS generates fundus images that are sharp, high contrast, and natural in colour. High quality images are obtained even in eyes with media opacity because of the confocal technology. Registration between the retinal image and retinal sensitivity threshold allows a direct correlation between visual function and retinal anatomy.

My clinical perspective

Visual field testing and acquiring high resolution, true colour images of the fundus and optic nerve head are essential when evaluating patients with glaucoma. Not only does COMPASS address both needs in a single time-saving examination, but it also generates a superimposed image that shows a precise overlap between areas of depressed sensitivity and areas of the retina with indications or source of defects, some of which cannot be seen with optical coherence tomography only.

The opportunity to simultaneously perform perimetry testing and fundus imaging is by itself a great benefit of COMPASS compared to standard automated perimeters, but its active retinal tracker further distinguishes COMPASS from standard automated perimeters that cannot actively compensate for eye movements during testing. The retinal tracking technology serves to increase test precision by measuring sensitivity at specific retinal locations with high topographic accuracy. Thus, it ensures accurate correlation between function (i.e. retinal threshold values) and structure (retinal appearance) and decreases test-retest variability. I believe that active retinal tracking brings added value for improving the clinical accuracy of visual field tests, their interpretation in general and especially in eyes that have several pathologies at different stages, and the reliability of detecting glaucomatous progression.

In addition, because active retinal tracking automatically positions stimuli correctly on the retina, despite fixation losses, blinking or movements of the eye or head, and since lost stimuli are repeated automatically, patients can blink, close the eye, or rest and continue without loss of data and technician involvement during COMPASS visual field testing. This decreases stress and fatigue in patients, is convenient for the operator, and decreases the need for retakes due to unstable fixation.

Multiple other features of the COMPASS make visual field testing operator-friendly, easier for patients, and more efficient. Designed with auto-focus that compensates for spherical refractive errors between -12 D and +15 D, COMPASS avoids the need for using trial lenses to perform visual field testing. Auto-focus therefore eliminates the potential for lens rim artefacts that can result in test misinterpretation and also saves time.

Further enhancing workflow efficiency, visual field testing with the iCare COMPASS is done without mydriasis for pupils larger than 3mm. Consequently, there is no delay waiting for the pupil to dilate nor any need to wait for the eye to adjust after a flash of light. As another time-saving feature, cleaning of the COMPASS is quick and simple because it has a smooth, narrow, convex design, lacks any sensitive structures, like a bowl, and has no trial lens assembly. The machine’s surfaces can be easily disinfected using only an alcohol wipe. This ease of decontamination holds increased importance because of COVID-19. All of these contributors to efficiency more than compensate for the slightly increased duration of combined visual field testing/fundus imaging with COMPASS compared to standard automated perimeters.

Clinical case

Figures 1 and 2 show the COMPASS printout and fundus image from one of my patients. The fixation plot in the printout (bottom left) shows that the patient had unstable fixation, but even in this situation it was possible to obtain a reliable visual field with adequate false positive and false negative indices as well as an MD of -2.68. The COMPASS fundus image revealed a significant peripapillary atrophy (as shown in the red-free image and in the zoomed ONH colour image) that is well represented as an enlarged blind spot on the visual field. The printout also shows a single focus in the superonasal visual field that needs to be confirmed by repeat testing. By providing excellent visual field test repeatability, COMPASS will enable the determination of whether the defect is an artefact or represents an early sign of glaucomatous damage.

Figures 1: COMPASS printout

Figures 2: fundus image

Conclusion

I find that COMPASS brings many benefits to clinical practice. It is the first automated perimeter that can perform standard visual field tests using a real-time retinal tracker while simultaneously delivering ultra-high resolution confocal TrueColor fundus images. In addition, it saves time in many ways and makes visual field testing more patient- and technician-friendly for many reasons.
In a study where patients underwent perimetric evaluation with both the Humphrey Field Analyzer and COMPASS, results of a post-test interview showed the participants had a strong preference for the COMPASS examination.1 Importantly, our own technicians give very positive feedback about their experience with this unique diagnostic device. Finally, I give COMPASS high ratings as a clinician because with its capabilities and benefits, COMPASS enables me to optimize patient care by helping me detect glaucoma and its progression accurately and early.

Dr. Mansouri is a consultant ophthalmologist, Clinique de Montchoisi, Lausanne, Switzerland, and adjoint professor, Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Denver, Colorado. Dr. Mansouri is a consultant to iCare. CENTERVUE S.P.A., ICARE FINLAND OY are parts of REVENIO GROUP and represent the brand iCare.

REFERENCE

1. Morbio R, Longo C, De Vitto AML, Comacchio F, Della Porta LB, Marchini G. Comparison between Fundus Automated Perimetry and Humphrey Field Analyzer: Performance and usability of the Fundus Automated Perimetry and Humphrey Field Analyzer in healthy, ocular hypertensive, and glaucomatous patients. Eur J Ophthalmol. 2021;31(4):1850-1856.

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A recent study by Tong et al.¹ highlights that diurnal IOP profiles obtained using the iCare HOME self-tonometer may reflect IOP responses to treatment more accurately than standard IOP measurements in the office. This more comprehensive understanding of IOP fluctuations offers the eye care professional valuable support in making glaucoma treatment decisions.
The study investigated daily peak IOPs, IOP fluctuations, and mean IOPs in patients with glaucoma and ocular hypertension using latanoprost and timolol. The effects of the medications were assessed by comparing mean percentage IOP reductions.

Current IOP measurement practices may fall short of the goal of evaluating therapy consistently and accurately

IOP measurement remains a fundamental component in the diagnosis and monitoring of glaucoma. However, current practices rely on single in-office measurements as the basis for choosing the appropriate treatment strategy.

According to Tong et al., IOP information recorded in this snapshot style solely during office hours does not show short-term IOP fluctuations and may fail to portray IOP peaks. Previous research shows that peak IOP measurements fall outside of office hours in up to 79% of glaucoma patients. ^2–4

This clearly indicates that in-office measurements alone do not suffice to reflect diurnal IOP profiles adequately.

Comprehensive diurnal IOP profiles obtained via self-tonometry can help eye care professionals to optimize treatment decisions

Tong et al. conclude that a more comprehensive characterization of diurnal IOP patterns is key in ensuring that glaucoma patients with slow disease progression receive the best possible care. The study emphasizes the clinical potential of new technologies that enable IOP measurement outside office hours, including self-tonometry devices such as the iCare HOME rebound tonometer.

In the crossover treatment trial, 14 participants took self-measurements of IOP with the iCare HOME tonometer four times a day for 1–4 weeks, depending on which medication program they were on. IOP fluctuations reached a target reduction of 30% more frequently than peak and mean IOPs did on both latanoprost and timolol.

The study found that the analysis of IOP fluctuation measured with self-tonometry was more consistent in evaluating target IOP, which highlights the importance of diurnal IOP profiles in ascertaining IOP responses to topical therapies. These findings also demonstrate that the iCare HOME tonometer can characterize IOP variations appropriately and be of significant use in clinical decision making.

The iCare HOME tonometer can characterize diurnal IOP patterns accurately within one week of self-tonometry

According to the treatment trial, one week of using the iCare HOME self-tonometer is sufficient to reliably portray diurnal IOP profiles. Furthermore, several previous studies show that at least 75% of patients can successfully learn to perform self-tonometry using the iCare HOME. ^5–7

This clinically promising figure is based on research on the world’s first self-tonometer, the iCare HOME tonometer. Its successor, the iCare HOME2 tonometer is even easier to use, comes with intuitive training materials, and can measure IOP in both sitting and supine positions.

Tong et al. recognize that the option of self-tonometry in the supine position could be invaluable in investigating differences between medications in more detail.

¹ Tong J., Huang J., Kalloniatis M., Coroneo M., Zangerl B. Clinical Trial: Diurnal IOP Fluctuations in Glaucoma Using Latanoprost and Timolol with Self-Tonometry. Optometry and Vision Science: August 2021 – Volume 98 – Issue 8 – p 901-913. doi: 10.1097/OPX.0000000000001751

² Barkana Y, Anis S, Liebmann J, et al. Clinical Utility of Intraocular Pressure Monitoring Outside of Normal Office Hours in Patients with Glaucoma. Arch Ophthalmol 2006;124:793–7.

³ Konstas AG, Mantziris DA, Cate EA, et al. Effect of Timolol on the Diurnal Intraocular Pressure in Exfoliation and Primary Open-angle Glaucoma. Arch Ophthalmol 1997;115:975–9.

⁴ Hughes E, Spry P, Diamond J. 24-Hour Monitoring of Intraocular Pressure in Glaucoma Management: A Retrospective Review. J Glaucoma 2003;12:232–6.

⁵ Huang J, Katalinic P, KalloniatisM, et al. Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial. Optom Vis Sci 2018;95:88–95.

⁶ Chen E, Querat L, Akerstedt C. Self-tonometry as a Complement in the Investigation of Glaucoma Patients. Acta Ophthalmol 2016;94:788–92.

⁷ Mudie LI, LaBarre S, Varadaraj V, et al. The iCare HOME (Ta022) Study: Performance of an Intraocular Pressure Measuring Device for Self-tonometry by Glaucoma Patients. Ophthalmology 2016;123:1675–84.

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A detailed panoramic view of the retina from the posterior pole to the periphery assists in earlier detection, diagnosis, and more accurate treatment of retinal pathologies. With the new iCare EIDON Ultra-Widefield Module, the eye care professional can see more in less time – in great detail, high resolution, and true-to-life colors.

Ultra-widefield and ultra-high-quality images thanks to TrueColor Confocal Technology

iCare’s Ultra-Widefield imaging technology expands the field of view of the retina up to 200°, revealing areas that were previously left undiscovered. The iCare EIDON UWF Module captures a 120° scope of the retina in a single shot. Panoramic images of up to 200° are acquired by combining three or more fields with the Mosaic functionality, a proprietary automatic stitching algorithm.
The new iCare EIDON UWF Module is built on the foundation of iCare’s TrueColor Confocal Technology, which produces superior-quality fundus images with high resolution, sharpness, and details in natural colors and in a patient-friendly dilation-free process.

Read more about the benefits of TrueColor Confocal Technology for eye care professionals.

The iCare EIDON UWF Module serves in a complete suite of imaging modalities

The iCare EIDON UWF Module complements the existing models of the EIDON family. In fact, it is compatible with all the imaging modalities of the EIDON Family devices (TrueColor, Infrared, Fundus Autofluorescence and Fluorescein Angiography).

The new module also offers the option of Fluorescein Angiography video in ultra-widefield. Video acquisition provides a dynamic perspective on retinal blood flow and a more comprehensive and informative documentation of the retinal vasculature than static photography can hope to offer. This is highly useful for example when monitoring and treating diabetic retinopathy.

Fast, automatic, and easy to use – with the iCare EIDON UWF Module, the eye care professional can see more in less time

All iCare’s fundus imaging devices are fully automated, quick and easy to use and require minimal staff training. The whole process of acquiring 200° panoramic views of the retina only takes one minute per eye. Eye care practitioners enjoy the efficient workflow and patients appreciate the comfortable examination experience and not needing to be dilated.

The lens of the iCare EIDON UWF Module is light and intuitive to handle. Overall, the combination of these features allows the operator to focus their attention on the patient instead of the device – ensuring the best possible eye care with the help of ultra-widefield retinal images.

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