Thomas V. Johnson, MD, PhD, notes the value of home monitoring lies in its ability to provide real-time insights into IOP fluctuations, enabling more precise glaucoma care and a deeper understanding of the patient's risk for vision loss.
This December, Ophthalmology Times® EyeCon 2023 will gather the nation’s leading ophthalmologists to share new data and practical strategies that clinicians can apply to their patients.
The conference will take place December 1 to 2 at the Marriott Sanibel Harbour Resort and Spa in Florida. Peter J. McDonnell, MD, director of the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland, and Oluwatosin U. Smith, MD, of Glaucoma Associates of Texas in Dallas, will serve as co-chairs of the meeting.
Thomas V. Johnson, MD, PhD, who is part of the faculty for EyeCon 2023, recently spoke with Sheryl Stevenson, Eye Care Group editorial director, to highlight his presentation. Johnson is The Shelley and Alan Holt Rising Professor of Ophthalmology and assistant professor of ophthalmology and cellular and molecular medicine with the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore.
To learn more about or to register for Ophthalmology Times® EyeCon 2023, click here.
Editor’s note - This transcript has been edited for clarity.
Sheryl Stevenson: We are joined today by Dr. Thomas Johnson, who is among the faculty at this year’s EyeCon conference in Sanibel Island, Florida, in early December.
Welcome to you! We’re so delighted to have you and curious to hear more about your presentation. I know you’ll be discussing in-office and home disease monitoring. What can you tell us about that?
Thomas V Johnson, MD, PhD: Yeah, well, thanks very much. I’m very pleased to be part of the program coming up. I’m going to be speaking primarily about the ways that we—as glaucoma doctors or any eye-care providers that take care of glaucoma patients—monitor people’s intraocular pressure [IOP].
We know that IOP is the most important risk factor for the progression of glaucoma and risk factor for vision loss. It’s interesting that the standard of care continues to be measuring intraocular pressure at a clinic visit, at sort of a random time of day, once every several months. We know that intraocular pressure is a highly dynamic variable. It fluctuates minute to minute, hour to hour, day to day.
The importance of fluctuations in physiologic parameters have been appreciated in medicine for decades. Cardiology, endocrinology, and primary care have been transformed by using at-home blood pressure monitors and blood glucose monitors. I think that ophthalmology is positioned to make the leap to really recognize the importance of IOP fluctuations and change how we monitor patients with glaucoma.
I’m going to be discussing current and emerging concepts in ways that we can measure IOP in the office and at home. There are some new devices and tools available to clinicians so that patients can measure their own eye pressure at home at all times of day and night. I think this has a lot of utility for several reasons.
First of all, it helps us better understand the range of eye-pressure stress that’s being placed on the optic nerve in individual patients. Sometimes there are patients that seem to be getting worse even though every time they come into clinic, their eye pressure is 10, 11, or 12 [mm Hg]. We’ve taken patients like that...asked them to do home tonometry and found that first thing in the morning their pressure is 25 [mm Hg]. Beyond that, I think it’s also a really useful tool for the clinician to more quickly and accurately understand the risks that their patients have for vision loss and the responses to treatment.
Other things that we often do will be to start an eye drop on a patient with glaucoma and then ask them to come back in the clinic a month or two months later to see what the pressure is. That requires a second clinic visit; the patient has to drive up to the clinic and sometimes take a day off work or bring someone; or have someone drive them to the visit. We don’t know the answer to what that pressure drop did for several weeks.
With home tonometry, we can get real-time data describing exactly how low the pressure goes with the eye drop...what the kinetics of the response are. In patients that don’t have a dramatic response, sometimes we can see reductions induced by eye-pressure medicines that otherwise would have been masked. If you have a patient whose IOP is fluctuating 4 [mm Hg] points every day, and you happen to catch them at a trough and then you start them on an eye drop and they come back 2 months later and they happen to be at a peak.... If the eye drop reduced the pressure by 4 points, but the fluctuation is 4 points, you might conclude that eye drop didn’t do anything. When you have many more data points spread out over time, you can have a much better sense of the effective treatments.
Those are just two examples of how I think remote monitoring of intraocular pressure can be really helpful to patients and to clinicians. I’ll be discussing some other scenarios and methods to employ this technology when I see you guys in a couple months.
Stevenson: Sounds fantastic. Thanks for those key takeaways. I wonder also does comanagement come into play just in terms of general overall awareness with patients who may be seeing both optometrists and ophthalmologists?
Johnson: Yeah, I think it absolutely can. It’s nice to have a centralized point of eye pressure measurements. If a patient has a home tonometer, their measurements get uploaded to a cloud database where that information is available to everyone taking care of the patient. I think this would really aid in cross-collaborations and comanagement among eye-care providers.