WIO 2026: Tackling tonometry barriers, ergonomics with Dr. Zhang

Home tonometry and its role in the future of glaucoma management remains an area shaped as much by clinical promise as by practical roadblocks, according to Amy Zhang, MD, clinical associate professor of ophthalmology and visual sciences at the Kellogg Eye Center, University of Michigan in Ann Arbor, Michigan.

Zhang spoke with Ophthalmology Times ahead of the Women in Ophthalmology (WIO) 2026 Summer Symposium, addressing home IOP monitoring, surgical ergonomics, and burnout within the glaucoma subspecialty.

Home tonometry’s promise and its coverage barriers

Zhang traced growing interest in home tonometry back to the COVID-19 pandemic, when clinicians needed new ways to track patients’ eye pressure outside the office. She likened it to home monitoring already established in other chronic diseases such as diabetes, noting a substantial body of literature supporting patients managing their own disease data. Home tonometry, she said, extends that same access to patients with glaucoma.

Adoption, however, remains constrained by reimbursement questions. Zhang pointed to unresolved issues around which billing codes apply, whether devices should be purchased or rented, and which monitoring modality suits different patients best. She emphasized that these logistics weigh most heavily on patients rather than physicians, since the added cost often lands on top of everything else patients already pay for in their care.

An ergonomic habit for early-career surgeons

Asked what ergonomic change she would recommend to an early-career glaucoma surgeon, Zhang said the starting point is simple: “You have to know how or what you look like when you’re operating.” She advised having a colleague record video or take photos during surgery to reveal habits that need adjusting. The stakes are higher for younger ophthalmologists, she said, because posture and technique become ingrained over time—making it far easier to build good habits early than to correct bad ones later, even when the correct position initially feels less comfortable.

Why uncertainty drives burnout in glaucoma

As wellbeing director for her department, Zhang has studied burnout drivers across her health system. Although she said all physicians carry some degree of burnout tied to systemic pressures, she identified something specific to glaucoma: the uncertainty inherent in the disease. Unlike cataract surgery, where patients can expect a clear, immediate visual improvement, glaucoma treatment is aimed at preserving existing vision—particularly peripheral vision—rather than improving it.

Communicating that distinction, and helping patients understand why continued pressure-lowering matters even without a visible benefit, is a recurring challenge, Zhang said, one that “can also be harder for those of us that have it day in and day out.”