What do you do if you are losing vision from glaucoma while doing everything right?

Imagine you are a surgeon (let's name you Dr. Surgeon) and your vision is slowly disappearing. You still want to work even though you are in your 70s. You have worked hard for your skills and your patients are benefiting from a lifetime of honing your craft. 

Then you visit your glaucoma specialist for what feels like the millionth time. You even wait two hours in the lobby after your testing, just like every other patient.

You remember the mantra you've told many of your own patients: "I'm sorry for the wait. It's annoying. I would know...doctors are patients, too. Ok what seems to be the problem..."

You make a mental note to change that introduction to: "Sorry for the delay. Being a patient sucks, doesn't it?"

"Sorry for the delay. Being a patient sucks, doesn't it?"

While you wait you have time to sit and wonder when your vision loss will put your patients in harms way. And worst of all you know you have been doing everything the doctor says and your pressures are "normal" every time you visit the ophthalmologist. "Get ready to be labeled noncompliant," you think to yourself.

Once you sit down with the Ophthalmologist you are told that your glaucoma continues to get worse despite all the drops you are using. If surgery is necessary then your hobbies of scuba diving and basketball become a higher risk activity. To put it mildly: today is not a good day.

This is the story one man is living, as described in a recent report by glaucoma specialist, Dr. Sayoko Moroi, MD, PhD in the journal Ophthalmology: Glaucoma.

Most people are not surgeons with the ethical dilemma of losing vision while operating, but all of us care deeply about providing for our families, our futures, and being able to pursue our passions!

Glaucoma causes blindness in millions of people worldwide, so what makes this article by Dr. Moroi worth publishing?

At the risk of giving away the ending, I'll tell you that this man was able to use home tonometry to discover that his pressures were significantly higher outside his doctor's office hours than in the clinic. His eye pressures were so much higher, in fact, that it was literally making him go blind.

So how did he lose vision and how do so many people with glaucoma lose vision?

Let's look at how a patient can get to this point, but first a reminder that the key to treatment of glaucoma is to lower the pressure and then monitor the eye pressure and other types of testing (pictures, visual fields) to see if glaucoma is getting worse.

Remember, the American Academy of Ophthalmology defines normal eye pressure from 10 up to and including 21 mmHg. This is important info to start with but...

...practically speaking, each person's eye has a safe level that their pressure should stay below. If it goes above that specific pressure for weeks or months then they lose vision.

This is called a target pressure because your doctor will try to "target" your eye pressure to stay below a specific number. For example: some people's eyes are safe even above the normal range (10-21 mmHg) in the low 20's (20-24). On the other hand, some patients are unsafe in the "normal" range and need their pressures to be below 12-16 mmhg.

Complicated? Yes! 

But now you know it is important to keep pressures under a certain level or you can lose vision...except the old standard is that doctors only check eye pressures during business hours. What if your eye pressure is high when your doctor is eating dinner and over months to years this causes vision loss? Well that would be important information and that is why Dr. Moroi wrote and published this article (linked below).

In the case of our patient, using home tonometry for a week or two helped everyone to find out why he was getting worse when he was doing everything right.

In the article published by Dr. Moroi, home tonometry with the iCare Home revealed that he had pressures that spiked up into the 40s only outside of clinic hours!

This was new information that proved high pressures were damaging his vision and may never have been detected without a portable eye pressure monitor. The graph above shows the time outside of clinic hours shaded in gray...you may notice that this is most of the day! These high pressures also did not occur every day so even if the patient spent a whole day checking pressures in clinic they would likely not have caught this.

For Dr. Surgeon, an adjustment was made to his night time medication and no high pressures were seen inside or outside of clinic hours. Notably, the patient avoided surgery. Without the after-hours eye pressure data, he was almost certainly headed to the operating room at least once in his life. 

Avoiding surgery is one thing, but even better is the peace of mind and vindication that Dr. Surgeon likely felt in his pursuit of the best glaucoma care he could find. Dr. Moroi and many other fantastic doctors are championing this next level of glaucoma management!

Based on this growing foundation of peer reviewed evidence, in my opinion, offering home tonometry to patients will quickly become the standard of care in developed countries because of the tremendous value this provides.

Purchase an Eye Pressure Measurement Device

Digital Glaucoma's mission is to empower any patient or eye doctor to be able to enhance glaucoma monitoring and to accelerate the adoption of affordable, portable tonometers in order to save more vision.

Purchase a home tonometer at digitalglaucoma.com to get exclusive access to a warranty that includes accidental damage for up to 3 years!

Affordability for Patients:

The iCare Home can be purchased over 36 months at 0% interest (using Split-It at check out), just like you might buy a Casper mattress or a Peloton bike over time.

$97.75/mos includes the

iCare Home + 3 year warranty + Personalized Eye Pressure Analysis Annual Subscription

Devices sold on our website include an option to include accidental-damage insurance (similar to AppleCare+). We highly recommend the 3-year insurance for all customers: glaucoma is a chronic disease and the peace of mind from monitoring your pressure at all times is even better if you know you can take it anywhere without worrying about breaking it. 

Investing in your vision is the best decision you can make - we made sure to give you access to this important warranty option to protect that financial investment from accidental damage.

Please contact us at info@digitalglaucoma.com with any questions or stay up to date by signing up for emails at the bottom of our homepage on DigitalGlaucoma.com.

Can patients get eye pressures outside of clinic without the iCare Home?

The short answer is: not really...or at least not right now.

Prior to the iCare Home tonometer, some particularly dedicated glaucoma specialists may have a patient dedicate a full day to sit in the office and get 10+ pressure checks. Even less common would be a doctor who comes in special for one patient to do a late evening eye pressure at 9 or 10pm. Therefore, even in the case of a very dedicated glaucoma specialist gathering data outside of office hours is unrealistic and is not as valuable as obtaining multiple pressures over time.

Recently, Sensimed created the Triggerfish contact lens that will likely also have a role in portable eye pressure monitoring. This eye pressure instrument uses a different technology than the iCare Home Tonometer and currently requires application of stickers on the face to communicate the pressures from the contact lens to a recording device. This technology is still very new, but is very promising.  Look for a blog post about this exciting technology sometime in the next few months.  

Eye Care Professionals

Become a Digital Glaucoma Eye Provider in your area by purchasing a device and subscription from our website. The Split-It pay over time allows you to limit your finance your capital expense at 0% interest. Your patients will thank you!

Please do not hesitate to reach out in regards to a cost-benefit analysis, tax depreciation benefits, and billing/coding training. Our Medical Practice Data Analysis Subscription includes all of this along with videos for training your patients to use the iCare Home. The subscription can also be paid using Split-It over up to 36 months with 0% interest, which makes the initial cost to a provider $135/mos for the device and software services.

Link to Dr. Sayoko Moroi's article:

https://www.sciencedirect.com/science/article/pii/S2589419620301125?via%3Dihub