Tele-Glaucoma and Home Monitoring in Aging Populations

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Tele-Glaucoma and Home Monitoring in Aging PopulationsGlaucoma is a chronic, age-related eye disease marked by optic nerve damage and visual field loss. As populations age, the number of glaucoma patients is rising – millions worldwide will require lifelong monitoring () (). Traditional care demands frequent clinic visits for intraocular pressure (IOP) checks, visual field (perimetry) testing, and imaging. This becomes taxing for older adults, many of whom face mobility issues, long travel distances, or a shortage of specialists () (). Tele-glaucoma (telemetry and home-monitoring approaches for glaucoma care) has emerged as a promising solution. By enabling patients to self-measure IOP and visual fields at home and consult virtually with doctors, telemedicine can potentially improve outcomes, equity, and convenience. In this article, we review evidence on remote IOP monitoring, home perimetry, and virtual glaucoma visits for older patients – comparing them to traditional care in terms of clinical effectiveness, access to care, patient satisfaction, and cost. We also discuss challenges (digital literacy, device usability, data integration) and highlight models that reduce travel burden and help prevent avoidable vision loss over the lifespan.Remote IOP MonitoringIntraocular pressure (IOP) is the most important modifiable risk factor in glaucoma. Remote IOP monitoring lets patients record pressures at home using portable devices. Common tools include rebound home tonometers (e.g. the iCare HOME) and even implantable or contact-lens sensors. These devices are designed for patient self-use without anesthetic drops (). Studies show that home tonometers reliably capture daily IOP patterns and peak pressures that are often missed in office visits () (). For example, home sensors frequently detected morning IOP spikes outside clinic hours – early alerts that allowed timely medication or laser adjustments to prevent nerve damage () (). In practice, this continuous pressure data gives the physician a much fuller picture of each elderly patient’s conditioning between visits () (). In clinical trials, home vs. clinic measurements of IOP have shown close agreement () (). Continuous monitoring has been found feasible and safe for older patients, with most participants able to learn tonometry. For instance, a UK feasibility trial (the I-TRAC study) trained glaucoma patients to use a rebound tonometer and a tablet perimetry app weekly. The trial saw 95% retention at 3 months and high patient adherence to home IOP checks (). Patients reported that the technology felt acceptable and convenient. These findings support that older patients, once properly instructed, can use home tonometry effectively (). When home IOP devices are integrated into a telemedicine program, clinicians can see each patient’s pressure trends remotely and intervene sooner than waiting for the next clinic review () (). However, some limitations are noted. Home rebound tonometers are slightly less exact than gold-standard in-clinic (Goldmann) measurements (), and technical glitches can occur. A systematic review found that a minority of patients experienced device malfunctions or connectivity problems, and a few were anxious about interpreting results on their own (). Thus robust technical support and training are needed. Despite these caveats, multiple studies conclude that remote IOP monitoring is reliable and clinically valuable, augmenting traditional care by catching spikes and fluctuations that normal