Effectiveness and Accuracy of iCare HOME Tonometer in Glaucoma Patients: A Systematic Review

To evaluate the effectiveness and accuracy of the iCare HOME tonometer for intraocular pressure (IOP) monitoring in glaucoma patients, comparing its performance to the clinical gold standard, Goldmann applanation tonometry (GAT).

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 guidelines, a systematic search of the PubMed and Cochrane Library databases from January 2017 to February 2025 was conducted. A total of 18 studies, including case series and observational studies, met inclusion criteria. Data on IOP measurement accuracy, repeatability, reproducibility, and patient-related factors were extracted and analyzed.

The iCare HOME tonometer demonstrated good agreement with GAT, with mean biases generally within ±2 mm Hg. Influencing factors included central corneal thickness, corneal biomechanics, alignment, and user training. Repeatability and reproducibility were high, with intraclass correlation coefficients ranging from 0.796 to 0.996. Most patients were able to obtain reliable readings after appropriate instruction. Although initial use posed challenges, especially with alignment, familiarity improved performance. Remote training showed promising outcomes. Patient satisfaction was high, although some patients noted the burden of frequent measurements. Although cost differences remain unclear, home monitoring offered time-saving advantages and captured diurnal IOP fluctuations, which were often missed in clinical settings.

The iCare HOME tonometer is a reliable and feasible tool for at-home IOP monitoring in glaucoma care, offering performance comparable to that of GAT under proper conditions. Its integration into teleophthalmology may enhance disease management, reduce clinic visits, and empower patients, especially those who would benefit from close monitoring or who are experiencing IOP fluctuations.