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Philadelphia Telemedicine Glaucoma Detection and Follow-up Study

Intraocular Pressure Measurements Found in a Population at High Risk for Glaucoma

Hark, Lisa A., PhD, RD*,†; Myers, Jonathan S., MD*,‡; Pasquale, Louis R., MD§; Razeghinejad, M. Reza, MD*,‡; Maity, Alisha, BA; Zhan, Tingting, PhD; Hegarty, Sarah E., MPhil; Leiby, Benjamin E., PhD; Waisbourd, Michael, MD; Burns, Christine*; Divers, Meskerem*; Molineaux, Jeanne, COA*; Henderer, Jeffrey D., MD#; Haller, Julia A., MD‡,**; Katz, L. Jay, MD*,‡

doi: 10.1097/IJG.0000000000001207
Original Studies

Precis: Intraocular pressure (IOP) measurements, when used during telemedicine eye screening alongside nonmydriatic fundus photography, were shown to improve the likelihood of accurate glaucoma and glaucoma-related diagnoses at the follow-up eye examination.

Purpose: To determine if IOP measurements, used as an adjunct to nonmydriatic fundus photography, are useful in glaucoma telemedicine screening.

Materials and Methods: A total of 902 high-risk individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening at visit 1 included fundus photography, assessing family history of glaucoma, and IOP measurements using a hand-held rebound tonometer. Participants with suspicious nerve findings for glaucoma, IOP>21 mm Hg or other ocular pathologies were invited for a follow-up appointment with an ophthalmologist (visit 2).

Results: Of the 902 individuals screened at visit 1, 19.6% (n=177/902) had elevated IOP (>21 mm Hg). Fifteen participants were found to have an IOP>30 mm Hg at visit 1, including 2 with an IOP of >40 mm Hg. Among all who attended visit 2 (n=347), 10.9% had glaucoma and 7.2% had ocular hypertension. For participants having both suspicious nerve findings and IOP>21 mm Hg compared with those with neither, the odds ratio (OR) of being diagnosed with glaucoma was 4.48 (95% CI, 1.50-13.93; P=0.007), whereas for participants with suspicious discs and IOP≤21 mm Hg the OR was 2.04 (95% CI, 0.83-5.53; P=0.15).

Conclusions: In this telemedicine vision screening setting, having a higher IOP at the screening visit increased the likelihood of receiving a final diagnosis of glaucoma. Therefore, this study supports incorporating IOP measurements, using a portable tonometer, into vision screening programs in high-risk populations.

*Wills Eye Hospital, Glaucoma Research Center

Sidney Kimmel Medical College, Thomas Jefferson University

Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University

#Department of Ophthalmology, Lewis Katz School of Medicine at Temple University

**Wills Eye Hospital, Philadelphia, PA

Department of Ophthalmology, Columbia University Irving Medical Center

§Department of Ophthalmology, Icahn School of Medicine at Mt Sinai, New York, NY

Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Supported by United States Centers for Disease Control and Prevention Cooperative Agreement: U01 DP005127.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure: The authors declare no conflict of interest.

Reprints: Lisa A. Hark, PhD, RD, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W. 165th Street, New York, NY 10032 (e-mail:

Received August 25, 2018

Accepted January 16, 2019

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