DIY tonometry: The iCare Home reviewed

Your last patient of the day, a 55-year-old hyperope with full fields and no ocular history of any relevance, is brought to you and the records show a tonometry reading of R 20mmHg and L 19mmHg taken at 5.30pm. How many readers would act on this information?

Consider now the case where, for some reason, this patient had missed this appointment and instead attended at a later date but this time at 9am. Would the pressure readings be different? It is typical, though by no means always the case, for IOP to be higher in the morning and we might expect the readings to perhaps be over 21mmHg at the second appointment. If it was repeatable at this visit, some practitioners might be tempted to refer under NICE guidance. There is a risk that whether the patient is to be referred is down to the time of their appointment.