Glaucoma Monitoring In Care Homes: Worth Getting Out Of Bed For?
Published 2026 - 44th Congress of the ESCRS
Reference: POGAU014 | Type: Poster | DOI: 10.82333/32ra-3438
Authors: Ms Shreena Patel* 1 , Ms Tania Kalsi 2 , Ms Sancy Low 3 , A/Prof. David Crabb 1 , Dr Pete R Jones 1
1Optometry & Visual Sciences,City St George's, University of London,London,United Kingdom, 2Geriatric and General Internal Medicine,Guy's and St Thomas' NHS Foundation Trust,London,United Kingdom, 3Ophthalmology,Guy's and St Thomas' NHS Foundation Trust,London,United Kingdom
Purpose
To assess the feasibility of performing "in bed" glaucoma monitoring assessments within a domestic (care home) setting, in order to reduce hospital outpatient appointments.
Setting
Simulated care home bedroom.
Methods
In this initial pilot, glaucoma patients (n=20), age-similar normally-sighted adults (n=20), and normally-sighted young adults (n=20) were asked to lie in a bed. They then received a glaucoma assessment by a trained optometrist (author SP), consisting of portable tonometry (iCare IC200), visual fields (Irida Eyectacher), fundus imaging (Optomed Aurora), and OCT (MiiS ACT100). Participants also underwent conventional clinical assessments for comparison (Topcon NW-500 fundus imaging, Tomey MR-6000 tonometry, Zeiss HFA SITA Fast visual fields, and Heidelberg Spectralis OCT). All participants were also asked to rate the acceptability of the various assays.
Results
In-bed fundus images were visibly lower quality, with only 26% graded "good" by QuickCal AI vs 99% in-clinic (confirmatory human grading ongoing). Yet, discs were always visible, and vertical cup-to-disc ratios were strongly correlated with in-clinic measures (r=0.98; P<0.001), with a 95% Coefficient of Repeatability {CI95%} of 0.10 {0.08–0.11}. In-bed IOP measurements were also well correlated with in-clinic IOPs (r=0.75; P<0.001), with a CoR95 of 5.05 {4.69–5.60} mmHg. 27%/58% of participants preferred in-bed fundus/IOP; while 56%/36% expressed no preference. Equivalent analyses for visual fields and OCT are ongoing, and shall also be reported.
Conclusions
Glaucoma assessments can be feasibly performed in bed. Such measurements were often preferred to conventional assays, and provide data which, while not always as high quality as in-clinic measures, may be sufficient for routine glaucoma monitoring purposes. This community-optometrist-led approach has the potential to improve our management of elderly or frail patients: simultaneously reducing costs and increasing patient comfort/accessibility. Future necessary work includes extending this pilot to hospital geriatric clinics (expected Q3 2026) and care homes (Q4 2026).