Validation of iCare IC200 tonometry during natural sleep in children under 3 years with glaucoma: reducing anesthesia dependence in clinical monitoring

TL;DR

The study shows that measuring eye pressure in sleeping children with glaucoma can reduce the need for anesthesia.

Contribution

Demonstrates the validity of non-anesthetic IOP measurements in young glaucoma patients.

Findings

Natural sleep IOP measurements were consistently higher than those under anesthesia.

A strong correlation (r = 0.95) was found between sleep and anesthesia IOP measurements.

Anesthesia use decreased by 40% with the new monitoring approach.

Abstract

To assess the agreement between intraocular pressure (IOP) measurements obtained with the iCare IC200 rebound tonometer during natural sleep and under general anesthesia (EUA) in children under 3 years of age with glaucoma, and to evaluate the impact of this approach on clinical follow-up frequency and anesthesia exposure.

This prospective study included 74 eye-session pairs from 74 eyes of 27 patients aged 0–36 months diagnosed with pediatric glaucoma. IOP was measured during natural sleep within ≤ 2 h prior to EUA under end-tidal sevoflurane 2–3%. Measurements were performed by the same examiner under both conditions. Office and EUA frequencies were compared to a historical cohort (2009–2012) to evaluate changes in clinical monitoring trends.

Mean age was 18.07 ± 13.97 months; 78% had primary congenital glaucoma. Natural sleep IOP (21.01 ± 11.77 mmHg) was consistently higher than EUA IOP (17.69 ± 9.85 mmHg), with mean difference of 3.32 ± 3.83 mmHg (14.96 ± 16.60%) (p < 0.05). A very strong correlation was observed between the two measurement conditions (r = 0.95, R² = 0.91). Current surveillance demonstrated 4.45 ± 2.70 EUA procedures versus 3.18 ± 2.44 office visits per patient, compared to pre-iCare era ratio of 7.39 ± 2.65 EUA versus 0.80 ± 0.70 office visits, representing a 40% reduction in anesthesia dependence.

Natural-sleep rebound tonometry supports bias-aware, clinic-based trend monitoring and can reduce anesthesia exposure in children under 3 years.

The online version contains supplementary material available at 10.1186/s12886-025-04549-z.

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