Background: 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.
Methods: 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.
Results: 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.
Conclusion: Natural-sleep rebound tonometry supports bias-aware, clinic-based trend monitoring and can reduce anesthesia exposure in children under 3 years.
Keywords: Anesthesia dependence; Natural sleep measurements; Pediatric glaucoma; Rebound tonometry.
© 2025. The Author(s).