Schuman warns on home tonometry

Joel Schuman’s warning is not about a lack of glaucoma technology. It is about what happens after the devices arrive. In comments published by *Ophthalmology Times* on May 25, 2026, Schuman said home tonometry, virtual visual fields and portable optical coherence tomography are the most likely glaucoma breakthroughs in 2026, but said each depends on whether clinics can make the resulting data usable. (ophthalmologytimes.com) That framing shifts the discussion away from a single new procedure or drug. (ophthalmologytimes.com) Schuman’s focus was on monitoring tools that could move testing out of the office and generate more frequent measurements over time, rather than relying on intermittent clinic visits alone. ### Why is Schuman focusing on monitoring tools instead of a new operation? Home tonometry is aimed at intraocular pressure measurement outside the clinic, while virtual visual fields and portable OCT extend functional and structural testing closer to the patient. Schuman identified those three categories as the areas most likely to produce near-term gains in glaucoma care. (ophthalmologytimes.com) Portable OCT matters because it could bring retinal nerve fiber layer and optic nerve assessment into more flexible settings. Virtual field testing matters because glaucoma progression is often assessed over time, and more frequent testing could, in theory, make change easier to detect. (ophthalmologytimes.com) ### What exactly is the problem with collecting more glaucoma data? Data volume is not the same as clinical usefulness. Schuman said dense longitudinal monitoring can fail if the measurements are unreliable, if patients do not use devices consistently, or if clinicians receive more information than existing workflows can absorb. Patient adherence is central because home monitoring only works if testing happens repeatedly and correctly. (ophthalmologytimes.com) Data reliability is equally important because noisy or inconsistent readings can make it harder, not easier, to distinguish true progression from artifact. ### Why does reimbursement matter as much as the hardware? (ophthalmologytimes.com) Reimbursement determines whether clinics can support the labor around remote monitoring. Schuman identified payment as one of the core barriers because collecting home pressure readings, remote field data or portable imaging is only part of the task; someone still has to review, triage and act on the results. (ophthalmologytimes.com) That creates a service problem as much as a device problem. If payers do not cover the work needed to monitor patients between visits, the technology may remain available but underused. ### How does this change the way glaucoma care is being described? (ophthalmologytimes.com) Schuman’s comments recast glaucoma management as a form of continuous or semi-continuous surveillance. The practical implication is that care could depend less on isolated office snapshots and more on trends built from repeated measurements taken over time. That approach would make workflow design more important. Clinics would need rules for which patients should be monitored at home, how often data should be reviewed, what thresholds trigger escalation, and how false alarms are filtered out. (ophthalmologytimes.com) Those operational questions sit underneath Schuman’s warning. ### Which patients are most likely to be affected first? Patients with suspected progression, inconsistent office pressure readings, follow-up barriers or advanced disease are the clearest candidates for denser monitoring, based on the use cases described in the report. The appeal is strongest where delay between visits carries the highest clinical cost. (ophthalmologytimes.com) For now, the next step is not a regulatory deadline or launch date named in the report. On May 25, 2026, the article’s immediate marker was Schuman’s list of hurdles — reliability, adherence and reimbursement — and whether glaucoma services build protocols around them before adopting the devices at scale. (ophthalmologytimes.com)