Agreement between iCare HOME and Goldmann applanation tonometry: systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis evaluated agreement between the iCare HOME rebound self-tonometer and Goldmann applanation tonometry (GAT) for intraocular pressure (IOP) measurement in adults. METHODS: Ovid MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from January 2015 to May 2026. Eligible studies compared in-clinic or at-home iCare HOME, including HOME and HOME2 models, with GAT in adults using mean differences, limits of agreement, or intraclass correlation coefficients. Random-effects meta-analysis pooled the mean difference in IOP for iCare HOME minus GAT. Risk of bias was assessed using QUADAS-2, and certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Post hoc analyses addressed unit of analysis, operator, and measurement variability. RESULTS: Twenty-two studies including 1857 eyes of 1517 patients were included; 16 studies involving 1333 eyes contributed to the meta-analysis. The pooled mean difference was -0.21 mm Hg (95% CI: -0.73 to 0.31; I² = 94.2%; p = 0.42). A prespecified REML Hartung-Knapp analysis was similar (95% CI: -0.82 to 0.39). The pooled standard deviation of paired differences was 2.66 mm Hg, corresponding to individual-level limits of agreement of approximately ±5 mm Hg. Leave-one-out, subgroup, and 1-eye-per-participant analyses did not materially change the results (1 eye per participant, -0.40 mm Hg; 95% CI: -1.18 to 0.38). Egger's test suggested possible small-study effects. GRADE certainty was very low because of inconsistency, imprecision, and possible publication bias. CONCLUSIONS: iCare HOME showed no significant systematic bias relative to GAT, including with 1 eye per participant, but substantial heterogeneity and wide individual-level agreement limits preclude routine interchangeability.