The influence of central corneal thickness and age on intraocular pressure measured by pneumotonometry, non-contact tonometry, the Tono-Pen XL, and Goldmann applanation tonometry

Comparison of dynamic contour tonometry and noncontact tonometry in ocular hypertension and glaucoma

PURPOSE

To assess the agreement in the measurement of intraocular pressure obtained by dynamic contour tonometer (DCT) and noncontact tonometer (NCT) in patients with glaucoma and ocular hypertension, to investigate the effect of corneal thickness on pressure readings by both instruments, and to assess the reproducibility of dynamic contour tonometer.

METHODS

NCT and DCT measurements were made on 104 eyes of 104 patients with primary open-angle glaucoma (n=75) or ocular hypertension (n=29), and agreement was assessed by means of Bland-Altman plots. The effect of corneal thickness on both tonometers was assessed by linear regression analysis. Interobserver and intraobserver variations for dynamic contour tonometer were assessed in 41 eyes of 41 patients.

RESULTS

The mean difference+/-SD (95% limits of agreement) between NCT and DCT was -0.80+/-2.98 (-6.6 to 5.1) mm Hg (P=0.009) and no relation between NCT/DCT differences and average was found. The intraocular pressure readings obtained by noncontact tonometer depended on central corneal thickness (P<0.001, adjusted r(2)=0.301). However, dynamic contour tonometer readings showed no effect of corneal thickness (P=0.388, adjusted r(2)=-0.002). The coefficient of repeatability for DCT was 0.92 (95% CI 0.85-0.96, P=0.001).

CONCLUSION

In subjects with primary open-angle glaucoma and ocular hypertension, NCT and DCT readings are not interchangeable. DCT measurements, unlike NCT measurements, did not depend on corneal thickness.

When is glaucoma really glaucoma?

The approach to the diagnosis and management of glaucoma has undergone considerable changes in recent years. Current concepts of glaucoma diagnosis focus on structural assessment and structure-function correlation, and relies less on the finding of visual field abnormalities. In turn, contemporary approaches to management have also changed and revolve around earlier initiation of pressure lowering medication based on pre-perimetric findings. This article presents an approach to the assessment of the patient with suspected glaucoma, highlighting those structural and ancillary diagnostic investigations that will aid in the correct diagnosis. It also discusses the differentiation of glaucoma from other, non-glaucomatous disease processes.

Corneal Thickness Measurement in the Management of Primary Open-angle Glaucoma

OBJECTIVE

To evaluate published literature to assess whether central corneal thickness (CCT) is a risk factor for the presence, development, or progression of glaucomatous optic nerve damage related to primary open-angle glaucoma (POAG).

METHODS

A PubMed literature search limited to English language articles conducted on November 15, 2004 retrieved 195 articles. The authors reviewed these abstracts and selected 57 to review in full text to determine relevance to the assessment questions. A further 24 studies of interest were identified from periodic updates to the literature search, surveillance of the literature, and reference lists of reviewed articles. From the 81 published reports identified, the first author applied specified selection criteria that yielded 37 articles for methodological review because of relevance to the assessment questions. The articles were rated according to the strength of evidence by the panel methodologist. A level I rating was assigned to well-designed properly conducted randomized clinical trials or similar quality-validated cohort studies with appropriate reference standards. A level II rating was assigned to well-designed case-control studies, exploratory cohort studies, and other nonrandomized clinical studies lacking consistently applied reference standards. A level III rating was reserved for poorly designed case-control studies, case series, and papers consisting only of expert opinion without supporting evidence. In addition, each study was graded as positive if it supported a statistical association of CCT with the risk of having or developing glaucomatous optic nerve damage or as negative if no such association was found.

RESULTS

There is strong and consistent level I and level II evidence that CCT is a risk factor for progression from ocular hypertension to POAG. Studies that were rated as providing the highest quality of evidence revealed mixed results with respect to glaucoma prevalence. One population-based study (level II) showed a positive association, another larger study (level I) revealed an association of marginal significance, and 3 studies (all level I) found no association of CCT with POAG prevalence.

CONCLUSIONS

There is strong evidence that measuring CCT is an important component of a complete ocular examination, particularly for patients being evaluated for the risk of developing POAG. Therefore, CCT measurement should be included in the examination of all patients with ocular hypertension. Although the evidence supporting the necessity of measuring CCT as part of screening for POAG or as a risk factor for glaucoma progression is not as strong, intraocular pressure (IOP) is the only modifiable risk factor in the treatment of glaucoma, and CCT has the potential to significantly impact IOP measurement by applanation tonometry in all patients.

Changes in corneal hysteresis after clear corneal cataract surgery

PURPOSE

To assess the changes in corneal hysteresis (CH) as measured by the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, New York, USA) to describe the influence of clear corneal cataract surgery on corneal viscoelastic properties and intraocular pressure (IOP) measured by noncontact tonometry (NCT) and Goldmann applanation tonometry (GAT).

DESIGN

Retrospective, interventional, comparative study.

METHODS

One hundred and one eyes of 101 consecutive patients who underwent routine clear corneal cataract surgery were evaluated. CH, NCT, and central corneal thickness (CCT) were measured by ORA before surgery and at postoperative day 1. A control group of 48 pseudophakic eyes (surgery >3 months previously) was included.

RESULTS

CCT increased from 556.82 +/- 32.5 microm before surgery to 580.26 +/- 45.5 microm after surgery (P < .001; control, 555.16 +/- 42.33 microm). Mean CH decreased from 10.35 +/- 2.5 mm Hg before surgery to 9.20 +/- 1.9 mm Hg after surgery (P < .001; control, 10.47 +/- 1.63 mm Hg). NCT values rose from 17.85 +/- 3.8 mm Hg before surgery to 20.10 +/- 6.3 mm Hg after surgery. GAT values were 14.85 +/- 2.8 mm Hg before surgery and 15.24 +/- 4.1 mm Hg after surgery (P = .52). There was no significant difference of CCT or CH between the preoperative values and the values of the control group (CCT, P = .986; CH, P = .166), in contrast to the difference between postoperative values and the values of the control group (CCT, P = .005; CH, P = .031).

CONCLUSIONS

At day 1 after clear corneal cataract surgery, CH is diminished, whereas CCT is increased significantly. Postoperative corneal edema leads to a change of corneal viscoelastic properties, resulting in a lower damping capacity of the cornea. It is supposed that GAT and NCT measurements are significantly different because of postoperative changes in viscoelastic properties of the cornea.

Heritability of intraocular pressure in older female twins

PURPOSE

To examine the heritability of intraocular pressure (IOP) among older women not diagnosed as having glaucoma.

DESIGN

Cross-sectional twin study.

PARTICIPANTS

94 monozygotic (MZ) and 96 dizygotic (DZ) female twin pairs aged 63-76 years and not diagnosed as having glaucoma.

METHODS

Intraocular pressure was measured using a noncontact tonometer. The contributions of genetic and environmental factors to individual differences in IOP were estimated by applying an independent pathway model to twin data.

MAIN OUTCOME MEASURES

Contribution of genetic and environmental effects to the variation in IOP among MZ and DZ twins.

RESULTS

Mean IOP of the study population was 14.1 mmHg (+/- standard deviation 3.1) with no differences observed neither between the MZ and the DZ individuals, nor between the left and the right eyes. The pair-wise correlations for IOP of the right eye were .61 in MZ and .25 in DZ and for the left eye .63 and .42. The phenotypic correlation between the left and the right eye IOP was high (r = 0.81), suggesting that they were indices of a single trait. Quantitative genetic modeling revealed that for both eyes 64% (95% confidence interval [CI], 53-71) of the variance in IOP was explained by additive genetic effects and 18% (95% CI, 11-27) by nonshared environmental factors in common. In addition, 18% (95% CI, 15-23) of the variance in IOP was explained by nonshared environmental factors specific to each eye.

CONCLUSIONS

Additive genetic influences explained most of the individual differences in IOP among older women not diagnosed as having glaucoma. Because elevated IOP is an important risk factor for glaucoma, genetic factors underlying IOP may have a significant role in determining the risk for glaucoma, a complex progressive disease leading to death of ganglion cells.

Effect of central corneal thickness and radius of the corneal curvature on intraocular pressure measured with the Tono-Pen and noncontact tonometer in healthy schoolchildren

PURPOSE

To determine the effect of central corneal thickness and radius of the corneal curvature on intraocular pressure (IOP) measurements using the Tono-Pen and a noncontact tonometer in healthy Turkish schoolchildren.

SUBJECTS AND METHODS

IOP was measured with the Tono-Pen and a noncontact tonometer in 602 eyes of 602 healthy schoolchildren with a mean age of 10.1 +/- 1.6 years. Central corneal thickness was measured using an ultrasonic pachymeter after all IOP determinations had been made. The effect of central corneal thickness, radius of the corneal curvature, and sex on measured IOP was explored by linear regression analysis.

RESULTS

The mean central corneal thickness was found to be 564.92 +/- 32 microm. The mean IOP readings were 17.9 +/- 2 mm Hg using the Tono-Pen, and 16.7 +/- 2 mm Hg using a noncontact tonometer. The Tono-Pen measured IOP values slightly greater than the noncontact tonometer (P < .0001). A significant association between measured IOP and central corneal thickness was found with each device. The IOP increased 2.1 and 4.2 mm Hg with every 100-microm increase in central corneal thickness for the Tono-Pen and the noncontact tonometer, respectively. The dependence of IOP on central corneal thickness did not differ between boys and girls. There was a significant association between the Tono-Pen and noncontact tonometer differences and central corneal thickness; the noncontact tonometer tended to overestimate IOP in eyes with thicker corneas.

CONCLUSIONS

The Tono-Pen readings appeared to be less affected by corneal thickness than those of the noncontact tonometer. The corneal radius of curvature had no significant effect on measured IOP with each device. Because the Tono-Pen was relatively easy to use and less affected by corneal thickness, it may be an alternative method for measuring IOP in children.

Der Einfluss von kornealer Hysterese und kornealem Resistenzfaktor auf die Messung des intraokularen Drucks

BACKGROUND

The influence of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) has been discussed extensively in recent years. The problem, however, has not been solved so far. In addition to CCT there are probably further biomechanical properties that play a role in IOP measurement. We wanted to find out whether these properties are related to Goldmann applanation tonometry (GAT), noncontact tonometry (NCT), or CCT.

MATERIAL AND METHODS

Biomechanical properties of the cornea such as corneal hysteresis (CH) and corneal resistance factor (CRF) can be measured with the Ocular Response Analyzer (ORA, Reichert Ophthalmic Instruments, Depew, NY, USA). Furthermore, a corneal compensated IOP (IOPcc) is given. We examined 156 normal eyes of 80 patients who did not show corneal pathology nor glaucoma. In each eye GAT, NCT, and ORA data as well as CCT were measured. Data were statistically analyzed with respect to agreement and the influence of CH and CRF on IOP measurement.

RESULTS

In our patients the following average values were calculated: GAT 14.8+/-3.0 mmHg, NCT 16.4+/-3.9 mmHg, IOPcc 16.2+/-4.1 mmHg, CH 10.6+/-2.3 mmHg, CRF 10.9+/-2.4 mmHg, and CCT 557+/-36 microm. IOPcc was not related to CCT in normal eyes and the only IOP value related to CH (p<0.01). CRF, however, was related to GAT and NCT values (p<0.01).

DISCUSSION

In our group of normal eyes IOPcc, i.e., the value that is adjusted by measurement of viscoelastic properties of the cornea, in contrast to GAT and NCT does not depend on central corneal thickness. Corneal hysteresis and corneal resistance factor provide further information about biomechanical properties of the cornea beyond central corneal thickness.

The effect of contact lens induced oedema on the accuracy of Goldmann tonometry in a mature population

AIM

To determine the effect of contact lens induced oedema on the accuracy of Goldmann tonometry measurements of intraocular pressure (IOP) in mature subjects.

METHODS

22 healthy subjects aged between 50 and 60 years were recruited. Corneal curvature, IOP, and central corneal thickness (CCT) were measured before and after two hours of monocular closed eye wear of a thick hydroxyethyl methacrylate (HEMA) contact lens. Measurements were then repeated at 20 minute intervals for one hour after lens removal.

RESULTS

Both CCT (+54.1 mum) and IOP (+2.7 mm Hg) increased significantly after lens wear (p<0.001, paired t test with Bonferroni correction). For the hour following lens removal, the measured IOP was correlated to the increase in CCT (r = 0.84, p<0.001), at a rate of 1.0 mm Hg/10 mum (95% confidence interval, 0.8 to 1.2 mm Hg/10 mum, linear mixed model analysis).

CONCLUSIONS

A relatively small increase in CCT from contact lens induced corneal oedema caused an overestimation error in Goldmann tonometry measurements of IOP in healthy mature subjects.

Novel pressure-to-cornea index in glaucoma

BACKGROUND

Several conversion tables and formulas have been suggested to correct applanation intraocular pressure (IOP) for central corneal thickness (CCT). CCT is also thought to represent an independent glaucoma risk factor. In an attempt to integrate IOP and CCT into a unified risk factor and avoid uncertain correction for tonometric inaccuracy, a new pressure-to-cornea index (PCI) is proposed.

METHODS

PCI (IOP/CCT(3)) was defined as the ratio between untreated IOP and CCT(3) in mm (ultrasound pachymetry). PCI distribution in 220 normal controls, 53 patients with normal-tension glaucoma (NTG), 76 with ocular hypertension (OHT), and 89 with primary open-angle glaucoma (POAG) was investigated. PCI's ability to discriminate between glaucoma (NTG+POAG) and non-glaucoma (controls+OHT) was compared with that of three published formulae for correcting IOP for CCT. Receiver operating characteristic (ROC) curves were built.

RESULTS

Mean PCI values were: Controls 92.0 (SD 24.8), NTG 129.1 (SD 25.8), OHT 134.0 (SD 26.5), POAG 173.6 (SD 40.9). To minimise IOP bias, eyes within the same 2 mm Hg range between 16 and 29 mm Hg (16-17, 18-19, etc) were separately compared: control and NTG eyes as well as OHT and POAG eyes differed significantly. PCI demonstrated a larger area under the ROC curve (AUC) and significantly higher sensitivity at fixed 80% and 90% specificities compared with each of the correction formulas; optimum PCI cut-off value 133.8.

CONCLUSIONS

A PCI range of 120-140 is proposed as the upper limit of "normality", 120 being the cut-off value for eyes with untreated pressures <or=21 mm Hg, 140 when untreated pressure >or=22 mm Hg. PCI may reflect individual susceptibility to a given IOP level, and thus represent a glaucoma risk factor. Longitudinal studies are needed to prove its prognostic value.

Comparisons between Pascal dynamic contour tonometry, the TonoPen, and Goldmann applanation tonometry in patients with glaucoma

PURPOSE

To compare intraocular pressure (IOP) measurements taken with Pascal dynamic contour tonometry (DCT), the TonoPen and the Goldmann applanation tonometry (GAT). The influence of central corneal thickness (CCT) on IOP measurements taken with Pascal DCT and the TonoPen was evaluated.

METHODS

One eye in each of 101 consecutive patients with primary open-angle glaucoma (POAG) underwent ultrasonic CCT measurement and IOP evaluation with GAT, Pascal DCT and the TonoPen in random order. The agreement between results from Pascal DCT and the TonoPen and those of GAT was assessed using the Bland-Altman method. The deviation of Pascal DCT and TonoPen readings from GAT values, corrected for CCT, was calculated and correlated to CCT using a linear regression model.

RESULTS

The mean of the differences in IOP measurements was 3.2 +/- 2.4 mmHg for Pascal DCT minus GAT readings and 0.5 +/- 4.5 mmHg for TonoPen minus GAT readings. The 95% confidence interval of differences in IOP measurements was higher between TonoPen and GAT readings (- 6 to 7 mmHg) than between Pascal and GAT readings (0.1-6.8 mmHg). Pascal DCT significantly overestimated IOP compared with GAT, especially for higher IOP readings. Bland-Altman scatterplots showed reasonable inter-method agreement between Pascal DCT and GAT measurements, and poor agreement between TonoPen and GAT measurements. The deviations of Pascal DCT and TonoPen readings from the corrected GAT values were both highly correlated with CCT values (linear regression analysis, p < 0.0001). The mean change in measured IOP for a 10-microm increase in CCT was 0.48 mmHg for Pascal DCT and 0.74 mmHg for the TonoPen.

CONCLUSIONS

Agreement with GAT measurements was higher for Pascal DCT than for TonoPen readings; however, Pascal DCT significantly overestimated IOP values compared with GAT. Measurements of IOP obtained with both Pascal DCT and the TonoPen appeared to be influenced by CCT, and this influence appeared to be greater for the latter.

Diurnal Variation of Central Corneal Thickness and Goldmann Applanation Tonometry Estimates of Intraocular Pressure

PURPOSE

To determine whether there is a temporal relationship between the diurnal variation of central corneal thickness (CCT) and intraocular pressure (IOP) by Goldmann applanation tonometry in young normal human participants in vivo.

METHODS

Twenty-five eyes of 25 young healthy normal participants were examined in a prospective observational cross-sectional study. IOP, CCT and corneal curvature were measured using standard clinical techniques over a 24-hour period, and the temporal interrelationships between these parameters were examined.

RESULTS

The overnight change in IOP measured by Goldmann tonometry was 3.1+/-2.4 mm Hg (P<0.001), CCT was 20.1+/-10.9 mum (P=0.016), with no statistical change in central corneal curvature (0.05 mm, P=0.477, paired t test with Bonferroni correction). Both IOP and CCT were highest on awakening at 7:00 then dropped rapidly to baseline levels by 9:00 (linear mixed models), and these two parameters were highly correlated (r=0.978, P<0.001). After 9:00, there was no correlation between these parameters (r=-0.453, P=0.260).

CONCLUSIONS

The results of this study have highlighted a potential link between the diurnal variation of CCT and the accuracy of Goldmann tonometry estimates of IOP during the first 2 hours after awakening. Clinicians should be wary of using Goldmann tonometry to estimate IOP until the overnight increase in CCT has resolved.

Clinical Evaluation of Applanation Resonance Tonometry

PURPOSE

The purpose of this study was to calibrate and evaluate the precision of the new applanation resonance tonometry (ART) in a clinical study designed in accordance with the International Standard Organization's requirements.

METHODS

This was a prospective, randomized, single-center study, where healthy volunteers and patients participated. A total of 153 eyes were divided into 3 groups with respect to their intraocular pressure (IOP) at screening: <16 mm Hg, 16 to 23 mm Hg, and >23 mm Hg. IOP was measured with Goldmann applanation tonometry (GAT) as reference method and by ART in both a biomicroscope (ARTBiom) and a handheld (ARTHand) setup with a 10-minutes pause between methods. The mean of 6 readings was regarded as one measurement value.

RESULTS

Mean age of the subjects was 59 years (range 20 to 87 y). GAT showed a mean IOP of 20.0 mm Hg (range 8.5 to 43.5 mm Hg, n=153). The precision was 2.07 mm Hg for ARTBiom and 2.50 mm Hg for ARTHand, with a significant dependency for age as compared with GAT. Measurement order produced a decreasing IOP with a mean of 2.3 mm Hg between the first and last method.

CONCLUSIONS

The precision obtained in both ARTBiom and ARTHand was within the limits set by the International Standard Organization standards for tonometers. The standardized procedure and the stability of the biomicroscope setup resulted in a slightly better precision as compared with the handheld setup. Despite a 10-minutes pause between measurements, the order was a significant factor, possibly because the patients were more apprehensive at the first measurement.

Age differences in central and peripheral intraocular pressure using a rebound tonometer

AIM

To evaluate the influence of age on the measurements and relationships among central and peripheral intraocular pressure (IOP) readings taken with a rebound tonometer.

METHODS

The IOPs were measured using the ICare rebound tonometer on the right eyes of 217 patients (88 men and 129 women) aged 18-85 years (mean 45.9 (SD 19.8) years), at the centre and at 2 mm from the nasal and temporal limbus along the horizontal meridian. Three age groups were established: young (< or =30 years old; n = 75), middle aged (31-60 years old; n = 77) and old patients (>60 years old; n = 65).

RESULTS

A high correlation was found between the central and peripheral IOP readings, with the central readings being higher than the peripheral ones. Higher IOP values for the central location were found in the younger patients. Older patients had significantly lower temporal IOP readings than those for the remaining two groups (p<0.001), whereas no significant differences were found among groups when IOP was measured at the central and nasal locations. A significant decrease was observed in the nasal and temporal IOP readings as the age increased (p = 0.011 and 0.006, respectively).

CONCLUSION

Older patients had lower IOP values than the middle-aged and younger patients in the temporal peripheral location. A negative correlation was found between age and IOP by rebound tonometry in the corneal periphery but not in its centre.

Evaluation of Goldmann Applanation Tonometry Using a Nonlinear Finite Element Ocular Model

Goldmann applanation tonometry (GAT) is the internationally accepted standard for intra-ocular pressure (IOP) measurement, which is important for the diagnosis of glaucoma. The technique does not consider the effect of the natural variation in the corneal thickness, curvature and material properties. As these parameters affect the structural resistance of the cornea, their variation is expected to lead to inaccuracies in IOP determination. Numerical Analysis based on the finite element method has been used to simulate the loading conditions experienced in GAT and hence assess the effect of variation in corneal parameters on GAT IOP measurements. The analysis is highly nonlinear and considers the hyper-elastic J-shaped stress-strain properties of corneal tissue observed in laboratory tests. The results reveal a clear association between both the corneal thickness and material properties, and the measured IOP. Corneal curvature has a considerably lower effect. Similar trends have been found from analysis of clinical data involving 532 patients referred to the Glaucoma Unit at Moorfields Hospital, and from earlier mathematical analyses. Nonlinear modelling is shown to trace the behaviour of the cornea under both IOP and tonometric pressure, and to be able to provide additional, and potentially useful, information on the distribution of stress, strain, contact pressure and gap closure.

Agreement of rebound tonometer in measuring intraocular pressure with three types of applanation tonometers

PURPOSE

To evaluate the agreement of iCare rebound tonometer in measuring intraocular pressure (IOP) with Goldmann applanation tonometer (GAT), Tonopen XL, and noncontact tonometer, and the influence of the central corneal thickness (CCT) on IOP measurements made with these four tonometers in 45 (12 control and 33 glaucomatous or ocular hypertensive) eyes.

DESIGN

Clinically relevant experimental study.

METHODS

Tonometer intermethod agreement was assessed by the Bland-Altman method. The relations of CCT with absolute IOP values and intertonometer differences were analyzed by linear regression.

RESULTS

The mean differences (95% limits of agreement) in IOP readings between iCare and GAT, Tonopen XL, and noncontact tonometer were 1.40 +/- 4.29, 0.00 +/- 4.78, and 2.22 +/- 4.19 mm Hg, respectively. All tonometries had a marked association with CCT. As the CCT got thicker, iCare considerably overestimated GAT and Tonopen XL.

CONCLUSIONS

Although influenced by CCT, iCare agrees well with applanation tonometers.

Corneal structure and biomechanics: impact on the diagnosis and management of glaucoma

PURPOSE OF REVIEW

Highlights recent studies relating to the impact of corneal structure and biomechanical properties on glaucoma evaluation and management.

RECENT FINDINGS

Central corneal thickness has been shown to play a role in the interpretation of intraocular pressure. Central corneal thickness has also been suggested as a glaucoma risk factor. The potential role of other corneal factors, such as stromal makeup, in the accurate measurement of intraocular pressure and the assessment of glaucoma risk remains to be determined.

SUMMARY

Improved understanding of central corneal thickness and corneal biomechanical properties may someday lead to a better understanding of glaucoma risk and its assessment.

Augeninnendruck und Hornhautdicke

OBJECTIVE

Corneal thickness and deformation seem to have a considerable influence on intraocular pressure measurement. Due to differences in the corneal deformation in either non-contact tonometry or applanation tonometry, both methods should be compared in the same patient group depending on central corneal thickness.

METHODS

In 106 eyes of 55 patients (18 males, 37 females, age 17-89 years, mean 63.3 years) with glaucoma and central corneal thickness between 409 and 644 microm (Orbscan II pachymetry) intraocular pressure was measured in each eye with non-contact tonometry (Reichert AT550) and 30 min later with Goldman applanation tonometry.

RESULT

Non-contact tonometry as well as applanation tonometry showed a positive correlation between measured intraocular pressure and corneal thickness. The steepness of the line of regression was 0.33 mmHg per 10 microm of corneal thickness in non-contact tonometry and 0.17 mmHg per 10 microm of corneal thickness in applanation tonometry.

CONCLUSION

Independently of the large differences in individual pressure measurements between non-contact tonometry and applanation tonometry, we found higher IOP values with non-contact tonometry in thicker corneas as compared with applanation tonometry. In thinner corneas there was a better correspondence between both methods. Thus, it seems very likely that corneal rigidity increases with corneal thickness.

Bilateral ring scotomas following laser in situ keratomileusis

A 53-year-old white man who had a history of transient ocular hypertension had bilateral laser in situ keratomileusis (LASIK) for myopia. Subsequent computerized static perimetry revealed bilateral, persistent, repeatable midperipheral ring scotomas. The pre-LASIK visual fields were within normal limits, and the optic discs appeared stable and not diagnostic for glaucomatous optic neuropathy. A comprehensive baseline data set before laser refractive surgery aids subsequent assessment of individuals at high risk for developing glaucoma.

Goldmann-Applanationstonometrie und dynamische Konturtonometrie

BACKGROUND

The aim of the study was to compare intraocular pressure (IOP) measurements between Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) during product certification according to the international requirements for ophthalmic instruments (tonometers, ISO 8612:2001).

METHODS

The study included 160 eyes of 80 subjects. IOP measurements were performed four times consecutively on each instrument in randomized order. The difference of mean IOP measurements between GAT and DCT was analyzed. Furthermore, Bland and Altman analysis was performed to assess agreement between the instruments.

RESULTS

The mean difference between DCT and GAT IOP measurements was 0.30+/-2.18 mmHg. At low to normal IOP values of 7-16 mmHg and higher IOP values of > or =23 mmHg, the difference between DCT IOP measurements and GAT IOP measurements increased in the opposite direction (1.44+/-1.59 mmHg and -1.47+/-2.57 mmHg). The Bland and Altman analysis revealed a fixed bias of -0.4+/-2.0 mmHg.

CONCLUSIONS

The test tonometer DCT exceeds the requirements for the international standard for tonometers ISO 8612:2001. The results are valid for a central corneal thickness of 540+/-40 microm.