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Cárceles Montoya A, Monera Lucas CE, Tarazona Jaimes CP, Romero Valero D, Moya Martínez A, Martínez Toldos JJ. Comparability analysis of the HNT-1P Huvitz non contact tonometer for the measurement of intraocular pressure. Eur J Ophthalmol 2024:11206721241263624. [PMID: 39056138 DOI: 10.1177/11206721241263624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
PURPOSE To evaluate the diagnostic validity of the HNT-1P non-contact tonometer (Huvitz) as a tool for accurately measuring intraocular pressure (IOP) in patients with healthy eyes, compared to the Goldmann applanation tonometer (GAT), which is the Gold Standard method for measurement of IOP. METHODS Observational, descriptive, transversal study using 148 eyes of 74 healthy patients without a diagnosis of glaucoma or other ophthalmological diseases. Three measurements of IOP were taken in each eye, using three tonometers: HNT-1P, ICR100, and GAT. The median IOP (quartiles) and mean IOP (SD) its statistical significance were calculated, and comparisons were made between the mean and median IOP values found in three groups: GAT-HNT, GAT-ICR, and HNT-ICR. The difference in mean and median IOP was analyzed in each of the three study groups, and its statistical significance and concordance correlation coefficient (CCC) were calculated. RESULTS The median IOP with HNT-1P was statistically significantly lower than the median IOP with GAT, (1.1 mmHg, p < 0.001). The median IOP with HNT-1P was also lower than the median IOP with ICR100. As an additional result, the median IOP with GAT was lower than the median IOP with ICR. The CCC was moderate for HNT-ICR (0.72) and low for GAT-HNT and GAT-ICR (0.43 and 0.38, respectively). CONCLUSIONS HNT-1P (Huvitz) provides statistically significantly lower IOP values than those obtained with GAT. HNT-1P could be used for screening of ocular hypertension in postoperative patients. The IOP measurement obtained with HNT-1P should be confirmed with GAT. HNT-1P yields lower IOP values than those obtained with ICR.
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Affiliation(s)
| | - Carlos Enrique Monera Lucas
- Ophthalmology Department, General University Hospital of Elche, Alicante, Spain
- Miguel Hernández University of Elche, Alicante, Spain
| | - Claudia Patricia Tarazona Jaimes
- Ophthalmology Department, General University Hospital of Elche, Alicante, Spain
- Miguel Hernández University of Elche, Alicante, Spain
| | - Daniel Romero Valero
- Ophthalmology Department, General University Hospital of Elche, Alicante, Spain
- Miguel Hernández University of Elche, Alicante, Spain
| | - Alejandro Moya Martínez
- Miguel Hernández University of Elche, Alicante, Spain
- Biostatistics, FISABIO, General University Hospital of Elche, Alicante, Spain
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Kulkarni VM, Ciociola EC, Vardhan AS, Sundar B, Rajendrababu S, Ramulu PY. A Comparative Analysis of Intraocular Pressure Measurement Accuracy With Reused iCare Probes. Ophthalmol Glaucoma 2024; 7:352-358. [PMID: 38401758 DOI: 10.1016/j.ogla.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE To assess the accuracy of reused iCare probes after disinfection with 70% isopropyl alcohol and ethylene oxide gas compared to new iCare probes and Goldmann applanation tonometry (GAT). DESIGN Prospective comparative analysis. PARTICIPANTS A total of 118 eyes from 59 patients recruited from the Aravind Eye Hospital glaucoma clinic in Tirupati, South India. METHODS Intraocular pressure (IOP) was measured on each eye using a new iCare tonometer probe, an iCare probe previously used and disinfected 1 time prior (once used probe) and 5 times prior (multiply used probe), as well as with GAT. Probes were disinfected after each use with 70% isopropyl alcohol swabs and ethylene oxide sterilization. MAIN OUTCOME MEASURES Agreement demonstrated with intraclass correlation coefficients (ICCs), mean difference in IOP values with limits of agreement, and Bland-Altman plots among IOP measurement approaches. RESULTS Compared to new iCare probes, both once used probes (ICC = 0.989, 95% confidence interval [CI] 0.985-0.993) and multiply used probes (ICC = 0.989, 95% CI 0.984-0.992) showed excellent agreement, and the mean difference in IOP was minimal for both once used probes (0.70 mmHg, 95% CI 0.29-1.11) and multiply used probes (0.75 mmHg, 95% CI 0.66-0.82) compared to new probes. Bland-Altman plots demonstrated minimal differences between new and reused probes across the spectrum of IOP. When comparing multiply used probes to once used probes, there was a high level of agreement (0.993) (95% CI 0.990-0.995) and negligible mean IOP difference 0.04 mmHg (95% CI 0.32-0.40). Additionally, ICC values for new probes (0.966, 95% CI 0.951-0.976), once used probes (0.958, 95% CI 0.940-0.971), and multiply used probes (0.957, 95% CI 0.938-0.970) compared to GAT were similar and all showed excellent agreement. Both new and reused iCare probes underestimated IOP by 2 to 3 mmHg compared to GAT. CONCLUSIONS In this prospective comparative analysis, we found that reusing iCare probes up to 5 times does not compromise the accuracy of IOP measurements when disinfected with 70% isopropyl alcohol swabs and ethylene oxide. Reusing iCare probes has the potential to transform care by reducing cost, decreasing environmental waste, and allowing for glaucoma screening camps and increased glaucoma monitoring in low resource settings leading to earlier identification and treatment of glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Vedesh M Kulkarni
- Department of Glaucoma, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
| | - Elizabeth C Ciociola
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashok S Vardhan
- Department of Glaucoma, Sri Venkateswara Aravind Eye Hospital, Tirupati, India.
| | - Balagiri Sundar
- Department of Glaucoma, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
| | | | - Pradeep Y Ramulu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Swaminathan S, Kisielewski AM, Nowroozzadeh MH, Hallaj S, Lee D, Kolomeyer NN, Myers JS, Razeghinejad R. A comparison of iCare and Goldmann applanation tonometry measurements during the COVID-19 pandemic: a retrospective study. Int Ophthalmol 2024; 44:260. [PMID: 38910200 PMCID: PMC11194190 DOI: 10.1007/s10792-024-03220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To evaluate factors associated with differences in intraocular pressure (IOP) readings between iCare and Goldmann applanation tonometry (GAT) in established glaucoma patients. METHODS This retrospective comparative study included clinical data of 350 eyes from 350 established glaucoma patients who had iCare and GAT IOP measured by an ophthalmic technician and a glaucoma specialist, respectively. The main outcome measure was the difference in IOP measurements of the right eyes with iCare and GAT. RESULTS The intraclass correlation coefficient (ICC) between GAT and iCare was 0.90. The mean IOP difference between tonometers was - 0.18 ± 2.89 mmHg. Bland-Altman plots indicated a 95% limit of agreement of - 5.8 to 5.5 mmHg. Central corneal thickness (CCT) and age were significantly correlated with the difference in IOPs of the iCare and GAT. GAT-IOP and age were significantly associated with the absolute difference in measured IOP of the two tonometers. The difference in measurements was not significantly associated with prior glaucoma surgery, average global index of optical coherence tomography, axial length, technician years of experience and certification, and IOP range. CONCLUSION Although there is good agreement between the iCare and GAT mean values, these devices are not interchangeable in glaucoma patients due to the wide range of the limit of agreement.
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Affiliation(s)
- Shreya Swaminathan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA.
| | - Amber M Kisielewski
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | | | - Shahin Hallaj
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Natasha N Kolomeyer
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA, 19107, USA
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Stodtmeister R, Menzel A, Klimova A, Herber R, Pillunat KR, Pillunat LE. Measurement of the retinal venous pressure with a new instrument in patients with primary open angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1633-1639. [PMID: 38214734 PMCID: PMC11031493 DOI: 10.1007/s00417-023-06326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/28/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE To compare the results of retinal venous pressure (RVP) measurement performed with contact lens dynamometry (CLD) and with the new IOPstim. METHODS In this cross-sectional study, we included 36 patients with primary open angle glaucoma with a median age (Q25; Q75) of 74 (64; 77) years (m/f = 18/18), baseline intraocular pressure (IOP): 13.9 (12.2; 15.1) mmHg. Median mean defect: - 5.8 (- 11.9; - 2.6) db. Principle of the IOPstim: an empty balloon with a diameter of 8 mm is positioned on the eye, laterally of the limbus. Under observation of the central retinal vein (CRV), the examiner inflates the balloon. As soon as the CRV starts pulsation, the inflation is stopped and the IOP is measured, equaling the RVP at this moment. In the CLD, the pulsation of the CRV is observed with a contact lens. The RVP is calculated from the attachment force applied when pulsation appears. COURSE OF EXAMINATIONS Three single measurements of RVP in quick succession with both methods. The sequence of the two methods was randomized. The means of the three RVP measurements were compared. RESULTS Pressures in mmHg. RVP: IOPstim: 19.4 ± 5.4 (mean ± SD), CLD: 20.3 ± 5.9. Range of three single measurements: IOPstim: 2.9 ± 1.5, CLD: 2.2 ± 1.1. The differences were RVPIOPstim - RVPCLD = - 0.94 ± 1.15, and approximately normally distributed. Bland-Altman analysis: only one data point was 0.5 mmHg higher than the upper line of agreement. The confidence interval of this line was 0.65 mmHg. Concordance correlation coefficient according to Lin (CCC): 0.96. Intraclass correlation coefficient: both methods, 0.94. CONCLUSION In both methods, the range of the single measurements may be taken as a sign of good reliability, the CCC of 0.96 as a sign of a very good agreement. At the mean, the IOPstim RVP values were 1 mmHg lower than those obtained with the CLD. This difference may be due to the different directions of the prevailing force vectors induced by the instruments. The IOPstim seems applicable in glaucoma diagnostics.
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Affiliation(s)
- Richard Stodtmeister
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Aline Menzel
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT/UCC), German Cancer Research Center (DKFZ), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307, Dresden, Germany
| | - Robert Herber
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Karin R Pillunat
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Lutz E Pillunat
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Duran M. Comparison of intraocular pressure measurements obtained by icare pro tonometer, non-contact tonometer and Goldmann applanation tonometer in healthy individuals. J Fr Ophtalmol 2023; 46:1195-1203. [PMID: 37666735 DOI: 10.1016/j.jfo.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The goal of this paper was to compare the intraocular pressure (IOP) measurements obtained via iCare Pro rebound (IRT), non-contact tonometry (NCT), and Goldmann applanation (GAT) tonometry in healthy subjects. MATERIALS AND METHODS One hundred and twenty-five healthy individuals were included in this study. The participants' IOP measurements were obtained via non-contact tonometry. After routine ophthalmic examination, central corneal thickness (CCT) was measured with a topography device. Intraocular pressure was measured via iCare Pro rebound tonometry. After waiting for 5minutes, three measurements were taken with GAT under topical anaesthesia, and their means were recorded. Interdevice agreement was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS The mean IOP measurements for NCT, IRT, and GAT were 15.97±2.99, 17.47±2.86, and 16.46±2.68mmHg, respectively. The mean difference between NCT and GAT was -0.49± 1.89mmHg, the mean difference between IRT and GAT was 1.01±1.90mmHg, and the mean difference between NCT and IRT was -1.50±2.02mmHg. Agreement between devices was found to be >0.8 for each tonometry ICC. There were significant positive correlations between the measurements obtained via these three instruments and CCT. CONCLUSION In this study, IOP was measured slightly lower with NCT than GAT, but it was about 1mmHg higher with IRT than GAT on average. All three devices appeared to be affected by CCT, with NCT being the most affected in this regard. The three instruments can be used for routine inspection and screening. However, considering the differences in the measurements obtained by using them, it is clear that following up IOP measurements with GAT measurements is beneficial in advanced glaucoma patients.
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Affiliation(s)
- M Duran
- Department of Ophthalmology, Erol Olcok Training and Research Hospital, Hitit University, Inönü avenue, N(o) 176, 19040, Çorum, Turkey.
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Sachdeva R, Iordanous Y, Lin T. Comparison of intraocular pressure measured by iCare tonometers and Goldmann applanation tonometer. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:426-432. [PMID: 35809628 DOI: 10.1016/j.jcjo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between the Goldmann applanation tonometer (GAT) and the iCare PRO and iCare IC200 tonometers in measuring intraocular pressure (IOP) in adult eyes with a diagnosis of glaucoma or glaucoma suspect. PARTICIPANTS AND METHODS One hundred and one eyes from 101 participants diagnosed with glaucoma or glaucoma suspect were evaluated in this study. IOP was measured by iCare PRO and iCare IC200 tonometers in a randomized sequence followed by IOP measurements by the GAT tonometer and then central corneal thickness measurements. After the IOP measurements, participants scored their comfort level using a visual analog scale with each tonometer. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to investigate the agreement among tonometers. SPSS and Microsoft Excel programs were used for statistical analysis. RESULTS Overall, there was good agreement among the 3 tonometers used in this study. The ICC for the iCare PRO and the iCare IC200 was 0.95 (p < 0.001), and the ICC for the iCare PRO and the GAT and the iCare IC200 and the GAT was >0.80 (p < 0.001). However, both iCare tonometers underestimated IOP by approximately 2 mm Hg compared with the GAT. Furthermore, 84% of iCare readings fall within ±5 mm Hg of GAT measurements. Neither body mass index nor central corneal thickness affected the IOP agreement among the tonometers. Participant response on visual analog scale rated IOP measurements by iCare tonometers to be more comfortable than the GAT. CONCLUSION Our results demonstrated a good agreement between iCare tonometers and GAT; but iCare tonometers underestimated IOP compared to the GAT.
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Affiliation(s)
| | | | - Tony Lin
- Department of Ophthalmology, Western University, London, Ont
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Kumar V, Bezzabotnov AI, Rustamova ZS, Dushina GN, Abu Zaalan KA, Shradqa ASS, Frolov MA. Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics. Vision (Basel) 2023; 7:59. [PMID: 37756133 PMCID: PMC10536777 DOI: 10.3390/vision7030059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
A surgical technique was developed to enhance aqueous humor (AH) flow through the non-trabecular outflow pathway by rerouting it from the anterior chamber (AC) to the suprachoroidal space (SCS) without detaching the ciliary body from the scleral spur. Medium- and long-term surgical outcomes were retrospectively analyzed in a case series of 58 glaucoma patients. At 6, 12, and 24 months, the mean IOP decreased from 27.8 ± 8.3 to 14.9 ± 5.0 mmHg, median 15.0 (25th percentile (p25)13.0; 75th percentile (p75) 18.0) and 15.2 ± 3.3 mmHg, and hypotensive medication use reduced from a median (p25; p75) of 3 (2; 3) to 0 (0; 2), 0 (0; 2), and 0 (0; 1.5), respectively. Intra- and postoperative complications were few and manageable. Following surgery, no bleb formation occurred in any of the cases (as confirmed by optical coherence tomography). Conjunctival lymphatic vessels (CLVs) developed in 50% of eyes (29/58). Clinically, they developed directly from sclera and had no connection to the surgical site. Analysis further showed that the development of CLVs and their longer visibility period had poor prognostic value for IOP control. If the fluid flow from the SCS to CLVs was resistance-free, no CLV development was evident. However, if any resistance existed in the flow, the fluid accumulated in lymphatics, resulting in their engorgement. The proposed technique was safe and effective in decreasing IOP in glaucoma patients by enhancing AH flow from the SCS to CLVs via connecting intrascleral microchannels.
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Affiliation(s)
- Vinod Kumar
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Andrey Igorevich Bezzabotnov
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Zarina Shaykuliyevna Rustamova
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
| | - Galina Nikolaevna Dushina
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Kamal Abdulmuhsen Abu Zaalan
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Ahmad Saleh Soliman Shradqa
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Mikhail Aleksandrovich Frolov
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
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Gui H, Zhang Y, Chang RT, Wang SY. Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records. Heliyon 2023; 9:e18703. [PMID: 37576221 PMCID: PMC10412763 DOI: 10.1016/j.heliyon.2023.e18703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/26/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To compare intraocular pressure (IOP) obtained with Tono-Pen (TP) and Goldmann applanation (GAT) using large-scale electronic health records (EHR). Design Retrospective cohort study. Methods A single pair of eligible TP/GAT IOP readings was randomly selected from the EHR for each ophthalmology patient at an academic ophthalmology center (2013-2022), yielding 4550 eligible measurements. We used Bland-Altman analysis to describe agreement between TP/GAT IOP differences and mean IOP measurements. We also used multivariable logistic regression to identify factors associated with different IOP readings in the same eye, including demographics, glaucoma diagnosis, and central corneal thickness (CCT). Primary outcome metrics were discrepant measurements between TP and GAT as defined by two methods: Outcome A (normal TP despite elevated GAT measurements), and Outcome B (TP and GAT IOP differences ≥6 mmHg). Result The mean TP/GAT IOP difference was 0.15 mmHg ( ± 5.49 mmHg 95% CI). There was high correlation between the measurements (r = 0.790, p < 0.001). We found that TP overestimated pressures at IOP <16.5 mmHg and underestimated at IOP >16.5 mmHg (Fig. 4). Discrepant measurements accounted for 2.6% (N = 116) and 5.2% (N = 238) for outcomes A and B respectively. Patients with thinner CCT had higher odds of discrepant IOP (OR 0.88 per 25 μm increase, CI [0.84-0.92], p < 0.0001; OR 0.88 per 25 μm increase, CI [0.84-0.92], p < 0.0001 for outcomes A and B respectively). Conclusion In a real-world academic practice setting, TP and GAT IOP measurements demonstrated close agreement, although 2.6% of measurements showed elevated GAT IOP despite normal TP measurements, and 5.2% of measurements were ≥6 mmHg apart.
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Affiliation(s)
- Haiwen Gui
- Stanford University School of Medicine, Stanford, United States
| | - Youchen Zhang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States
| | - Robert T. Chang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States
| | - Sophia Y. Wang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States
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Porwal AC, Shrishrimal M, Punamia RP, Mathew BC. Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness. Indian J Ophthalmol 2023; 71:1927-1931. [PMID: 37203058 PMCID: PMC10391371 DOI: 10.4103/ijo.ijo_1982_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non-contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT). Methods This was a prospective, cross-sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non-glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland-Altman graph was plotted. Results Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037). Conclusion The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.
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Affiliation(s)
- Amit C Porwal
- Senior Consultant Cataract and Head Glaucoma Services, Department of Cataract and Glaucoma, Choithram Netralaya, Indore, Madhya Pradesh, India
| | - Meghna Shrishrimal
- Department of Community Ophthalmology, Choithram Netralaya, Indore, Madhya Pradesh, India
| | - Ravin P Punamia
- Department of Ophthalmology, Choithram Netralaya, Indore, Madhya Pradesh, India
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Keller WJ. International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis. Medicine (Baltimore) 2023; 102:e33078. [PMID: 36897721 PMCID: PMC9997780 DOI: 10.1097/md.0000000000033078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/02/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Investigate intraocular pressure (IOP), as measured by Tono-Pen (TP) and Goldmann applanation tonometry (GAT), in healthy adults. Provide an updated synthesis of multinational, primary studies, reported during the 10-year period 2011 to 2021 and offer an evidence-based benchmark, against which IOP can be evaluated across subject variables and pathologies. Three primary research questions are investigated: Is there a statistically significant difference between IOP measured by TP and GAT? If yes, is the difference clinically significant? Is measurement of IOP affected by the country or setting location, in which the measurements are made? METHODS An aggregate meta-analysis was conducted on 22 primary studies, from 15 different countries. IOP measurements were made from each healthy adult subject, with both the TP and GAT. Primary studies were identified and data extracted according to recommended preferred reporting items for systematic reviews and meta-analysis protocol guidelines. Meta-analysis summary results are reported as the point estimate of the raw mean difference of IOP. RESULTS Meta-analysis reveals a statistically significant difference in raw mean differences in IOP, when measured by TP and GAT, in the healthy adult population. Tono-Pen IOP measurements are higher than GAT IOP measurements. The point estimate for the summary effect size = -0.73 mm Hg, P = .03. The prediction interval for the true effect size, in 95% of all comparable populations, is -4.03 to 2.58 mm Hg. There is no clinically significance difference in IOP when measured by TP and GAT. Meta-regression analysis reveals statistically significant differences in measurement of IOP by countries, R2 analog = 0.75, P = .001. There is no statistically significant difference in measurement of IOP as a function of measurement location setting, R2 analog = -0.17, P = .65. CONCLUSIONS IOP measured by TP are marginally higher compared to GAT, in the healthy adult population. However, from a clinical practice perspective, TP and GAT produce similar IOP measurements. There is evidence of significant variabilities in IOP measurements as a function of country. IOP measurements collected in a research laboratory setting are similar to IOP collected in a clinical setting. Results have implications for the primary care physician requiring a portable, inexpensive, reliable, and easily administered instrument to assess IOP.
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Affiliation(s)
- William J. Keller
- Medical Education, Nova Southeastern University, Kiran C. Patel College of Allopathic Medicine (NSU-MD), Fort Lauderdale, Florida, USA
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Bisorca-Gassendorf L, Murovski S, Julich-Härtel H, Rickmann A, Szabo JE, Erokhina M, Wenzel M, Januschowski K. Asynchronous Teleophthalmology for Monitoring Glaucoma Patients in a Rural German Region: A Retrospective Observational Pilot Study. Cureus 2022; 14:e24210. [PMID: 35602839 PMCID: PMC9117824 DOI: 10.7759/cureus.24210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has created an escalating need for limiting in-person examination and potential viral exposure. Under these circumstances, teleophthalmology allows ophthalmologists to continue providing care to patients while ensuring their safety and that of the medical staff. Objective: The primary objective of this study was to assess patient satisfaction with an asynchronous teleconsultation for glaucoma patients in a rural German area. Secondary endpoints were patient adherence and the need to change the therapeutic regime. Methods: This retrospective, observational, and monocentric study included 50 patients diagnosed with primary open-angle glaucoma (n = 49) and ocular hypertension (n = 1) requiring medication to lower intraocular pressure (IOP). Only patients with well-controlled diseases were included, and a brief questionnaire was evaluated, which was completed one year after the baseline visit. Best-corrected visual acuity (BCVA), IOP measurements, visual fields, optical coherence tomography images of the optic nerve head, ultra-widefield photographs of the fundus, and photographs of the anterior segment of the eye were taken at each visit by an experienced optometrist. Results: Of the 50 patients included, the mean number of follow-up visits in this observation period was 4.4. No patient was lost to follow-up, and there were a total of nine missed follow-up visits (but not lost to follow-up). No patients required a change in their treatment regime during the observational period. Regarding patient-focused assessment, the majority of patients were satisfied or very satisfied with teleconsultation in general. Conclusion: Asynchronous teleophthalmology is a promising option and effective means to monitor glaucoma patients. The majority of teleophthalmology patients were satisfied with their teleconsultation and adhered to the follow-up schedule. However, prospective trials with a larger number of patients and a more focused examination on specific patient populations are required. Further trials should also focus on the aspect of cost-effectiveness.
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Ye Y, Yang F, Ding L, Xia F, Niu L, Wang X, Zhao J, Zhou X. Comparison of Icare HOME and non-contact tonometer in intraocular pressure measurement in the early stage after ICL V4c implantation. Eur J Ophthalmol 2022; 32:3303-3311. [PMID: 35422146 DOI: 10.1177/11206721221093990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To investigate the characteristics of intraocular pressure (IOP) measurements using the Icare HOME rebound tonometer (RBT) and non-contact tonometer (NCT) during the early stage after implantable collamer lens (ICL) V4c implantation, and to assess the agreement between the two methods. Methods This prospective case series study included 104 eyes of 53 patients (mean age 28.77 ± 5.34 years), who underwent ICL V4c implantation. IOP was measured preoperatively, and at 0.5, 1, 2, 4, and 24 h postoperatively by Icare HOME and NCT, respectively. Results All surgeries were uneventful. IOP measurements by Icare and NCT preoperatively were 14.03 ± 2.90 mmHg and 14.09 ± 2.87 mmHg, respectively.The corresponding values were 12.56 ± 8.09 mmHg and 14.12 ± 6.52 mmHg (P > 0.05) at postoperative 0.5 h, 19.21 ± 8.74 mmHg and 19.60 ± 7.66 mmHg at postoperative 1 h (P > 0.05), 21.21 ± 8.10 mmHg and 20.31 ± 6.93 mmHg at postoperative 2 h (P > 0.05), 16.11 ± 5.89 mmHg and 17.04 ± 4.84 mmHg at postoperative 4 h (P > 0.05), and 14.04 ± 3.88 mmHg and 14.78 ± 2.80 mmHg at postoperative 24 h, respectively (P > 0.05). There was good agreement based on intraclass correlation coefficients (ICCs) between NCT and Icare HOME (all ICCs > 0.6 at different time points [range, 0.6986–0.956]). The Bland-Altman plot showed a mean percentage of over 95.81% of the points falling within the limits of agreement. There was a significant difference in the low IOP measurements (<10 mmHg) between Icare HOME and NCT (7.28 ± 2.55 vs. 10.65 ± 2.48, P < 0.001). Conclusion Icare HOME can be used for IOP measurement after ICL V4c implantation and demonstrated good agreement with NCT, except in cases with low intraocular pressure (<10 mmHg).
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Affiliation(s)
- Yuhao Ye
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Fangwen Yang
- The second affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Lan Ding
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Fei Xia
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lingling Niu
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Intraocular pressure measurement: A Review. Surv Ophthalmol 2022; 67:1319-1331. [DOI: 10.1016/j.survophthal.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
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Petersen CA, Chen A, Chen PP. How should we measure intraocular pressure in the era of coronavirus disease 2019? Balancing infectious risk, cleaning requirements, and accuracy. Curr Opin Ophthalmol 2022; 33:67-72. [PMID: 35025839 PMCID: PMC8826615 DOI: 10.1097/icu.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Accurate and precise measurement of intraocular pressure (IOP) is a vitally important component of the ophthalmic examination. There are multiple methods of tonometry, each of which has considerations in light of the ongoing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. This review discusses these considerations and compares various tonometer methods with the gold standard of Goldmann applanation tonometry (GAT). RECENT FINDINGS The SARS-CoV-2 virus may spread via droplets, microaerosols, or direct contact in the ophthalmology clinic. Tonometry poses a high risk of contamination. The accuracy and reliability of various methods of tonometry with single-use disposable equipment has been compared with Goldmann applanation tonometry. SUMMARY Goldmann applanation tonometry with disposable applanation tips, Tono-pen, and iCare employ single use tips to decrease the risk of cross-contamination of infectious agents. Review of the literature demonstrates good correlation between these devices and GAT, although the published level of agreement between devices varies.
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Kumar V, Abu Zaalan KA, Bezzabotnov AI, Dushina GN, Shradqa ASS, Rustamova ZS, Frolov MA. Bleb-Independent Glaucoma Surgery to Activate the Uveolymphatic Route of Non-Trabecular Aqueous Humor Outflow: Short-Term Clinical and OCT Results. Vision (Basel) 2022; 6:4. [PMID: 35076640 PMCID: PMC8788431 DOI: 10.3390/vision6010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
The deep sclerectomy technique was modified to enhance aqueous humor (AH) outflow via the non-trabecular pathway. A pilot study was carried out to assess its safety and effectiveness. Thirty-eight patients were under observation. After superficial scleral flap (4 × 4 mm), deep scleral layers were divided into three parts by three parallel-to-limbus incisions. Deep sclerectomy without creating a window in the Descemetes' membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised to expose the uvea and implant. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7-10. Outcome measures were IOP change, use of hypotensive medication(s), complications, and the need for a second surgery. At six months, the mean IOP decreased from 29.1 ± 9.2 mm Hg to 14.0 ± 4.3 mm Hg (p = 1.4 × 10-9); hypotensive medication use reduced from 2.9 ± 0.9 to 0.6 ± 1.0 (p = 1.3 × 10-10); complete success was achieved in 68.4% of cases and partial success was achieved in 31.6% of cases. Intraoperative and postoperative complications were rare and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near the operation site and over it in 32 patients. IOP decrease in the proposed technique was achieved by activation of the uveolymphatic route of AH outflow.
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Affiliation(s)
- Vinod Kumar
- Department of Eye Diseases, Medical Institute, RUDN University, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (K.A.A.Z.); (G.N.D.); (Z.S.R.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina St., 141407 Khimki, Russia; (A.I.B.); (A.S.S.S.)
| | - Kamal Abdulmuhsen Abu Zaalan
- Department of Eye Diseases, Medical Institute, RUDN University, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (K.A.A.Z.); (G.N.D.); (Z.S.R.); (M.A.F.)
| | | | - Galina Nikolaevna Dushina
- Department of Eye Diseases, Medical Institute, RUDN University, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (K.A.A.Z.); (G.N.D.); (Z.S.R.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina St., 141407 Khimki, Russia; (A.I.B.); (A.S.S.S.)
| | | | - Zarina Shaykuliyevna Rustamova
- Department of Eye Diseases, Medical Institute, RUDN University, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (K.A.A.Z.); (G.N.D.); (Z.S.R.); (M.A.F.)
| | - Mikhail Aleksandrovich Frolov
- Department of Eye Diseases, Medical Institute, RUDN University, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (K.A.A.Z.); (G.N.D.); (Z.S.R.); (M.A.F.)
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Gene-Morales J, Gené-Sampedro A, Martín-Portugués A, Bueno-Gimeno I. Do Age and Sex Play a Role in the Intraocular Pressure Changes after Acrobatic Gymnastics? J Clin Med 2021; 10:4700. [PMID: 34682821 PMCID: PMC8541003 DOI: 10.3390/jcm10204700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
To evaluate the effects of an acrobatic gymnastics (AG) training session on intraocular pressure (IOP), a familiarization session was employed to confirm the participant's suitability for the study. Forty-nine gymnasts (63.27% females, 18-40 years old) voluntarily agreed to participate. As age, sex, baseline IOP, and central corneal thickness (CCT) were considered as potential predictors of the IOP variations, in the second session measurements of the above parameters were taken before and after 90 min of AG. A mixed-factorial analysis of variance evaluated differences. Linear regression was conducted to potentially predict the IOP variation with the exercise. After the scheduled exercise, highly significant (p < 0.001, effect size: 0.73) reductions in IOP, but no significant changes in CCT (p = 0.229), were observed. IOP was significantly modified in males, older than 25 years, and subjects with baseline IOP > 14 mmHg (p ≤ 0.001, effect sizes: 0.57-1.02). In contrast, the IOP of females, younger participants, and subjects with baseline IOP ≤ 14 mmHg was not significantly modified (p = 0.114). With the regression analyses, we concluded that both sex and baseline IOP levels were significant predictors of the IOP fluctuation with AG. These findings could be of interest for gymnasts, coaches, ophthalmologists, and/or optometrists in the prevention and control of risk factors associated with glaucoma.
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Affiliation(s)
- Javier Gene-Morales
- Research Group Prevention and Health in Exercise and Sport (PHES), University of Valencia, St. Gascó Oliag 3, 46010 Valencia, Spain;
- Research Institute on Traffic and Road Safety (INTRAS), University of Valencia, St. Serpis 29, 46022 Valencia, Spain
| | - Andrés Gené-Sampedro
- Research Institute on Traffic and Road Safety (INTRAS), University of Valencia, St. Serpis 29, 46022 Valencia, Spain
- Department of Optics, Optometry & Vision Science, University of Valencia, St. Dr Moliner 50, 46100 Burjassot, Spain;
| | - Alba Martín-Portugués
- Department of Optics, Optometry & Vision Science, University of Valencia, St. Dr Moliner 50, 46100 Burjassot, Spain;
| | - Inmaculada Bueno-Gimeno
- Department of Optics, Optometry & Vision Science, University of Valencia, St. Dr Moliner 50, 46100 Burjassot, Spain;
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Different Effects of Aging on Intraocular Pressures Measured by Three Different Tonometers. J Clin Med 2021; 10:jcm10184202. [PMID: 34575313 PMCID: PMC8471438 DOI: 10.3390/jcm10184202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compare intraocular pressures (IOP) using different tonometers, Goldmann applanation (IOPGAT), non-contact (IOPNCT), and rebound (IOPRBT), and to assess the effects of aging and central corneal thickness (CCT) on the measurements. The IOPGAT, IOPNCT, IOPRBT, mean patient age (65.1 ± 16.2 years), and CCT (521.7 ± 39.2 µm) were collected retrospectively from 1054 eyes. The differences among IOPs were compared by the paired t-test. Possible correlations between devices, age, and CCT were assessed by linear regression analyses. The effects of age and CCT on the IOP reading were assessed by mixed-effects regression models. The IOPGAT values were 2.4 and 1.4 mmHg higher than IOPNCT and IOPRBT, respectively; the IOPNCT was 1.0 mmHg lower than IOPRBT (p < 0.0001 for all comparisons). The IOPs measured by each tonometer were highly correlated with each other (r = 0.81–0.90, t = 45.2–65.5). The linear regression analyses showed that age was negatively correlated with IOPNCT (r = −0.12, t = −4.0) and IOPRBT (r = −0.14, t = −4.5) but not IOPGAT (r = 0.00, t = −0.2); the CCT was positively correlated with IOPGAT (r = 0.13, t = 4.3), IOPNCT (r = 0.29, t = 9.8), and IOPRBT (r = 0.22, t = 7.2). The mixed-effect regression models showed significant negative correlations between age and IOPNCT (t = −2.6) and IOPRBT (t = −3.4), no correlation between age and IOPGAT (t = 0.2), and a significant positive correlation between CCT and the tonometers (t = 3.4–7.3). No differences between IOPGAT and IOPRBT were seen at the age of 38.8 years. CCT affects IOPs from all tonometers; age affects IOPNCT and IOPRBT in different degrees. IOPRBT tended to be higher than IOPGAT in young subjects, but this stabilized in middle age and became higher in older subjects.
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Brusini P, Salvetat ML, Zeppieri M. How to Measure Intraocular Pressure: An Updated Review of Various Tonometers. J Clin Med 2021; 10:3860. [PMID: 34501306 PMCID: PMC8456330 DOI: 10.3390/jcm10173860] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma.
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Affiliation(s)
- Paolo Brusini
- Department of Ophthalmology, Policlinico “Città di Udine”, 33100 Udine, Italy;
| | - Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy;
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Nakakura S, Asaoka R, Terao E, Nagata Y, Fukuma Y, Oogi S, Shiraishi M, Kiuchi Y. Evaluation of rebound tonometer iCare IC200 as compared with IcarePRO and Goldmann applanation tonometer in patients with glaucoma. EYE AND VISION 2021; 8:25. [PMID: 34193284 PMCID: PMC8247177 DOI: 10.1186/s40662-021-00249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022]
Abstract
Background This study investigated the agreement between a new rebound tonometer, IC200, and IcarePRO and Goldmann applanation tonometry (GAT). Methods This was a prospective cross-sectional study. We measured the intraocular pressure (IOP) in 145 eyes of 145 glaucoma patients in the sitting position using GAT, IcarePRO, and IC200. IcarePRO and IC200 measurements were also obtained in the supine position. IC200 measurement was performed using two modes: single six (IC200-single) and automatic (IC200-continuous) six-measurements mode. Results All tonometers provided high reproducibility in both positions (all intraclass correlation coefficients > 0.90), although it was highest with GAT, followed by IC200-continuous and IC200-single and then IcarePRO. In the sitting position, the mean (± SD) IOPs of GAT, IcarePRO, IC200-single, and IC200-continuous were 14.5 ± 2.9 mmHg, 13.3 ± 3.2 mmHg, 11.6 ± 3.2 mmHg, and 11.5 ± 3.2 mmHg, respectively. IOPs measured with IcarePRO or IC200 were significantly lower than those with GAT, particularly in patients with low IOP. IOPs measured with all tonometers were significantly elevated in the supine position as compared with the sitting position, but this difference was significantly greater with IC200-single and IC200-continuous compared with IcarePRO. IOP elevation was significant in eyes without bleb versus those with bleb, but this finding was not observed when IOP was measured with IcarePRO. The IOPs of the single and continuous modes of IC200 were interchangeable in both positions. Conclusions GAT, IcarePRO, and IC200 had sufficiently high reproducibility, but measurements with IcarePRO may not be accurate in the supine position. Elevation of IOP in the supine position, especially in eyes with bleb, was more sensitively captured with IC200 than with IcarePRO. Trial registration Japan Clinical Trials Register, No. UMIN000039982. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-021-00249-z.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan.
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. .,Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
| | - Etsuko Terao
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yuki Nagata
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yasuko Fukuma
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Satomi Oogi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Miku Shiraishi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1 Aboshi Waku, Himeji, 671-1227, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Liinamaa MJ, Stoor K, Leiviskä I, Saarela V. Correlation of iCare ic100 tonometry with iCare TA01i in screening of unselected population in Northern Finland Birth Cohort Eye study. Eur J Ophthalmol 2021; 32:11206721211014387. [PMID: 33951959 DOI: 10.1177/11206721211014387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE iCare tonometers are easy-to-use and portable devices for measuring the intraocular pressure (IOP). Purpose was to evaluate the IOP values measured by both novel iCare ic100 and conventional model TA01i devices in unselected population. METHODS IOP was measured with iCare ic100 and TA01i tonometers in 149 participants aged 32-33 years (born in 1985 or 1986) of the Northern Finland Birth Cohort Eye 2 study. The right eye of each participant was selected for analysis. We also collected data on axial length, corneal curvature and central corneal thickness (CCT). Bland-Altman plot was used for comparing the values obtained by these devices. RESULTS Mean IOP measured with the ic100 device was 13.8 (3.4) mmHg, with TA01i it was 12.5 (3.0) mmHg. The mean difference between these devices was 1.30 mmHg (p < 0.001) and R2 was 0.694. In Bland-Altman analysis, the agreement between the two tonometers ic100 and TA01i was constantly good (mean difference -1.30, ic100 device showing higher measures). There was a correlation between IOP and CCT (r = 0.269, p < 0.001 for ic100 and r = 0.255, p = 0.002 for TA01i), but not with IOP and corneal curvature or IOP and axial length. CONCLUSION In summary, we found ic100 rebound tonometry to be both reliable and effective, although CCT may influence IOP measurements with ic100 and TA01i. Therefore, iCare ic100 is suitable for IOP measurement in large cohort studies.
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Affiliation(s)
- M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
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24-h intraocular pressure patterns measured by Icare PRO rebound in habitual position of open-angle glaucoma eyes. Graefes Arch Clin Exp Ophthalmol 2021; 259:2327-2335. [PMID: 33914159 DOI: 10.1007/s00417-021-05192-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To measure the 24-h intraocular pressure (IOP) by Icare PRO rebound in healthy and primary open-angle glaucoma (POAG) eyes and compare it with non-contact tonometry (NCT). METHODS Thirty POAG patients, who were under IOP-lowering treatment, and 30 healthy subjects were included. Participants were hospitalized overnight for the 24-h IOP measurement. IOPs were measured by Icare PRO and NCT according to a standard protocol every 2 h during 24 h. The 24-h IOP curve and IOP-related parameters were compared between Icare PRO and NCT groups in POAG and healthy eyes. RESULTS The IOPs measured by Icare PRO in habitual position increased notably at 22:00 in the normal group and at 20:00 in the POAG group, reached peak at 0:00, stayed high until 4:00, and then decreased in both groups (all p < 0.05). The POAG patients had higher mean 24-h IOP, peak IOP, IOP fluctuation, and greater IOP change from supine to sitting position in the nocturnal period than those in the normal subjects even after adjusting for eyes, age, gender, CCT, and axial length (all p < 0.05). CONCLUSIONS The Icare PRO provides a well-tolerated approach for 24-h IOP monitoring in habitual position. Twenty-four-hour IOP in habitual position is more sensitive for detecting high nocturnal IOP peaks and greater IOP fluctuation for POAG patients.
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Blumberg MJ, Varikuti VNV, Weiner A. Real-world comparison between the Tonopen and Goldmann applanation tonometry in a university glaucoma clinic. Int Ophthalmol 2021; 41:1815-1825. [PMID: 33651312 DOI: 10.1007/s10792-021-01742-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether Tonopen intraocular pressure (IOP) measurements by Ophthalmic technicians are interchangeable with Goldmann applanation tonometry (GAT) by a specialist in our glaucoma clinic. METHODS Ophthalmic technician Tonopen and glaucoma specialist GAT IOP measurements were performed on both undilated eyes of 300 consecutive patients during the same visit to our glaucoma clinic. RESULTS Among all 600 eyes of 300 patients (age 65.4, range: 23-92 years, male: 44.3%), Tonopen and GAT IOPs were similar (15.5 ± 0.6 vs. 15.4 ± 0.7 mmHg, respectively, p = 0.63) and directly correlated (r2 = 0.58, p < 0.0001). However, among 120 patients with bilateral primary open-angle glaucoma GAT IOP was significantly higher than Tonopen in the right eyes (17.1 ± 1.1 vs. 16.2 ± 0.9 mmHg, p = 0.024) and in the left eyes (17.0 ± 1.0 vs. 16.3 ± 1.0 mmHg, p = 0.029). In all 300 right eyes, Tonopen underestimated IOP in 48.3% of eyes and overestimated in 39% (difference range: ( - )14 to ( + )12 mmHg), with IOP difference > ± 3 mmHg in 34% of eyes. In eyes with GAT IOP ≥ 22 mmHg, Tonopen IOP was significantly lower (24.7 ± 2.6, range: 11-43 mmHg vs. 28.2 ± 2.2, range: 22-43 mmHg, p = 0.0002, mean difference: - 3.6 ± 1.7 mmHg), and the Tonopen measured IOP ≤ 21 mmHg in 33.3% of eyes. In eyes with Tonopen IOP ≤ 10 mmHg GAT measured IOP of 11-17 mmHg in 65.7% of eyes. CONCLUSIONS Tonopen may mask a third of eyes with elevated IOP and two third of eyes with potentially above-goal IOP. The Tonopen may not be interchangeable with GAT or sufficiently reliable for patient management or screening in our glaucoma clinic. However, further study is recommended to assess the limitations of the Tonopen IOP measurements in eyes with higher or lower GAT IOPs. CLINICAL TRIALS REGISTRATION The Institutional review board, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY does not require this retrospective study to register.
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Affiliation(s)
- Max J Blumberg
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, NY, USA.,Albany Medical Center, PGY-1 Ophthalmology, Albany, NY, USA
| | - Venkata N V Varikuti
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), 1176 Main Street, Buffalo, NY, 14209, USA.,Lexitas Pharma Services, Durham, NC, USA
| | - Asher Weiner
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), 1176 Main Street, Buffalo, NY, 14209, USA.
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Olyntho Junior MADC, Augusto LB, Gracitelli CPB, Tatham AJ. The Effect of Corneal Thickness, Densitometry and Curvature on Intraocular Pressure Measurements Obtained by Applanation, Rebound and Dynamic Contour Tonometry. Vision (Basel) 2020; 4:vision4040045. [PMID: 33096873 PMCID: PMC7711663 DOI: 10.3390/vision4040045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Evaluate the effect of corneal thickness, densitometry and curvature on intraocular pressure (IOP) measurements obtained by Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), rebound tonometry (RT), and dynamic contour tonometry (DCT). A cross-sectional prospective study involving 40 participants was performed. Corneal measurements were obtained using Pentacam (Oculus GMbH, Wetzlar, Germany), densitometry was measured at annuli of 0–2, 2–6, 6–10 and 10–12 mm. The relationship between corneal thickness (central, 4 and 6 mm), corneal astigmatism and corneal densitometry and IOP was examined. There was a significant relationship between corneal thickness (central, 4 and 6 mm) and GAT180, GAT90, RT, and NCT (P < 0.001 for all comparisons) but not for DCT. Higher corneal densitometry (6–10 mm and 10–12 mm zones) was associated with higher IOP from GAT180 and GAT90, and higher densitometry in the 6–10 mm zone correlated with higher IOP from NCT, however corneal densitometry increased with age. Accounting for age, the relationship between corneal densitometry and IOP measurements was not significant. In eyes with greater corneal astigmatism there was a greater difference between GAT90 and GAT180 measurements. IOP measurements may be affected by corneal thickness, densitometry and curvature. DCT was less affected by properties of the cornea compared to other devices.
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Affiliation(s)
| | | | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, 13565-905 São Paulo, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, 07750-000 Vinhedo, São Paulo, Brazil
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Abstract
Ophthalmological examination requires a strict contact between caregivers and patients. In the COVID-19 era, this may be a risk factor for virus spread, and the use of facial masks for all in-office ophthalmological procedures has been recommended. In this case-series, we report about some errors in intraocular pressure measurement, that may occur during the slit-lamp examination of patients wearing filtering facepiece masks and N95 respirators. This is mainly due to the greater dimensions of these masks in comparison with the surgical standard ones, and to the presence of a preshaped rigid nose area that may press against the Goldmann tonometer. Special care should be taken when measuring intraocular pressure in these cases.
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Repeatability, reproducibility, agreement, and safety of Tono-Pen tip cover for intraocular measurement using latex and polyethylene wrap. PLoS One 2020; 15:e0239875. [PMID: 32986771 PMCID: PMC7521710 DOI: 10.1371/journal.pone.0239875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate repeatability, reproducibility, and agreement of intraocular pressure measurement with Tono-Pen using Ocufilm and polyethylene wrap tip cover in human eyes. METHODS This is a cross-sectional, experimental study. A gas-sterilized, polyethylene wrap was used as an alternative for Tono-Pen tip cover. For the right eye, 4 measurements using polyethylene wrap tip cover were done by two examiners (A and B) in random order to assess intra-observer repeatability and inter-observer reproducibility. For the left eye, 4 measurements were done by examiner A using both polyethylene wrap tip cover and Ocufilm in random order to assess intra-observer repeatability and agreement. Bland-Altman plot and intraclass correlation coefficient (ICC) were used in all analyses. Cost minimization analysis was evaluated. RESULTS For examiner A, the repeatability of polyethylene wrap tip cover was -0.34, 95% limits of agreement (LOA) were -3.04 to 2.36, and ICC was 0.93 in the right eyes. As for the left eyes, the repeatability of polyethylene wrap tip cover was -0.33, 95% LOA were -3.01 to 2.36, and ICC was 0.93. For examiner B, the repeatability of polyethylene wrap tip cover was -0.02, 95% LOA were -2.88 to 2.83, and ICC was 0.92. The inter-observer reproducibility of polyethylene wrap tip cover was 0.36, 95% LOA were -3.34 to 4.07, and ICC was 0.90. The repeatability of Ocufilm was -0.42, 95% LOA were -2.75 to 1.91, and ICC was 0.95. The agreement of polyethylene wrap tip cover and Ocufilm was -0.71, 95% LOA were -5.18 to 3.76, and ICC was 0.83. There were no allergic reactions or serious complications. From the cost minimization analysis, the local cost for polyethylene tip cover was approximately 8 times lower compared to Ocufilm. CONCLUSIONS Tono-pen with Ocufilm and polyethylene wrap tip cover were used to measure the intraocular pressure. The polyethylene wrap tip cover demonstrated acceptable repeatability, reproducibility, and agreement with Ocufilm in normotensive eyes, and had a good safety profile.
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Li M, Zheng B, Wang Q, Sun X. Impact of Visual Field Testing on Intraocular Pressure Change Trends in Healthy People and Glaucoma Patients. J Ophthalmol 2020; 2020:7936205. [PMID: 32714610 PMCID: PMC7355374 DOI: 10.1155/2020/7936205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the impact of visual field (VF) testing on intraocular pressure (IOP) change trends between healthy subjects and glaucoma patients. METHODS We recruited healthy volunteer subjects who did not have previous ocular diseases and open-angle glaucoma patients who were medically controlled well. IOP in both eyes of each participant was measured by using a noncontact tonometer at five time points: before, immediately after (0 minute), and 10, 30, and 60 minutes after the standard automated perimetry. Repeated measures ANOVA was used to analyze the effect of VF testing on IOP change trends in healthy and glaucoma eyes. RESULTS Forty healthy subjects (80 eyes) and 31 open-angle glaucoma patients (62 eyes) were included for the study. The baseline IOP of healthy and glaucoma eyes was 16.11 ± 3.01 mmHg and 15.78 ± 3.57 mmHg, respectively. After the VF testing, the IOP in healthy eyes was decreased by 1.5% at 0 minute, 6.5% at 10 minutes (P < 0.001), 6.6% at 30 minutes (P < 0.001), and 7.0% at 1 hour (P < 0.001), indicating that this reduction was sustained for at least 1 hour. However, the IOP in glaucoma eyes was increased by 12.7% at 0 minute (P < 0.001) and, then, returned towards initial values 1 hour after the VF testing. CONCLUSIONS IOP change trends after VF field testing between healthy subjects and glaucoma patients were quite different. VF testing led to a mild and relatively sustained IOP decrease in healthy subjects, whereas IOP in open-angle glaucoma patients tended to significantly increase immediately after VF testing and, then, returned to pretest values after 1 hour. These findings indicate that the factors of VF testing should be considered in the clinical IOP measurements.
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Affiliation(s)
- Mengwei Li
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Bingxin Zheng
- Department of Nursing, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Qi Wang
- Department of Nursing, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Liu W, Qin L, Xu C, Huang D, Guo R, Ji J, Jansonius NM. Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure. BMC Ophthalmol 2020; 20:209. [PMID: 32471378 PMCID: PMC7260842 DOI: 10.1186/s12886-020-01483-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background To introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery. Methods Thirteen APAC eyes (13 patients) were enrolled in this prospective case series as study group. All patients underwent emergency TCP (20 pulses of 2000 mW during 2000 ms applied to the inferior quadrant) followed by scheduled cataract surgery. They were compared to 13 age- and gender-matched patients treated with emergency phacotrabeculectomy. We recorded intraocular pressure (IOP), best corrected visual acuity (BCVA), and complications, and several ultrasound biomicroscopy (UBM) parameters before and after TCP. Results In the study group, IOP decreased from 51.5 ± 7.0 mmHg (mean ± standard deviation) before TCP to 16.4 ± 5.4 mmHg 1 day after TCP (P < 0.001). At 6 months, there was no significant difference in IOP between the study group (14.0 ± 3.4 mmHg) and control group (16.7 ± 4.3 mmHg; P = 0.090); IOP lowering medications were used by 0/13 in the study group and 2/13 patients in the control group (P = 0.48). At 6 months, there was no significant difference in BCVA between the study group and the control group (20/25 (20/200 to 20/25) and 20/30 (20/50 to 20/25), respectively; P = 1.0). The UBM parameters anterior chamber depth (P = 0.016), angle-opening distance at 500 μm (P = 0.011), and maximum ciliary body thickness (P < 0.001) increased significantly while the iris-ciliary process distance decreased significantly (P = 0.020) after TCP. Conclusions TCP effectively lowers IOP and modifies the anterior chamber morphology in APAC; TCP followed by cataract surgery can be considered an alternative to treat refractory APAC but needs further evaluation. Trial registration This project was registered in Chinese Clinical Trial Registry (ChiCTR1800017475) at July, 31, 2018 (http://www.chictr.org.cn/edit.aspx?pid=29629&htm=4).
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Affiliation(s)
- Wei Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China.,Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luning Qin
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China
| | - Chenjia Xu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China
| | - Dandan Huang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China
| | - Ruru Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China
| | - Jian Ji
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Nankai District, Tianjin, 300384, China.
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Uzlu D, Akyol N, Türk A, Oruç Y. A comparison of three different tonometric methods in the measurement of intraocular pressure in the pediatric age group. Int Ophthalmol 2020; 40:1999-2005. [DOI: 10.1007/s10792-020-01375-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
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Almazyad EM, Ameen S, Khan MA, Malik R. Guidelines and Recommendations for Tonometry Use during the COVID-19 Era. Middle East Afr J Ophthalmol 2020; 27:73-78. [PMID: 32874038 PMCID: PMC7442084 DOI: 10.4103/meajo.meajo_237_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 11/10/2022] Open
Abstract
The novel coronavirus disease COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a substantial change in eye care and clinical practice. There has been conflicting information and weak evidence on the virus's transmission through tears. Yet, virus detection on cornea and conjunctiva surface as a gateway for infection is not well-studied. Moreover, there have been no reported cases of SARS-CoV-2 transmission through tonometry to date. Thus, this uncertainty has urged this review on evidence-based guidelines and recommendations on tonometer use in the COVID-19 era. The aim of this article is to provide ophthalmologists with recommendations for tonometry practice based on current evidence and best practice guidelines.
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Affiliation(s)
- Enmar M. Almazyad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sally Ameen
- Western Eye Hospital, Imperial NHS Foundation Trust, London, UK
| | - Mohammad A. Khan
- Department of Microbiology, Prince Mohammed Bin Abdul Aziz Hospital, Riyadh, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Mendez-Hernandez C, Arribas-Pardo P, Sanchez Jean R, Garcia-Feljoo J. Influence of Axial Length on Intraocular Pressure Measurement With Three Tonometers in Childhood Glaucoma. J Pediatr Ophthalmol Strabismus 2020; 57:27-32. [PMID: 31972037 DOI: 10.3928/01913913-20191106-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/03/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the agreement between intraocular pressure (IOP) measurements obtained using the handheld version of the Goldmann applanation (Perkins; Clement-Clarke, Haag-Streit, Harlow, United Kingdom), rebound Icare-Pro (Icare, Tiolat Oy, Helsinki, Finland), and Tonopen XL (Reichert Inc., Depew, NY) tonometers in children with childhood glaucoma and to identify factors that may affect those measurements. METHODS Ninety-one eyes of 46 children with early-onset childhood glaucoma were included in this cross-sectional study in which IOP, ocular axial length, anterior chamber depth, lens thickness, vitreous length, and central corneal thickness measurements were obtained under general anesthesia. Agreement between tonometers was evaluated using intraclass correlation coefficients (ICCs) and the Bland-Altman method. The influence of ocular biometric parameters and central corneal thickness on IOP measurements was analyzed using multiple linear regression analysis. RESULTS The mean age of the children in the current study was 29.1 months (range: 13 to 31 months). The Icare-Pro and Tonopen XL overestimated IOP measurements compared to the Perkins tonometer (Icare-Pro-Perkins mean IOP difference: 2.2 ± 3.4 mm Hg, P < .0001, 95% confidence interval [CI]: 1.5 to 2.9 vs Tonopen XL-Perkins mean IOP difference: 6.7 ± 7.1 mm Hg, P < .0001, 95% CI: 5.2 to 8.2). The Icare-Pro showed greater agreement with the Perkins tonometer than the Tonopen XL (ICC: 0.789, 95% CI: 0.697 to 0.856, P < .0001 vs 0.453, 95% CI: 0.272 to 0.603, P < .0001). Ocular axial length affected IOP measurements the most, finding increased impact on Tonopen XL (slope: 0.086, 95% CI: 0.013 to 0.16, P = .022 vs 0.997, 95% CI: 0.369 to 1.625, P = .002 vs 1.571, 95% CI: 0.541 to 2.602, P < .0001 for Perkins, Icare-Pro, and Tonopen XL IOP measurements, respectively). CONCLUSIONS Ocular axial length affects IOP measured by the Perkins, Icare-Pro, and Tonopen XL devices in patients with childhood glaucoma. The Icare-Pro shows more agreement with the Perkins tonometer than the Tonopen XL; therefore, it seems to be a more suitable option for these patients. [J Pediatr Ophthalmol Strabismus. 2020;57(1):27-32.].
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Kumar V, Frolov M, Dushina G, Shradqa A, Bezzabotnov A, Abu Zaalan K. Reverse meridional cyclodialysis ab interno in management of open angle glaucoma — a preliminary report. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2019. [DOI: 10.24075/brsmu.2019.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The uveoscleral outflow as an alternate route of aqueous drainage is of great interest in glaucoma surgical treatment. A cyclodialysis cleft allows one to create a direct connection between the anterior chamber (AC) and the suprachoroidal space (SCS) which is the key element of uveoscleral outflow. The purpose of the study was to evaluate the safety and effectiveness of reverse meridional cyclodialysis ab interno (RMCai) in decreasing intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) and refractory glaucoma (RG). Fourteen patients who exhibited POAG and RG (11 men and 3 women, age 77.3 ± 7.8 years) were included in the study. All patients underwent RMCai with the help of custom-designed spatula. The spatula, inserted through a clear corneal incision, was used to detach the ciliary body from the scleral spur to create a 2.0–2.5 mm wide and 6.0–6.5 mm deep cleft. Outcome measures were IOP change, use of hypotensive medication(s), complications, and need for a second surgery. Decrease in IOP by more than 20% and IOP between 6 and 21 mmHg without hypotensive medication constituted complete success. Similar changes in IOP with medication constituted partial success. Need for second surgery constituted failure. The follow-up period was >3 months. Baseline IOP and hypotensive medication use were 22.0 ± 8.5 mmHg (95% confidence interval (CI), 17.6–26.4) and 2.6 ± 0.9 (95% CI, 2.2–3.1). At 3, 6, 12, 18, and 24 months, complete success was achieved in 64.3%, 77.8%, 55.6%, 37.5%, and 40% of patients respectively; partial success — in 14.3%, 22.2%, 44.4%, 50.0%, and 60.0%. Four patients required a second surgery. Failure occurred because of cleft closure by fibrosis. It was concluded that RMCai is safe and effective in decreasing IOP in POAG and RG patients.
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Affiliation(s)
- V. Kumar
- Peoples' Friendship University of Russia, Moscow, Russia; Skhodnya City Hospital, Khimki, Moscow Region, Russia; Centre for eye microsurgery "Pro zrenie", Khimki, Moscow Region, Russia
| | - M.A. Frolov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - G.N. Dushina
- Peoples' Friendship University of Russia, Moscow, Russia; Centre for eye microsurgery “Pro zrenie”, Khimki, Moscow Region, Russia
| | - A.S. Shradqa
- Centre for eye microsurgery "Pro zrenie", Khimki, Moscow Region, Russia
| | - A.I. Bezzabotnov
- Skhodnya City Hospital, Khimki, Moscow Region, Russia; Centre for eye microsurgery "Pro zrenie", Khimki, Moscow Region, Russia
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Abstract
SIGNIFICANCE Precise measurement of intraocular pressure (IOP) is essential when diagnosing and managing glaucoma. We compared the IOP readings of three different tonometers and analyzed agreement among tonometers in eyes with high IOPs. PURPOSE The purpose of this study was to compare the IOP readings obtained using a Goldmann applanation tonometer (GAT), a rebound tonometer (RT), and a Tono-Pen (TP) in angle-closure eyes with elevated IOP before and after medical IOP-lowering therapy. METHODS Twenty-five eyes of 25 patients with angle closure and IOPs of greater than 30 mmHg were enrolled. Intraocular pressure was measured using RT (iCare Pro), TP (Tono-Pen XL), and GAT before and after medical treatment. The mean IOP readings of the tonometers were compared before and after treatment. The agreement among the tonometers was assessed via Bland-Altman analysis. RESULTS The measurements from 22 eyes of 22 patients were suitable for statistical analyses. Before medical treatment, the mean TP-IOP was significantly lower than the mean GAT-IOP (44.0 ± 10.3 vs. 50.4 ± 8.9 mmHg, respectively; P < .001), but no significant difference was evident between the RT-IOP and the GAT-IOP (50.8 ± 10.9 vs. 50.4 ± 8.9 mmHg, respectively; P = .79). After IOP-lowering treatment, the mean GAT-IOP (14.9 ± 4.7 mmHg) did not differ from either the mean RT-IOP (15.6 ± 4.4 mmHg) or the mean TP-IOP (15.4 ± 5.0 mmHg; P = .05 and P = .18, respectively). The random measurement error among tonometers was greater for high IOP readings. CONCLUSIONS Compared with RT or GAT, TP underestimated IOP in angle-closure eyes with a GAT-IOP of greater than 30 mmHg. Intraocular pressure reading agreement among the three tonometers was lower in eyes with high IOP.
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Chen M, Zhang L, Xu J, Chen X, Gu Y, Ren Y, Wang K. Comparability of three intraocular pressure measurement: iCare pro rebound, non-contact and Goldmann applanation tonometry in different IOP group. BMC Ophthalmol 2019; 19:225. [PMID: 31726999 PMCID: PMC6857285 DOI: 10.1186/s12886-019-1236-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/01/2019] [Indexed: 01/23/2023] Open
Abstract
Background Measurement of intraocular pressure (IOP) is essential for glaucoma patients. Many factors such as central corneal thickness (CCT) can affect the accuracy of IOP measurement. The purpose of this study was to evaluate the agreement of IOP measured by non-contact tonometer (NCT), iCare pro rebound tonometer (iCare), and Goldmann applanation tonometer (GAT) in different IOP group. Methods This was a Hospital-based cross-sectional study. Two hundred subjects were enrolled in this study. All subjects underwent IOP measurement using an NCT–iCare–GAT sequence. Bland-Altman, Pearson correlation and intraclass correlation analysis were performed using SPSS 17.0 software. The influence of CCT on each IOP measurement methods was evaluated by linear regression analysis. Results The mean difference (Δ) of NCT–GAT did not differ from (Δ) iCare–GAT in IOP < 10 and 10–21 mmHg group. However, (Δ) NCT–GAT was significantly higher than (Δ) iCare–GAT in IOP 22–30 and > 30 mmHg group (P < 0.05). Bland–Altman analysis showed significant agreement between the three devices (P < 0.01). IOP measurements of the three methods were significantly correlated with CCT (P < 0.01). Conclusions ICare pro shows a higher agreement with GAT over a wide range of IOP compared with NCT. The consistency between the three tonometers was similar in a low and normal IOP range. However, NCT shows a greater overestimate of IOP in moderate and higher IOP group. The variability of IOP measurement affected by CCT is NCT > iCare pro > GAT.
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Affiliation(s)
- Min Chen
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Lina Zhang
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China.,Lishui People's Hospital, Lishui, Zhejiang, China
| | - Jia Xu
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xinyi Chen
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuxiang Gu
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuping Ren
- Shaoxing Traditional Chinese Medicine Hospital, Shaoxing, Zhejiang, China
| | - Kaijun Wang
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, China. .,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China.
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Otsuka M, Tojo N, Hayashi A. Error in measurement of intraocular pressure with the Icare and IcarePRO. Int Ophthalmol 2019; 40:439-445. [PMID: 31691898 DOI: 10.1007/s10792-019-01204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to determine whether changes in the measurement angle of the Icare TA01i and IcarePRO tonometers led to errors in the measurement of intraocular pressure (IOP). METHODS In this prospective, single-facility study, we analyzed 77 patients from November 2017 to September 2019. We measured IOP with the Icare TA01i and IcarePRO while changing the angle of the device with the cornea center and analyzed the associated changes in the measurement. RESULTS IOP measured with the Icare tilted - 30°, - 15° vertically was significantly higher than that measured with the Icare tilted horizontally (p < 0.0001, p < 0.0001). The IOP measured with a + 10° vertical tilt was significantly lower than that measured horizontally (p < 0.0001). When the IcarePRO was tilted + 90° vertically, the IOP was significantly lower with the patient in the supine position than in the lateral position (p = 0.00058). CONCLUSIONS IOP measured with the Icare and IcarePRO is affected by the measurement angle. The study results will direct the clinicians to exercise extra precautions in determining the measurement angle while measuring IOP.
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Affiliation(s)
- Mitsuya Otsuka
- Department of Ophthalmology and Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Naoki Tojo
- Department of Ophthalmology and Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology and Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Tono-Pen versus Goldmann Applanation Tonometry. ACTA ACUST UNITED AC 2019; 2:435-439. [DOI: 10.1016/j.ogla.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/21/2022]
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Kutzscher AE, Kumar RS, Ramgopal B, Rackenchath MV, Sathi Devi, Nagaraj S, Moe CA, Fry DM, Stamper RL, Keenan JD. Reproducibility of 5 Methods of Ocular Tonometry. ACTA ACUST UNITED AC 2019; 2:429-434. [DOI: 10.1016/j.ogla.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022]
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38
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Comparison of the Intraocular Pressure Measured Using the New Rebound Tonometer Icare ic100 and Icare TA01i or Goldmann Applanation Tonometer. J Glaucoma 2019; 28:172-177. [DOI: 10.1097/ijg.0000000000001138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The rebound tonometer has a unique mechanism for measuring intraocular pressure (IOP) and has become popular worldwide due to its ease of use. The most notable advantages are the lack of an air-puff and need for topical anesthesia, ease of operation and transport, and the ability to use it with children. Four rebound tonometers (Icare® TA01i, Icare PRO, Icare HOME, and Icare ic100) are currently available for clinical examination. It is important to understand the characteristics of each tonometer and select the most appropriate one because the IOP values and the purpose of measurement are different. In this review, with the goal of improving the understanding of a range of tonometers, the issues with each device are discussed.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji City, Japan,
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40
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Effect of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on intraocular pressure in dogs. Int Ophthalmol 2018; 39:1467-1474. [PMID: 29934932 DOI: 10.1007/s10792-018-0969-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To measure IOP in animals, it is often necessary to use topical anesthetics. The use of these drugs may cause changes in IOP and interfere with the final results. To address this issue, the effects of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on IOP were investigated in ten adult dogs. METHODS One drop of tetracaine was instilled in the right eye of half of the dogs and in the left eye of the other dogs; normal saline was instilled in the fellow eyes. The IOP in each dog was measured before and at 0, 5, 10, 15, 20, 25, 30, and 35 min after drug instillation using an electronic rebound tonometer. The effects of the other anesthetics were studied in the same way at intervals of at least 1 week. RESULTS After instillation of tetracaine, the IOP decreased gradually, such that after 15 min, the IOP was significantly lower than the baseline (p = 0.022) and control values (p = 0.048). Proparacaine also reduced IOP after 10 min compared to baseline values (p = 0.046), but the two other drugs, bupivacaine and lidocaine, had no significant effect on IOP. The duration of eye anesthesia was 16, 20, 22, and 34 min for tetracaine, lidocaine, bupivacaine, and proparacaine, respectively. CONCLUSION We recommend using drugs that combine inducing longer anesthesia with producing the smallest change in IOP, such as bupivacaine and, subsequently, lidocaine. Tetracaine and proparacaine have a significant effect on IOP, and if these drugs are used, this effect should be considered.
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