Inter-user and intra-user variation of two tonometers in horses

Comparison of first, second, and third versus the average of six probe-corneal touches for intraocular measurement of two rebound tonometers in healthy horses

The aim of this study was to evaluate the intraocular pressure (IOP) measurements obtained from first, second, and third probe-cornea touch (PCT) and compare them with the average of six PCTs using two rebound tonometers in horses. This study enrolled a total of thirty-eight stallions, comprising of 24 Arabian horses and 14 cross-breeds (with an average age of 8 ± 3 years). The IOP measurements of first, second, and third, as well as the average of six PCTs were obtained using either Tonovet (TV) or Tonovet Plus (TV+) rebound tonometers. The mean differences (95% limits of agreement) between the average of six PCTs and the first, second, and third PCTs were 0.1 (-4.8 to 5), 0.2 (-4.8 to 4.5), and 0.2 (-3.6 to 4.0) mmHg with TV, respectively. With TV+, the differences were 0.3 (-6.6 to 7.2), 1.1 (-8.6 to 10.8), and -0.2 (-3.6 to 4.0) mmHg, respectively. Compared to the average of six PCTs, only 89.5%, 92.1%, and 97.4% of IOP measurements obtained from TV and 78.9%, 73.3%, and 65.8% of IOP measurements obtained from TV+ were within 4 mmHg of the average of six PCTs for first, second, and third PCTs, respectively. In conclusion, the measurement of IOP in the first PCT achieved best agreement with the IOP measurement of six average PCTs. Therefore, the first PCT could be considered as an alternative option for measuring IOP in horses when obtaining an average of six PCTs is not feasible.

Comparison of four tonometers in the measurement of intraocular pressure in healthy horses

BACKGROUND

Measurement of the intraocular pressure (IOP) is a useful diagnostic tool in equine ophthalmology. Handheld tonometers, such as Tonovet and Tonovet Plus (rebound), Tono-Pen AVIA Vet (applanation), and Kowa HA-2 (applanation using the Goldmann methodology) are used to obtain IOP measurements in veterinary medicine.

OBJECTIVES

To compare and evaluate the accuracy of four handheld tonometers in measuring IOP using different methodologies in healthy horses.

STUDY DESIGN

In vivo experiment and cross-sectional survey of healthy horses.

METHODS

Intraocular pressure was measured in 72 eyes of 36 horses. An in vivo study was conducted on sedated horses to compare the real IOP values obtained using manometry versus those obtained using tonometry, and a field study was conducted on unsedated healthy horses with normal eyes to measure the IOP values using different tonometers.

RESULTS

In the in vivo study, the mean IOP values using ocular manometry was 24.9 ± 4.0 mmHg (range, 20.0-30.0 mmHg). The mean IOP values using tonometry were: Tonovet, 25.7 ± 5.8 mmHg (range 19.5-33.0 mmHg); Tonovet Plus, 24.8 ± 7.1 mmHg (range 13.2-33.2 mmHg); Tono Pen AVIA Vet, 19.2 ± 4.7 mmHg (range 13.1-26.5 mmHg); and Kowa Ha-2, 24.1 ± 1.2 mmHg (range 22.8-25.8 mmHg). In the field study, the IOP values were: Tonovet, 30.7 ± 5.6 mmHg (range 21.7-38.0 mmHg); Tonovet Plus, 29.6 ± 6.7 mmHg (range 16.2-38.6 mmHg); Tono-Pen AVIA Vet, 27.3 ± 5.8 mmHg (range 14.6-37.1 mmHg); and Kowa HA-2, 23.4 ± 2.2 mmHg (range 20.2-28.7 mmHg).

MAIN LIMITATIONS

This study included only healthy horses and a limited number of animals in the in vivo study.

CONCLUSIONS

There was a strong correlation between the IOP values and manometry for all tonometers. IOP should be estimated using the same tonometer over time, and the bias of the tonometer used, such as overestimation (rebound tonometer) and underestimation (applanation tonometer), should be acknowledged. A normal reference value for each tonometer should be established in horses.

Comparison of three methods of tonometry in horses presented for ophthalmic disease

OBJECTIVE

To compare the measurement of intraocular pressure in horses with clinical ocular disease using three tonometry devices.

ANIMALS STUDIED

A total of fifty horses were presented to the New Bolton Center Ophthalmology Service.

PROCEDURE

Intraocular pressure was taken on 50 client-owned horses (100 eyes) using the TonoVet, TonoVet Plus and Tono-Pen Avia tonometers. Clinical equine patients included were presented to New Bolton Center for ophthalmic examination. Auriculopalpebral blocks were performed but horses were unsedated.

RESULTS

All three tonometers were found to have strong agreement among them. The strongest agreement was between the TonoVet and the TonoVet Plus with the TonoVet on average 1.330 mmHg less than the TonoVet Plus (standard deviation 4.388 mmHg). This was followed by the TonoVet and the Tono-Pen Avia Vet with the TonoVet on average 2.531 mmHg greater than the Tono-Pen Avia Vet (standard deviation 4.124 mmHg). The weakest agreement was between the TonoVet Plus and the Tono-Pen Avia with the TonoVet Plus on average 3.854 mmHg greater than the Tono-Pen Avia (standard deviation 4.724 mmHg).

CONCLUSIONS

All three tonometers showed strong agreement, however, the TonoVet and the TonoVet Plus carried the strongest agreement with the TonoVet Plus having slightly higher measurements overall compared with the TonoVet. Due to small variations between devices, it is recommended that the same device be used for serial measurements of intraocular pressure. However, all three devices are appropriate to use in horses presented for ophthalmic evaluation.

Comparison of three rebound tonometers in normal and glaucomatous dogs

OBJECTIVE

The objectives of the study were to compare intraocular pressure (IOP) readings across a wide range and obtained via three rebound tonometers in ADAMTS10-mutant Beagle-derived dogs with different stages of open-angle glaucoma (OAG) and normal control dogs and to investigate the effect of central corneal thickness (CCT).

ANIMALS STUDIED

Measurements were performed on 99 eyes from 50 Beagle-derived dogs with variable genetics-16 non-glaucomatous and 34 with ADAMTS10-OAG. Seventeen OAG eyes were measured twice-with and without the use of IOP-lowering medications.

PROCEDURES

IOP was measured in each eye using three tonometers with their "dog" setting-ICare® Tonovet (TV), ICare® Tonovet Plus® (TVP), and the novel Reichert® Tono-Vera® Vet (TVA)-in randomized order. CCT was measured with the Accutome® PachPen. Statistical analyses included one-way ANOVA, Tukey pairwise comparisons, and regression analyses of tonometer readings and pairwise IOP-CCT Pearson correlations (MiniTab®).

RESULTS

A total of 116 IOP measurements were taken with each of the three tonometers. When comparing readings over a range of ~7-77 mmHg, mean IOPs from the TV were significantly lower compared with TVP (-4.6 mmHg, p < .001) and TVA (-3.7 mmHg, p = .001). We found no significant differences between TVA and TVP measurements (p = .695). There was a moderate positive correlation between CCT and IOP for TVA (r = 0.53, p < .001), TVP (r = 0.48, p < .001), and TV (r = 0.47, p < .001).

CONCLUSIONS

Our data demonstrate strong agreement between TVP and TVA, suggesting that the TVA may similarly reflect true IOP values in canines. CCT influenced IOP measurements of all three tonometers.

Effect of multiple head positions on intraocular pressure in healthy, anesthetized horses during hoisting

OBJECTIVE

To evaluate changes in intraocular pressure (IOP) with variable head position in healthy, anesthetized horses in hoisted inversion and to assess the influence of various cofactors (age, sex, body weight, body condition score, and neck length) on IOP changes during hoisting.

ANIMALS STUDIED

Seventeen healthy adult horses without significant ocular abnormalities.

PROCEDURES

Subjects were administered intravenous xylazine/butorphanol premedication and ketamine/midazolam induction with xylazine/ketamine boluses for anesthetic maintenance. While hoisted, IOP was measured in triplicate for each eye via rebound tonometry (TonoVet) at neutral head position (ie, eyes level with the withers), at multiple 5 cm increments above and below neutral (-20 cm through +20 cm) using foam pads for head support, and with eyes above heart level via manual support.

RESULTS

In hoisted positions, IOP ranged from 18 to 51 mmHg. Intraocular pressure significantly decreased with head position elevated ≥+15 cm from neutral and significantly increased when lowered ≤-5 cm from neutral. Neck length significantly influenced IOP (P = .0328) with linear regression indicating a median (range) increase of 0.244 (0.034-0.425) mmHg in IOP for every 1 cm increase in neck length. Age, sex, breed, body weight, body condition score, and eye (OD vs OS) did not significantly influence IOP. Intraocular pressure only varied significantly between eyes at +10 cm above neutral (OS > OD, 1.7 ± 0.6 mm Hg, P = .0044).

CONCLUSIONS

Intraocular pressure in healthy, anesthetized horses varies with head position during hoisting; increased neck length may be associated with larger changes in IOP during hoisting.

Intraocular pressure following four different intravenous sedation protocols in normal horses

BACKGROUND

Intravenous sedation is frequently necessary for ophthalmic examination in horses. Common sedation protocols have not been directly compared in terms of relative intraocular pressure (IOP) reduction, duration of IOP reduction and time to maximum IOP reduction.

OBJECTIVES

To compare the effects of standing sedation protocols on IOP.

STUDY DESIGN

Randomised cross-over experiment.

METHODS

Twelve healthy horses received four intravenous sedation protocols with a 48 hours washout: 0.5 mg/kg xylazine and 0.01 mg/kg butorphanol (SED1); 10 µg/kg detomidine and 0.01 mg/kg of butorphanol (SED2); 10 µg/kg detomidine (SED3); 0.5 mg/kg xylazine (SED4). IOP was measured with rebound tonometry before sedation (Tpre) and 5, 10, 15, 30, 45 and 60 minutes post-sedation (Tpost). Post-sedation readings were taken with the head elevated to the Tpre position. Separately, IOP readings were also obtained following sedation with the head not elevated (TpostHeadDown). IOP values were compared using mixed ANOVA and ANCOVA models respectively with significance at P < .05.

RESULTS

All protocols decreased IOP compared with baseline with greatest reduction at Tpost5. IOP at Tpre (mean ± SD) was 21.8 ± 4.4 mm Hg. At Tpost5, IOP was 16.3 ± 3.8 mm Hg (SED1), 14.5 ± 2.9 mm Hg (SED2), 17.1 ± 3.8 mm Hg (SED3) and 16.9 ± 4.2 mm Hg (SED4). SED2 Tpost5 IOP was lower than other treatments. Considering all time points following sedation, SED3 IOP readings were higher than other treatments. TpostHeadDown IOPs were higher than readings taken with the head elevated (P < .001).

MAIN LIMITATIONS

Animals with ocular disease were not studied. No animals received mock sedation or equivalent.

CONCLUSIONS

A combination of detomidine and butorphanol causes greater IOP reduction 5 minutes following sedation than other commonly used sedation protocols. IOP reduction is less pronounced when detomidine is used alone. Consideration of head height is important when performing IOP measurements in horses.

Comparison of two rebound tonometers in healthy horses

Objective

To obtain a reference range for evaluation of intraocular pressure (IOP) in horses using Tonovet Plus^®, to compare the IOP readings obtained with Tonovet^® and Tonovet Plus^®, and to evaluate the repeatability of readings.

Animals studied and Procedures

Intraocular pressure of 30 client‐owned horses (60 eyes) with no signs of illness or ocular disease was evaluated using Tonovet^® and Tonovet Plus^® rebound tonometers. Horses’ mean age was 10.7 (range 6‐17) years. Triplicate measurements were performed without using sedatives or local anesthetics, with minimal restraint.

Results

Calculated reference intervals (the CLSI robust method) were 14.4‐27.2 mmHg for Tonovet^® and 16.0‐26.1 mmHg for Tonovet Plus^®. Mean values (± standard deviation, SD [± coefficient of variation, CV]) obtained with Tonovet Plus^® (21.6 ± 2.45 mmHg [11.3%]) were on average 0.6 mmHg higher than with Tonovet^® (21.0 ± 3.14 mmHg [15.0%]), and a negligible statistical difference between the devices was found using the paired sample t test (P = .049). The correlation coefficient for the averaged triplicate measurements was 0.73. The average CV was 4.6% and 4.4% for Tonovet^® and Tonovet Plus^®, respectively.

Conclusions

The repeatability of measurements was very good with both devices. The readings between the two devices differed statistically significantly, but the correlation was considered good and the variation was numerically small, and thus, the difference was considered clinically irrelevant. When monitoring disease process or treatment response in an individual patient, repeated readings are best performed using a similar device to avoid false interpretation of results.