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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Topical cyclosporine A 1 mg/ml for atopic keratoconjunctivitis: Five-year case series of 99 children and young people. Acta Ophthalmol 2023; 101:e197-e204. [PMID: 36151755 DOI: 10.1111/aos.15251] [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: 03/18/2022] [Revised: 05/20/2022] [Accepted: 09/03/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To explore the effects of cyclosporine A (CsA) in the management of atopic keratoconjunctivitis (AKC). METHODS Open single-group interventional consecutive cohort study (case series) at a single eye care facility in the UK. We reviewed the electronic patient records of 99 children and young people (CYP) aged 3.4-18 years with AKC treated with topical CsA 1 mg/ml. Main outcome measures were number of prescriptions and hospital clinic visits over 12 months before and after the start of CsA and the proportion of CYP affected by adverse effects. RESULTS The median number of inflammatory episodes requiring treatment with topical corticosteroids (tCS) fell from 3 (interquartile range IQR 1-4) during the 12 months prior to CsA to 1 (IQR 0-3) during the 12 months after, excluding tCS prescriptions with the first CsA prescription (Wilcoxon signed ranks test, 2 tailed, p < 0.01). In the 12-month period following initiation of CsA 1 mg/ml with concomitant prescription of tCS (n = 66), daily dosage of steroids was reduced in 62 CYP (93.9%), and they were discontinued in 43 (65.2%). The median number of hospital visits fell from 4 (IQR 3-6) to 3 (IQR 2-5; Wilcoxon p < 0.01). Adverse events leading to discontinuation of CsA were stinging (instillation site pain; 9/99, 9%) and a transient skin rash (1/99, 1%). CONCLUSIONS Off-label use of commercial preparations of CsA 1 mg/ml significantly reduces the need for concomitant topical corticosteroids and hospital clinic visits in CYP with AKC. Stinging and skin rash can lead to discontinuation.
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Affiliation(s)
- Annegret H Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK.,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Steroid-sparing effect of ciclosporin A 1 mg/mL: 5-year case series of 107 children and young people with vernal keratoconjunctivitis. BMJ Open Ophthalmol 2022; 7:e001040. [PMCID: PMC9756209 DOI: 10.1136/bmjophth-2022-001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background/aims To explore the steroid-sparing and other therapeutic effects of ciclosporin A (CsA) 1 mg/mL in the management of vernal keratoconjunctivitis (VKC). Methods Open retrospective single-group interventional consecutive cohort study (case series) of 107 children and young people (CYP) age 4.4–18 years with severe and/or recurrent VKC who were prescribed CsA 1 mg/mL between November 2015 and May 2021 at one institution. Review of electronic patient records, noting clinical indication for prescribing CsA 1 mg/mL, dosage prescribed at initiation and follow-up, impact on steroid usage before and after commencing CsA as well as adverse events and indications for discontinuation of treatment. Results The median number of inflammatory episodes requiring treatment with topical corticosteroids fell from 3 (IQR 2–4) during the 12 months prior to CsA 1 mg/mL to 1 (IQR 0–3) during the 12 months after, excluding steroid prescriptions with the first CsA 1 mg/mL prescription (Wilcoxon signed ranks test, two tailed, p<0.01). In the 12-month period following initiation of CsA 1 mg/mL with concomitant prescription of topical corticosteroids (n=82), daily dosage of steroids was reduced in 79 (96.3%) and discontinued in 67 (81.7%). The median number of hospital clinic visits fell from 4 (IQR 3–5) to 3 (IQR 2–5) (Wilcoxon p<0.01). Adverse events leading to discontinuation of CsA 1 mg/mL within 12 months of starting included stinging (instillation site pain) (6/107, 5.6%) and skinrash (1/107, 0.9%). Conclusion Commercial preparations of CsA 1 mg/mL, licensed for severe VKC in CYP, significantly reduce the need for concomitant topical corticosteroids and hospital clinic visits. Adverse events which may lead to discontinuation are stinging and skin rash.
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Affiliation(s)
- Annegret Hella Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Kirithika Muthusamy
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Strzalkowska A, Pirlich N, Stingl JV, Schuster AK, Rezapour J, Wagner FM, Buse J, Hoffmann EM. Intraocular Pressure Measurement in Childhood Glaucoma under Standardized General Anaesthesia: The Prospective EyeBIS Study. J Clin Med 2022; 11:2846. [PMID: 35628971 PMCID: PMC9144815 DOI: 10.3390/jcm11102846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: We aimed to compare intraocular pressure (IOP) measurements using iCare® PRO rebound tonometry (iCare) and Perkins applanation tonometry (Perkins) in childhood glaucoma subjects and healthy children and the influence of anaesthesia depth, age and corneal thickness. Material: Prospective clinical, case-control study of children who underwent an ophthalmologic examination under general anaesthesia according to our protocol. Children were 45.45 ± 29.76 months old (mean ± SD (standard deviation)). Of all children, 54.05% were female. IOP was taken three times (T1−T3), according to duration and the depth of anaesthesia. The order of measurement alternated, starting with iCare. Agreement between the device measurements was evaluated using Bland−Altman analysis. Results: 53 glaucoma subjects and 22 healthy controls. Glaucoma subjects: IOP measured with iCare was at T1: 27.2 (18.1−33.8), T2: 21.6 (14.8−30.6), T3: 20.4 mmHg (14.5−27.0) and Perkins 17.5 (12.0−23.0), 15.5 (10.5−20.5), 15.0 mmHg (10.5−21.0) (median ± IQR (interquartile range)). Healthy controls: IOP with iCare: T1: 13.3 (11.1−17.0), T2: 10.6 (8.1−12.4), T3: 9.6 mmHg (7.7−11.7) and Perkins 10.3 (8.0−12.0), 7.0 (5.5−10.5), 7.0 mmHg (5.5−8.5) (median ± IQR). The median IOP was statistically significantly higher with iCare than with Perkins (p < 0.001) in both groups. The mean difference (iCare and Perkins) was 6.0 ± 6.1 mmHg for T1−T3, 7.3 at T1, 6.0 at T2, 4.9 mmHg at T3. Conclusion: The IOP was the highest in glaucoma subjects and healthy children at T1 (under sedation), independently of the measurement method. iCare always leads to higher IOP compared to Perkins in glaucoma and healthy subjects, regardless of the duration of anesthesia.
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Affiliation(s)
- Alicja Strzalkowska
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Nina Pirlich
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany;
| | - Julia V. Stingl
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Jasmin Rezapour
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Felix M. Wagner
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Justus Buse
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany; (A.S.); (J.V.S.); (A.K.S.); (J.R.); (F.M.W.); (J.B.)
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Umfress AC, Glaser TS, Ploysangam P, Freedman SF. Rebound tonometry by iCare 200 (IC200): comparison with Tono-Pen in the operating room and Goldmann applanation in the clinic. J AAPOS 2021; 25:329.e1-329.e6. [PMID: 34737080 DOI: 10.1016/j.jaapos.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tonometry guides decision making in children with known or suspected glaucoma. The iCare IC200 is a recently FDA-approved rebound tonometer that can measure intraocular pressure (IOP) in both supine and upright patients. The purpose of this study was to evaluate this new tonometer against more commonly used standard instruments: Tono-Pen in the operating room (OR arm) and Goldmann applanation in the clinic (clinic arm). METHODS The OR arm included sequential children undergoing general anesthesia. The clinic arm included cooperative children seen in clinic. IOP was measured twice (right eye then left eye, repeat) with IC200 and either Tono-Pen (OR arm) or Goldmann (clinic arm). RESULTS A total of 99 children were included: 75 for the OR arm and 24 for the clinic arm. There was a strong correlation between the IOP measured by IC200 and each device (R2 = 0.81 for Tono-Pen; R2 = 0.78 for Goldmann). In the OR arm, the overall mean IOP difference (ΔIOP [Tono-Pen - IC200]) was -1.6 mm Hg. For eyes with corneal edema (n = 12), ΔIOP ranged from -8 to 15 mm Hg. At IOP >20 mm Hg, mean ΔIOP was -3.7 mm Hg. In the clinic arm, the mean ΔIOP (ΔIOP [Goldmann - IC200]) was -1.2 mm Hg. CONCLUSIONS In eyes of children under general anesthesia with IOP <20 mm Hg without corneal edema, IC200 and Tono-Pen correlated well. In cooperative clinic patients, Goldmann and IC200 correlated well over the range of IOP studied.
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Affiliation(s)
- Allison C Umfress
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tanya S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Pimpiroon Ploysangam
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Angmo D, Ramesh P, Mahalingam K, Azmira K, Pandey S, Gupta V, Sihota R, Dada T. Comparative Evaluation of Rebound and Perkins Tonometers in Pediatric Glaucoma With Varied Corneal Characteristics. J Glaucoma 2021; 30:312-316. [PMID: 33399355 DOI: 10.1097/ijg.0000000000001765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
PRECIS Icare tonometer overestimated intraocular pressure (IOP) as compared with Perkins and this variation was higher in IOP>19 mm Hg and corneal opacity in patients with pediatric glaucoma. PURPOSE To compare the IOP measured by Icare ic200 with Perkins tonometer in pediatric glaucoma with different corneal characteristics. METHODS Patients of pediatric glaucoma posted for routine examination under anesthesia, age below 12 years were enrolled. All patients underwent IOP measurement with Perkins and Icare ic200 tonometer by the same observer. Basic demographic data and other relevant clinical data were recorded. Central corneal thickness (CCT), horizontal corneal diameter, and corneal characteristics such as cornea clarity was recorded. RESULTS A total of 194 eyes of 105 patients were analyzed. The difference between Perkins and Icare IOP was -0.816 mm Hg with the Bland-Altman plot 95% limits of agreement (LoA) from -11.194 to 9.562 mm Hg and 5.1% (10) values lying outside LoA. At IOP <19 mm Hg, the difference was -0.65 mm Hg and IOP ≥19 mm Hg, the difference was higher, -1.12 mm Hg. In the clear cornea group (123 eyes), the difference in IOP by 2 tonometers was -0.776 mm Hg with the Bland-Altman plot 95% LoA between -10.679 and 9.128 mm Hg. In hazy corneas (36 eyes), the difference in IOP was 0.531 mm Hg. The Bland-Altman plot showed 95% LoA between -6.242 and 7.303 mm Hg. In the scarred cornea group (35 eyes), the difference in IOP between the 2 was -2.343 mm Hg and the Bland-Altman plot showed wide 95% LoA from -16.302 to 11.616 mm Hg. CONCLUSION Icare tonometer overestimated IOP as compared with Perkins and this variation was higher in eyes with IOP≥19 mm Hg, CCT >615 μm, and scarred corneas. A moderate correlation between IOP and CCT for both tonometers was noted.
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Affiliation(s)
- Dewang Angmo
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
| | | | | | | | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
| | | | - Tanuj Dada
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
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7
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Saffren B, Price JM, Zhang QE, Hamershock RA, Sharpe J, Levin AV. Falsely high rebound tonometry. J AAPOS 2021; 25:97.e1-97.e5. [PMID: 33901671 DOI: 10.1016/j.jaapos.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rebound tonometry (RBT) can be used to measure intraocular pressure (IOP) in children unable to tolerate measurement with applanation tonometry (AT) while awake. RBT readings are often 2-3 mm Hg higher than AT. We have experienced children with a repeatedly higher difference between RBT and AT measurements (≥6 mm Hg). The purpose of this study was to identify demographic and ocular characteristics that contribute to this artifactuous discrepancy. METHODS The medical records of pediatric patients with IOP measured by RBT followed by AT within 6 months without intervening surgery or change in medical management were retrospectively reviewed to identify potential predictors of greater difference between RBT and AT readings. RESULTS A total of 123 eyes of 65 patients were included. In patients with normal IOP (≤24 mm Hg), 18.5% had a ≥6 mm Hg difference between RBT and AT, with RBT being higher. Risk factors for this included presence of persistent fetal vasculature (PFV), increased corneal diameter, and higher initial RBT value (>20). In patients with elevated IOP (>24 mm Hg), 77% had ≥6 mm Hg difference, with larger corneal diameter being the sole predictor. Eyes were less likely to have significant RBT-AT difference if there was corneal opacity or iris abnormalities in eyes with elevated IOP (>24 mm Hg). CONCLUSIONS In some children, RBT readings are ≥ 6 mm Hg higher than AT readings. Caution should be taken when interpreting RBT values in patients with PFV, increased corneal diameter, and higher initial RBT values.
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Affiliation(s)
- Brooke Saffren
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Jade M Price
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Ed Zhang
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rose A Hamershock
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Sharpe
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Campbell P, Edgar DF, Shah R. Inter-optometrist variability of IOP measurement for modern tonometers and their agreement with Goldmann Applanation Tonometry. Clin Exp Optom 2021; 104:602-610. [DOI: 10.1080/08164622.2021.1878831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Rakhee Shah
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Jose J, Ve RS, Pai HV, Biswas S, Parimi V, Poojary P, Nagarajan T. Agreement and repeatability of Icare ic100 tonometer. Indian J Ophthalmol 2020; 68:2122-2125. [PMID: 32971622 PMCID: PMC7728033 DOI: 10.4103/ijo.ijo_546_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To find the agreement and repeatability of Icare ic100 tonometer. Methods We included 150 subjects above the age of 18 years for this cross-sectional, multicenter study with intraocular pressure (IOP) ≥7 mmHg. After the initial ophthalmic examination, two masked examiners took five IOP measurements using three different instruments; Icare ic100, Icare TA01i, and Goldmann applanation tonometer (GAT) in only one eye of the participants. Comparison of agreement of IOP using different instruments was quantified with intraclass correlation coefficient (ICC) using the two-way random effects models of absolute agreement and Cronbach's alpha. The test-retest variability of the instruments was assessed by deriving repeatability coefficient (RC) and coefficient of variation (CV). Results Agreement between the tonometers across the different IOP groups had no statistically significant difference in their mean IOP. Icare ic100 was found to have good reliability across all IOP groups (ICC value >0.78) when compared with Icare TA01i. In comparison with GAT, Icare ic100 showed good reliability across all IOP groups (ICC >0.87) except >16 to <23 mmHg group where it showed moderate reliability (ICC = 0.52). Icare ic100 showed good repeatability with RC and CV of 2.67 and 4.89, respectively. Conclusion Icare ic100 rebound tonometer can measure IOP with relatively small measurement error and can provide a reliable and repeatable reading in comparison with GAT across a wide pressure range without hampering corneal health.
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Affiliation(s)
- Judy Jose
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Ramesh S Ve
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - H Vijaya Pai
- Ophthalmology Department, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Sayantan Biswas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Vamsi Parimi
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | | | - T Nagarajan
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Perez-Garcia P, Morales-Fernandez L, Saenz-Frances F, Mendez-Hernandez CD, Garcia-Feijoo J, Santos-Bueso E, Martinez-de-la-Casa JM. Comparision of intraocular pressure measured using the new icare 200™ rebound tonometer and the Perkins™ applanation tonometer in healthy subjects and in patients with primary congenital glaucoma. ACTA ACUST UNITED AC 2020; 96:175-180. [PMID: 32690372 DOI: 10.1016/j.oftal.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare intraocular pressure (IOP) measurements obtained using the Icare 200™ (IC200) rebound tonometer and the hand-held version of the Goldmann Applanation Tonometer (Perkins™ tonometer, GAT) in patients with primary congenital glaucoma (PCG) and in healthy subjects. MATERIAL AND METHODS A total of 42 eyes of healthy subjects (G1) and 40 patients with PCG (G2) were analysed. The following clinical data were collected: gender, age, Cup/Disc ratio, central corneal thickness (CCT). IOP was determined in the examination room using the IC200 and GAT tonometers, in the same order. Agreement between both tonometers was determined using the intraclass correlation coefficient (ICC) and Bland-Altman plot. A linear regression analysis was used to establish the IOP was affected by the studied variables. RESULTS Mean IOP between both tonometers (IC200 minus GAT) was: G1=15.91 (2.57) mmHg vs. 15.06 (2.12) mmHg (mean difference, MD=0.84 (0.50) mmHg; P<.101) and G2=20.10 (6.37) vs.19.12 (5.62) (MD=0.98 (1.36); P=.474). Excellent agreement was found between IC200 and GAT in both groups (ICC=G1: 0.875 (95% CI; 0.768-0.933; P<.001); G2: 0.924 (95% CI; 0.852-0.961; P<.001), and there was a statistically significant correlation between the IOP difference measured with IC200 and GAT and CCT in G1 (B=0.021; 95% CI; 0.005-0.037; P=.008), but was not statistically significant in G2. CONCLUSION There was excellent agreement between the IC200 and GAT tonometers, both in healthy subjects and PCG, with a trend to overestimate IOP when measured with IC200. There was no influence by CCT on IOP measurements in patients with PGC.
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Bunce C, Czanner G, Moschandreas J, Stratton IM, Doré C, Freemantle N. Ophthalmic statistics note 14: method agreement studies in ophthalmology: the intraclass correlation coefficient? Br J Ophthalmol 2020; 104:1033-1035. [PMID: 32277011 DOI: 10.1136/bjophthalmol-2019-314947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Catey Bunce
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Gabriela Czanner
- Applied Mathematics, Liverpool John Moores University-City Campus, Liverpool, Merseyside, UK
| | - Joanna Moschandreas
- Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | | | - Caroline Doré
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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12
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Fayed MA, Chen TC. Pediatric intraocular pressure measurements: Tonometers, central corneal thickness, and anesthesia. Surv Ophthalmol 2019; 64:810-825. [DOI: 10.1016/j.survophthal.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
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13
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Esmael A, Ismail YM, Elhusseiny AM, Fayed AE, Elhilali HM. Agreement profiles for rebound and applanation tonometry in normal and glaucomatous children. Eur J Ophthalmol 2018; 29:379-385. [DOI: 10.1177/1120672118795060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To investigate agreement between intraocular pressure measurements by the rebound tonometer and handheld Perkins applanation tonometer in children with and without primary congenital glaucoma and test agreement with intraocular pressure and age variations. Materials and methods: A prospective non-interventional comparative study done on 223 eyes of 115 children, 161 normal eyes, and 62 eyes with primary congenital glaucoma. Intraocular pressure measurements were obtained in the upright position by rebound tonometer first, followed by installation of topical anesthetic eye drops (benoxinate), then measured by Perkins applanation tonometer. Results: For all eyes, mean difference between Perkins applanation tonometer and rebound tonometer was −0.59 ± 2.59 mmHg, p = 0.001. Regression analysis with (r) = 0.9, (r2) = 0.79, and p < 0.001. In primary congenital glaucoma: there was a mean difference of −.79 ± 2.82 (p = 0.032), a good correlation with (r) = 0.94, (r2) = 0.87%, and 95% level of agreement: –6.34 to +4.76. In normal eyes: mean difference was −.52 ± 2.5 (p = 0.01), correlation: (r) = 0.8, (r2) = 0.64, and p = 0.001. The 95% level of agreement −5.41 and +4.36 mmHg. In intraocular pressure ⩽ 15 mmHg: mean difference −0.89 ± 2.15 mmHg, 95% level of agreement between −5.1 and +3.32 mmHg, p < 0.001. In intraocular pressure >15 mmHg: mean difference was 0.04 ± 3.28 mmHg, 95% level of agreement −6.38 and +6.46 mmHg, p = 0.914. Conclusion: There is a good correlation between rebound tonometer and Perkins applanation tonometer in children with and without primary congenital glaucoma; however, rebound tonometer overestimates the intraocular pressure, and in intraocular pressure >15 mmHg there is less agreement between the two devices. Hence, in higher intraocular pressure measurement caution should be taken when interpreting rebound tonometer readings, and a confirmatory measurement using Perkins applanation tonometer is advised.
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Affiliation(s)
- Amanne Esmael
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yomna M Ismail
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Alaa E Fayed
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala M Elhilali
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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14
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Munsamy AJ, Gopaul K, Perumaul K, Moosa MM, Bidla L, Shaetonhodi TL, Vilakazi B. A comparative analysis of the postural and diurnal ocular perfusion pressure of young healthy individuals of different ethnicities. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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Agreement of patient-measured intraocular pressure using rebound tonometry with Goldmann applanation tonometry (GAT) in glaucoma patients. Sci Rep 2017; 7:42067. [PMID: 28165028 PMCID: PMC5292696 DOI: 10.1038/srep42067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/05/2017] [Indexed: 11/08/2022] Open
Abstract
This study aims to determine the agreement of patient-measured intraocular pressure (IOP) using rebound tonometry with ophthalmologist-measured IOP using Goldmann applanation tonometry (GAT). Fifty-three glaucoma patients used rebound tonometry (Icare ONE, Icare Finland Oy., Finland) to measure their own IOP in ambient environments for 1 week, 5 times per day. Clinic IOP measurements were performed by ophthalmologists using GAT and by patients using rebound tonometry on examination days 1, 4 and 7 of the same week. The agreement between the two tonometries was evaluated by modified Bland-Altman plots and intra-class correlation coefficient (ICC) was determined. Differences in ICCs of them among the three examination days were evaluated by bootstrap resampling analysis. Respective within-measurement ICC of GAT and rebound tonometry were 0.98 and 0.94 on Day 1, 0.98 and 0.93 on Day 4, and 0.96 and 0.92 on Day 7. In a modified Bland-Altman plot, the mean difference ±1 standard deviation (SD) between the two tonometries was 0.15 ± 0.65 mmHg (p = 0.682). Between-measurement ICC were 0.66, 0.76 and 0.73 on the 3 examination days. There was no significant difference among ICCs. In conclusion, patient-measured IOP using rebound tonometry and ophthalmologist-measured IOP using GAT demonstrate good agreement.
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Weng J, Tsai IL, Kuo LL, Tsai CY, Woung LC, Hsiao YC. Intraocular pressure monitoring by rebound tonometry in children with myopia. Taiwan J Ophthalmol 2017; 7:149-154. [PMID: 29034154 PMCID: PMC5637380 DOI: 10.4103/tjo.tjo_45_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE: Topical atropine treatment is generally accepted to retard the progression of myopia, but it is associated with side effects such as photophobia and elevation of intraocular pressure (IOP). IOP measurements in children are challenging. The traditional applanation tonometry by direct contact with the cornea will require patient's cooperation. The rebound tonometer, using a dynamic electromechanical method for measuring IOP, shows good correlation with traditional tonometry. The purpose of this study is to evaluate the IOP of myopic children under atropine treatment using rebound tonometer and to compare the characteristics between rebound tonometry and applanation tonometry. METHODS: This study is a prospective study measuring IOP by rebound tonometer in myopic children under regular low-dose atropine treatment. We recruited children with refraction error showing myopia over −0.5 D with 0.15%, 0.3%, or 0.5% atropine eye drops use every night or every other night for myopia control. Children with treatment duration of atropine <1 month were excluded from the study. IOP measurements were performed by applanation tonometer (Tono-Pen XL, Reichert) and rebound tonometer (ICARE). The reliability of rebound tonometer was analyzed with percentage. Comparison of IOP between rebound tonometer and applanation tonometry was presented. RESULTS: The rebound tonometry was well tolerated by all participants and caused no complaints, discomfort, or adverse events. Totally 42 myopic eyes of 42 subjects were included in the study. The average age of these participants was 10 years old, range from 5 to 16. Median = 10 years old. The average IOP of the right eye by rebound tonometer was 17.4 ± 3 mmHg, and 17.1 ± 3 mmHg by applanation tonometry. Nearly 19%, 33%, and 24% of difference of IOP readings between rebound tonometer and Tono-Pen applanation are within 0 mmHg, 1 mmHg, and 1–2 mmHg, respectively. CONCLUSIONS: Rebound tonometry has good correlation with applanation tonometry and 76.1% of differences between two tonometers are <2 mmHg. The advantage of drop-free rebound tonometry has made it easier to obtain IOP readings in myopia children under atropine treatment.
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Affiliation(s)
- Jenchieh Weng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - I-Lun Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Li-Lin Kuo
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Community Medicine Research Center, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Community Medicine Research Center, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Chuan Hsiao
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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17
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Galgauskas S, Strupaite R, Strelkauskaite E, Asoklis R. Comparison of intraocular pressure measurements with different contact tonometers in young healthy persons. Int J Ophthalmol 2016; 9:76-80. [PMID: 26949614 DOI: 10.18240/ijo.2016.01.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/29/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the correlation of Goldmann applanation tonometer (GAT), I-Care tonometer and Tono-Pen tonometer results in young healthy persons, and to investigate the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements recorded with these tonometers. METHODS We conducted a pilot clinical study in 78 eyes of 78 subjects aged 22-28 years old (44 women and 34 men; mean age 23.8±1.19y). IOP was measured using GAT, I-Care and Tono-Pen tonometers, followed by measurements of CCT. Statistical analysis was performed using SPSS 20.0. RESULTS The mean IOPs and standard deviation (±SD) for GAT, I-Care and Tono-Pen were 15.62±2.281 mm Hg, 16.29±2.726 mm Hg and 16.32±2.393 mm Hg, respectively. The mean CCT was 555.15±29.648 µm. Clear positive correlations between GAT and I-Care, GAT and Tono-Pen, and I-Care and Tono-Pen tonometers were found (r=0.867, P<0.001; r=0.861, P<0.001; r=0.915, P<0.001, respectively). In comparison between devices, Bland-Altman analysis showed a significant mean difference (MD) in the measurements by GAT and I-Care of -0.679 mm Hg and by GAT and Tono-Pen of -0.705 mm Hg ( P<0.001), but there was no significant difference between I-Care and Tono-Pen ( P>0.05). Both non-gold standard tonometers were affected by CCT; that is, both I-Care and Tono-Pen tonometer values were significantly higher with higher CCT means (>555 µm; MD=-1.282, P<0.001; MD=-0.949, P<0.001, respectively) compared with GAT. CONCLUSION Both I-Care and Tono-Pen tonometers overestimated IOP compared with the GAT values. Either the I-Care or Tono-Pen tonometer could be used instead of GAT because there was no significant difference between their results. Higher CCT values (>555 µm) were associated with overestimated IOP values.
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Affiliation(s)
| | - Rasa Strupaite
- Center of Eye Diseases, Vilnius University, Vilnius LT-08661, Lithuania
| | | | - Rimvydas Asoklis
- Center of Eye Diseases, Vilnius University, Vilnius LT-08661, Lithuania
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18
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Mendez-Hernandez C, Arcos-Villegas G, Garcia-Sanchez J, Garcia-Feijoo J. Clinical classification and medical treatment options in childhood glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:557-561. [PMID: 26358844 DOI: 10.1016/j.oftal.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/10/2015] [Accepted: 07/01/2015] [Indexed: 06/05/2023]
Affiliation(s)
- C Mendez-Hernandez
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - G Arcos-Villegas
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España
| | - J Garcia-Sanchez
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - J Garcia-Feijoo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
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19
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Ugalahi MO, Seidu MA, Olusanya BA, Baiyeroju AM. Does patient comfort influence the choice of tonometer for the measurement of intraocular pressure? Int Ophthalmol 2015; 36:385-9. [PMID: 26471789 DOI: 10.1007/s10792-015-0139-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/07/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to compare patient comfort and preference between the use of Icare tonometer and Goldmann applanation tonometer for the measurement of intraocular pressure (IOP). This was a prospective study carried out at the Eye clinic of the University College Hospital, Ibadan on volunteers aged 18 years and above. Demographic information of the participants was collected using a proforma. All participants had Icare tonometry and Goldmann applanation tonometry (GAT) performed on them in sequence within a 15-min period. After the measurements, participants were asked to report their assessment of the level of comfort with each method and to state their preferred choice for IOP measurement. One hundred subjects participated in the study; 45 (45 %) were males, and the mean age was 47.1 (± 17.4) years. Forty-three subjects (43 %) reported that Icare was either much more comfortable or more comfortable than GAT, while 31 (31 %) stated that Goldmann applanation was either much more or more comfortable. Twenty-six participants (26 %) reported that the level of comfort was the same with the two instruments. With regard to which of the instruments will be preferred for IOP check at another clinic visit, 53 (53 %) of the respondents preferred the Goldmann applanation tonometer. Some of the participants preferred GAT because they believed it was more sophisticated, while the main reported reason for preferring Icare was the stinging sensation of the anesthetic eye drop when using GAT. Although more participants reported the Icare tonometer to be more comfortable, the Goldmann tonometer was preferred by majority of the respondents.
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Affiliation(s)
- Mary O Ugalahi
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Mukaila A Seidu
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
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21
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Sinha G, Gupta S, Temkar S, Pandey V, Sihota R, Dada T. IOP agreement between I-Care TA01 rebound tonometer and the Goldmann applanation tonometer in eyes with and without glaucoma. Int Ophthalmol 2014; 35:89-93. [DOI: 10.1007/s10792-014-0026-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
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22
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Fuest M, Kotliar K, Walter P, Plange N. Monitoring intraocular pressure changes after intravitreal Ranibizumab injection using rebound tonometry. Ophthalmic Physiol Opt 2014; 34:438-44. [DOI: 10.1111/opo.12134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Konstantin Kotliar
- Department of Medical Engineering and Applied Mathematics; University of Applied Sciences; Aachen Germany
| | - Peter Walter
- Department of Medical Engineering and Applied Mathematics; University of Applied Sciences; Aachen Germany
| | - Niklas Plange
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
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Fuest M, Mamas N, Walter P, Plange N. Tonometry in Corneal Edema after Cataract Surgery: ReboundversusGoldmann Applanation Tonometry. Curr Eye Res 2014; 39:902-7. [DOI: 10.3109/02713683.2014.888451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim C, Demetriades AM, Radcliffe NM. One Year of Glaucoma Research in Review: 2012 to 2013. Asia Pac J Ophthalmol (Phila) 2014; 3:48-55. [PMID: 25177529 PMCID: PMC4148017 DOI: 10.1097/apo.0000000000000041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The objective of this study was to provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published from 2012 to 2013. DESIGN Literature review. METHODS The authors conducted a 1-year (July 1, 2012, to September 30, 2013) English-language glaucoma literature search on PubMed using the following terms: glaucoma, automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, glaucoma medical therapy, neuroprotection, glaucoma laser treatment, secondary glaucoma, glaucoma surgery, and miscellaneous topics in glaucoma. RESULTS Of 2659 articles on glaucoma published during our time frame, this review selected original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts. Preference was given to human research. CONCLUSIONS This review focuses on literature that is applicable to ophthalmologists in practice and also highlights studies that may enhance the diagnosis and management of glaucoma.
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Affiliation(s)
- Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Anna M Demetriades
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Nathan M Radcliffe
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
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Farrahi F, Sharifipour F, Malekahmadi M, Cheraghian B. Comparison of IOPen rebound tonometer with Goldmann applanation tonometer at different IOP levels. Int J Ophthalmol 2013; 6:637-40. [PMID: 24195039 DOI: 10.3980/j.issn.2222-3959.2013.05.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/29/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the accuracy of IOPen rebound tonometer with Goldmann applanation tonometer (GAT) in individuals with low, normal and high intraocular pressure (IOP) and to evaluate the effect of central corneal thickness (CCT) on IOP measurements. METHODS This cross-sectional study consisted of 159 participants. IOP of one eye of each subject was measured consecutively with IOPen and GAT. Then CCT was measured using an ultrasonic pachymeter. Based on GAT IOP readings, participants were divided into low, normal and high IOP groups. Correlation between tonometers and CCT was calculated by spearman's correlation coefficient. Agreement between tonometers was evaluated using Bland-Altman method. RESULTS Non-significant underestimation of IOP by IOPen was observed in low IOP group (Mean difference: 0.20mmHg; P=0.454) and also in normal IOP group (Mean difference: 0.56mmHg; P=0.065). However, IOPen significantly overestimated IOP in high IOP group (Mean difference: 1.06mmHg; P=0.038). The 95% limits of agreement (LoA) width between IOPen and GAT IOPs were 7.84, 8.57 and 14.27mmHg in low, normal and high IOP groups, respectively. Low IOP group had thinner corneas compared to high IOP group (P=0.034). IOP measurements taken by IOPen were not influenced by CCT (P=0.099) while poor correlation between CCT and GAT was found (R=0.17, P=0.032). Using receiver operating characteristic (ROC) curve, cutoff value of 18.75mmHg was determined for IOPen with sensitivity of 98.1 and specificity of 97.2%. CONCLUSION Accuracy of IOPen is comparable to GAT in patients with low or normal IOP but IOPen overestimates IOP at high IOP levels. CCT does not affect IOP readings with IOPen.
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Affiliation(s)
- Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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