Analysis of differences in intraocular pressure evaluation performed with contact and non-contact devices

Evaluating Intraocular Pressure After Myopic Photorefractive Keratectomy: A Comparison of Different Tonometers

PRCIS

All devices evaluated in this study showed a significant underestimation in intraocular pressure (IOP) measurement after myopic photorefractive keratectomy (PRK), Goldmann tonometer more than others. Corneal biomechanics indicated a different influence on the different kinds of tonometry.

PURPOSE

The aim was to investigate the reliability of Goldmann applanation tonometry (GAT), rebound tonometry (RT), ocular response analyzer (ORA), Corvis ST (CST), and dynamic contour tonometry (DCT) in IOP evaluation after myopic PRK.

MATERIALS AND METHODS

One eye of 145 patients who underwent myopic PRK for a refractive defect ranging from -10.25 to -0.50 D (mean -4.69±2.00 D) was included in this retrospective comparative study. A complete eye visit with corneal tomography and IOP measurement with GAT, DCT, ORA, RT, and CST was performed before surgery and at 1, 3, and 6 months follow-up. Values provided by each device were tested and compared at each follow-up. Correlation analyses were run between changes in IOP and the corneal, morphologic and biomechanical parameters were measured after PRK.

RESULTS

GAT, DCT, ORA, RT, and CST showed a significant (P<0.01) underestimation of IOP at 6 months follow-up. GAT showed the greatest underestimation (-14.1%) and stronger correlations with corneal deformation parameter changes, whereas ORA, DCT, and RT appeared to be less conditioned by these variations. At 6 months follow-up DCT, ORA, RT, and CST provided IOP values with nonsignificant differences compared with GAT before PRK.

CONCLUSIONS

Each tested tonometer showed a significant IOP underestimation after myopic PRK. As this was most observed with GAT compared with all devices, we suggest DCT, ORA, RT, or CST to evaluate IOP in these patients following surgery.

Intraocular pressure after myopic laser refractive surgery measured with a new Goldmann convex prism: correlations with GAT and ORA

Background

The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA).

Methods

Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA.

Results

Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703–0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: − 0.185 – 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = − 0.266, 95% CI: − 3.896 – 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: − 0.332 – 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182).

Conclusions

Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy.

The use of infrared thermal imaging in tonometry with a Scheimpflug camera

Infrared thermal imaging is currently used in almost every field of medicine. This paper presents the novel use of thermography in ophthalmology - using a thermal camera to assess correct intraocular pressure measurement depending on the position of the patient's head during non-contact tonometry. For the analysed group of 10 healthy subjects, thermographic images of the face were recorded before and after intraocular pressure testing. Pressure was tested with a non-contact tonometer with a Scheimpflug camera. For the acquired 20: 2D images (thermograms), an analysis of the characteristic areas of the face determined temperature changes of the patient's face in contact with the tonometer frame. Analysis and processing of the acquired thermograms was carried out in MATLAB® with the Image Processing Toolbox. The results clearly showed a decrease in the patient's face temperature where the face was in contact with tonometer supports. Temperature changes in the patient's face provide valuable information about the correct position of their head in the device, which directly translates into measurement quality. Therefore, the analysis of changes in the patient's face temperature both before and after the examination can be a tool for assessing correct patient positioning in the tonometer supports.

[Comparison of Goldmann tonometry with air-puff tonometry. A study of 159 patients in Abidjan]

PURPOSE

The goal of this study was to compare the intraocular pressure (IOP) values obtained with each of the tonometry methods as well as to study the effect of corneal pachymetry on the measurements obtained by each method.

MATERIAL AND METHODS

We carried out a cross-sectional, descriptive, analytical, prospective study in the ophthalmology department of a multispecialty clinic in Abidjan (Ivory Coast) from April 2018 to August 2018. Patients aged 15 and over were included in the study. Over this period, IOP was measured by Goldman Applanation Tonometer (HaagStreit, AT 900, Switzerland) and air-puff Tonopachymeter (Nidek, NT 530 P, Japan), which also permitted measurement of central optical corneal pachymetry. The data analyzed focused on socio-demographic characteristics, ophthalmologic history, tonometry, and central corneal pachymetry. The comparison of the values obtained by both devices and the effect of central corneal thickness (CCT) on tonometry were analyzed using EpiDataAnalysis V2.2.2.183 software.

RESULTS

We examined 318 eyes of 159 patients whose mean age was 40±12.57 years, range 16 to 82 years. The gender ratio was 1. A past ophthalmologic history was noted in 79.2% of patients. The mean IOP by Goldmann applanation tonometry was 12.75±3.17mmHg, and that by non-contact air-puff tonometry was 13.83±3.80mmHg. The mean central corneal thickness was 530.50±32.61μm. The difference between IOP measured by non-contact tonometry and that measured by contact tonometry was statistically significant, with P=0.00. There was no statistically significant relationship between central corneal pachymetry and contact tonometry (P=0.80). However, there was a statistically significant relationship between non-contact tonometry and central pachymetry (P=0.00). The values obtained with the air-puff tonometer are more affected by central corneal thickness.

CONCLUSION

The values obtained by Goldmann applanation tonometry are not equivalent to those obtained by non-contact air-puff tonopachymetry.

The Effect of Corneal Thickness, Densitometry and Curvature on Intraocular Pressure Measurements Obtained by Applanation, Rebound and Dynamic Contour Tonometry

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.

Adreno-melatonin receptor complexes control ion homeostasis and intraocular pressure - their disruption contributes to hypertensive glaucoma

BACKGROUND AND PURPOSE

Often, glaucoma presents with elevated eye hydrostatic pressure, which is regulated by endogenous melatonin. Phenylephrine increases cytoplasmic [Ca²⁺ ], via α₁ -adrenoceptor activation, that is detrimental in glaucoma. The aims of this study were (a) to elucidate the role of melatonin receptors in humour production and intraocular pressure (IOP) maintenance and (b) to identify glaucoma-relevant melatonin-adrenoceptor interactions.

EXPERIMENTAL APPROACH

Biophysical and proximity ligation assays were performed to identify interactions in heterologous expression systems, in cell lines and in human eyes. G_s /G_i /G_q signalling was investigated in these systems and in cells producing aqueous humour. IOP was determined in a mice model of glaucoma. Retinography and topically pharmacological treatment were performed in control and in glaucomatous mice.

KEY RESULTS

α₁ -adreno- and melatonin receptors form functional complexes in which the C-terminal tail of the adrenoceptor plays a role. Remarkably, activation of α₁ -adrenoceptors in these complexes did not lead to cytosolic Ca²⁺ increases, suggesting G_s instead of G_q coupling is involved. The number of these complexes significantly decreased in models of glaucoma and, importantly, in human samples from glaucoma patients. This has led to hypothesize that melatonin, a hypotensive agent, plus blockade of α₁ -adrenoceptors could normalize pressure in glaucoma. Remarkably, co-instillation of melatonin and prazosin, an α₁ -adrenoceptor antagonist, resulted in long-term decreases in IOP in a well-established animal model of glaucoma.

CONCLUSIONS AND IMPLICATIONS

The findings are instrumental to understand the physiological function of melatonin in the eye and its potential to address eye pathologies by targeting melatonin receptors and their complexes.

Impact of corneal parameters on intraocular pressure measurements in different tonometry methods

AIM

To evaluate the impact of central corneal thickness (CCT) and corneal curvature on intraocular pressure (IOP) measurements performed by three different tonometers.

METHODS

IOP in 132 healthy eyes of 66 participants was measured using three different tonometry techniques: Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), and ICare rebound tonometer (RT). CCT and corneal curvature were assessed.

RESULTS

In healthy eyes, DCT presents significantly higher values of IOP than GAT (17.34±3.69 and 15.27±4.06 mm Hg, P<0.0001). RT measurements are significantly lower than GAT (13.56±4.33 mm Hg, P<0.0001). Compared with GAT, DCT presented on average 2.51 mm Hg higher values in eyes with CCT<600 µm and 0.99 mm Hg higher results in eyes with CCT≥600 µm. The RT results were lower on average by 1.61 and 1.95 mm Hg than those obtained by GAT, respectively. Positive correlations between CCT in eyes with CCT<600 µm were detected for all IOP measurement techniques, whereas a similar relationship was not observed in eyes with thicker corneas. A correlation between IOP values and keratometry in the group with CCT<600 µm was not detected with any of the tonometry methods. In thicker corneas, a positive correlation was found for GAT and mean keratometry values (R=0.369, P=0.005).

CONCLUSION

The same method should always be chosen for routine IOP control, and measurements obtained by different methods cannot be compared. All analysed tonometry methods are dependent on CCT; thus, CCT should be taken into consideration for both diagnostics and monitoring.