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Komninou MA, Seiler TG, Enzmann V. Corneal biomechanics and diagnostics: a review. Int Ophthalmol 2024; 44:132. [PMID: 38478103 PMCID: PMC10937779 DOI: 10.1007/s10792-024-03057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Corneal biomechanics is an emerging field and the interest into physical and biological interrelations in the anterior part of the eye has significantly increased during the past years. There are many factors that determine corneal biomechanics such as hormonal fluctuations, hydration and environmental factors. Other factors that can affect the corneas are the age, the intraocular pressure and the central corneal thickness. The purpose of this review is to evaluate the factors affecting corneal biomechanics and the recent advancements in non-destructive, in vivo measurement techniques for early detection and improved management of corneal diseases. METHODS Until recently, corneal biomechanics could not be directly assessed in humans and were instead inferred from geometrical cornea analysis and ex vivo biomechanical testing. The current research has made strides in studying and creating non-destructive and contactless techniques to measure the biomechanical properties of the cornea in vivo. RESULTS Research has indicated that altered corneal biomechanics contribute to diseases such as keratoconus and glaucoma. The identification of pathological corneas through the new measurement techniques is imperative for preventing postoperative complications. CONCLUSIONS Identification of pathological corneas is crucial for the prevention of postoperative complications. Therefore, a better understanding of corneal biomechanics will lead to earlier diagnosis of ectatic disorders, improve current refractive surgeries and allow for a better postoperative treatment.
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Affiliation(s)
- Maria Angeliki Komninou
- Department of Ophthalmology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Theo G Seiler
- Department of Ophthalmology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
- Klinik Für Augenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
- Institut Für Refraktive Und Opthalmo-Chirurgie (IROC), Zurich, Switzerland
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Volker Enzmann
- Department of Ophthalmology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland.
- Department of BioMedical Research, University of Bern, Bern, Switzerland.
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Montolío-Marzo E, Morales-Fernández L, Saenz-Frances San Baldomero F, García-Saenz S, García-Feijoo J, Piñero DP, Martínez-de-la-Casa JM. Easyton® transpalpebral versus Perkins applanation tonometry in different populations. Int Ophthalmol 2023; 43:3491-3497. [PMID: 37286775 DOI: 10.1007/s10792-023-02754-7] [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: 01/08/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare intraocular pressure (IOP) measurements obtained using the new transpalpebral Easyton® tonometer and Perkins applanation tonometer (PAT) in three different clinical populations. METHODS The participants of this prospective study were 84 subjects divided into the groups: 22 healthy children (G1), 42 healthy adults (G2), and 20 adult patients with primary open angle glaucoma (G3). The data recorded in 84 eyes of these subjects were age, sex, gender, central corneal thickness (CCT), and axial length (AL). In all eyes, IOP was determined in the same examination room by the same experienced examiner using Easyton® and PAT in random order. RESULTS Mean differences in IOP readings between Easyton® and PAT were 0.45 ± 1.97 (p = 0.295), - 0.15 ± 2.13 (p = 0.654), - 1.65 ± 3.22 (p = 0.033), and - 0.018 ± 2.50 mmHg (p = 0.500) in the groups G1, G2, G3, and whole sample (G4), respectively. Correlations between Easyton® and PAT IOP values were 0.668 (p = 0.001) for G1, 0.463 (p = 0.002) for G2, 0.680 (p < 0.001) for G3, and 0.605 (p < 0.001) for G4. Moderate to good agreement between the two tonometers was found in all groups according to intraclass correlation coefficients, which were 0.794 (p < 0.001) for G1, 0.632 (p < 0.001) for G2, 0.809 (p < 0.001) for G3, and 0.740 (p < 0.001) for G4. The lower and upper limits of agreement between the devices were - 5.1 and 4.7 mmHg, respectively, in the complete group. No correlation was noted between CCT or AL and the Easyton® IOP measurements. CONCLUSION IOP measurements obtained with Easyton® and PAT show an acceptable level of agreement mainly in healthy individuals, recommending it for IOP screening in children and in patients in which PAT measurement may be impared as patients with hemifacial spasms, corneal irregularities, or reduced mobility. It is not recommended for glaucoma patients follow-up.
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Affiliation(s)
- Elena Montolío-Marzo
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Laura Morales-Fernández
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Federico Saenz-Frances San Baldomero
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Sofía García-Saenz
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Julián García-Feijoo
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Jose M Martínez-de-la-Casa
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
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Queiruga-Piñeiro J, Barros A, Lozano-Sanroma J, Fernández-Vega Cueto A, Rodríguez-Uña I, Merayo-LLoves J. Assessment by Optical Coherence Tomography of Short-Term Changes in IOP-Related Structures Caused by Wearing Scleral Lenses. J Clin Med 2023; 12:4792. [PMID: 37510907 PMCID: PMC10381863 DOI: 10.3390/jcm12144792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The mechanism that could increase intraocular pressure (IOP) during scleral lens (SL) wear is not fully understood, although it may be related to compression of the landing zone on structures involved in aqueous humor drainage. METHODS Thirty healthy subjects were fitted with two SLs of different sizes (L1 = 15.8 mm, L2 = 16.8 mm) for 2 h in the right eye and left eye as a control. Central corneal thickness (CCT), parameters of iridocorneal angle (ICA), Schlemm's canal (SC), and optic nerve head were measured before and after wearing both SLs. IOP was measured with a Perkins applanation tonometer before and after lens removal and with a transpalpebral tonometer before, during (0 h, 1 h, and 2 h), and after lens wear. RESULTS CCT increased after wearing L1 (8.10 ± 4.21 µm; p < 0.01) and L2 (9.17 ± 4.41 µm; p < 0.01). After L1 removal, the ICA parameters decreased significantly (p < 0.05). With L2 removal, nasal and temporal SC area and length were reduced (p < 0.05). An increased IOP with transpalpebral tonometry was observed at 2 h of wearing L1 (2.55 ± 2.04 mmHg; p < 0.01) and L2 (2.53 ± 2.22 mmHg; p < 0.01), as well as an increased IOP with Perkins applanation tonometry after wearing L1 (0.43 ± 1.07 mmHg; p = 0.02). CONCLUSIONS In the short term, SL resulted in a slight increase in IOP in addition to small changes in ICA and SC parameters, although it did not seem to be clinically relevant in healthy subjects.
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Affiliation(s)
- Juan Queiruga-Piñeiro
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Alberto Barros
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Javier Lozano-Sanroma
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Andrés Fernández-Vega Cueto
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Ignacio Rodríguez-Uña
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-LLoves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
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Jerrome S, Joseph S, Niranjana B, Vidya S, Kumaragurupari T, Balagiri S, Senthilkumar VA, Krishnadas SR. Evaluation of the agreement and reliability of Transpalpebral Tonometers compared with Goldmann Applanation Tonometer - A systematic Review and Meta-Analysis Protocol. Indian J Ophthalmol 2023; 71:2225-2229. [PMID: 37202955 PMCID: PMC10391437 DOI: 10.4103/ijo.ijo_3321_22] [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: 12/22/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 05/20/2023] Open
Abstract
In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane's Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg's and Egger's tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693.
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Affiliation(s)
- Selvaraj Jerrome
- Research Division, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Sanil Joseph
- Research Division, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | | | - S Vidya
- Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Thandavarayan Kumaragurupari
- Library and Information Centre, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sundar Balagiri
- Research Division, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
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Gurnani B, Kaur K. Empowering outreach activities and ocular screening through trained manpower. Indian J Ophthalmol 2023; 71:2311. [PMID: 37202992 PMCID: PMC10391410 DOI: 10.4103/ijo.ijo_2890_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, External Diseases, Trauma. Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janki Kund, Chitrakoot, Madhya Pradesh, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janki Kund, Chitrakoot, Madhya Pradesh, India
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Agreement of iCare IC200 tonometry with Perkins applanation tonometry in healthy children. J AAPOS 2022; 26:235.e1-235.e5. [PMID: 36122876 DOI: 10.1016/j.jaapos.2022.07.007] [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: 02/24/2022] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess interdevice agreement between the iCare IC200 rebound tonometer and Perkins applanation tonometry (gold standard) in a healthy pediatric population. METHODS A total of 42 eyes of 42 healthy children were assessed using both tonometers. Data was collected on subject's age, sex, best-corrected visual acuity, and central corneal thickness (CCT). Intraclass correlation coefficient (ICC) and Bland-Altman analyses were used to determine agreement between IC200 and Perkins applanation tonometers. Linear regression analyzed the effects of intraocular pressure (IOP) on device difference. RESULTS The mean age and standard deviation of healthy pediatric subjects was 10.0 ± 3.3 years. The mean difference between IC200 and Perkins tonometers (IC200-Perkins) was 0.72 mm Hg, with a mean of 17.1 ± 3.0 mm Hg and 16.4 ± 2.5 mm Hg, respectively. The absolute agreement, or ICC, between tonometers was 0.63 (95% CI, 0.56-0.70). Bland-Altman analysis showed 95% limits of agreement ranging from -5.2 to +6.6 mm Hg. CCT was not correlated with IOP for either the IC200 (P = 0.35) or the Perkins tonometer (P = 0.052). CONCLUSIONS Compared to applanation tonometry, IC200 overestimated IOP in healthy children, with a greater frequency of readings > +2 mm Hg than < -2 mm Hg compared to Perkins. There was moderate agreement between tonometers. CCT was not found to influence IOP measurement for either tonometer.
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Agorastou V, Schön J, Verma-Fuehring R, Dakroub M, Hillenkamp J, Puppe F, Loewen NA. HIOP-Reader: Automated Data Extraction for the Analysis of Manually Recorded Nycthemeral IOPs and Glaucoma Progression. Transl Vis Sci Technol 2022; 11:22. [PMID: 35737376 PMCID: PMC9233288 DOI: 10.1167/tvst.11.6.22] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Nycthemeral (24-hour) intraocular pressure (IOP) monitoring in glaucoma has been used in Europe for more than 100 years to detect peaks missed during regular office hours. Data supporting this practice are lacking, because it is difficult to correlate manually drawn IOP curves to objective glaucoma progression. To address this, we developed an automated IOP data extraction tool, HIOP-Reader. Methods Machine learning image analysis software extracted IOP data from hand-drawn, nycthemeral IOP curves of 225 retrospectively identified patients with glaucoma. The relationship between demographic parameters, IOP, and mean ocular perfusion pressure (MOPP) data to spectral-domain optical coherence tomography (SDOCT) data was analyzed. Sensitivities and specificities for the historical cutoff values of 15 mm Hg and 22 mm Hg in detecting glaucoma progression were calculated. Results Machine data extraction was 119 times faster than manual data extraction. The IOP average was 15.2 ± 4.0 mm Hg, nycthemeral IOP variation was 6.9 ± 4.2 mm Hg, and MOPP was 59.1 ± 8.9 mm Hg. Peak IOP occurred at 10 am and trough at 9 pm. Progression occurred mainly in the temporal-superior and temporal-inferior SDOCT sectors. No correlation could be established between demographic, IOP, or MOPP variables and disease progression on OCT. The sensitivity and specificity of both cutoff points (15 and 22 mm Hg) were insufficient to be clinically useful. Outpatient IOPs were noninferior to nycthemeral IOPs. Conclusions IOP data obtained during a single visit make for a poor diagnostic tool, no matter whether obtained using nycthemeral measurements or during outpatient hours. Translational Relevance HIOP-Reader rapidly extracts manually recorded IOP data to allow critical analysis of existing databases.
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Affiliation(s)
- Vaia Agorastou
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Julian Schön
- Institute for Artificial Intelligence and Knowledge Systems, Department of Informatics, University of Würzburg, Würzburg, Germany
| | | | - Mohamad Dakroub
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Frank Puppe
- Institute for Artificial Intelligence and Knowledge Systems, Department of Informatics, University of Würzburg, Würzburg, Germany
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany.,Artemis Eye Centers, Frankfurt, Germany
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Dakroub M, Verma-Fuehring R, Agorastou V, Schön J, Hillenkamp J, Puppe F, Loewen NA. Inter-eye correlation analysis of 24-h IOPs and glaucoma progression. Graefes Arch Clin Exp Ophthalmol 2022; 260:3349-3356. [PMID: 35501491 PMCID: PMC9477895 DOI: 10.1007/s00417-022-05651-4] [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] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To determine whether 24-h IOP monitoring can be a predictor for glaucoma progression and to analyze the inter-eye relationship of IOP, perfusion, and progression parameters. Methods We extracted data from manually drawn IOP curves with HIOP-Reader, a software suite we developed. The relationship between measured IOPs and mean ocular perfusion pressures (MOPP) to retinal nerve fiber layer (RNFL) thickness was analyzed. We determined the ROC curves for peak IOP (Tmax), average IOP(Tavg), IOP variation (IOPvar), and historical IOP cut-off levels to detect glaucoma progression (rate of RNFL loss). Bivariate analysis was also conducted to check for various inter-eye relationships. Results Two hundred seventeen eyes were included. The average IOP was 14.8 ± 3.5 mmHg, with a 24-h variation of 5.2 ± 2.9 mmHg. A total of 52% of eyes with RNFL progression data showed disease progression. There was no significant difference in Tmax, Tavg, and IOPvar between progressors and non-progressors (all p > 0.05). Except for Tavg and the temporal RNFL, there was no correlation between disease progression in any quadrant and Tmax, Tavg, and IOPvar. Twenty-four-hour and outpatient IOP variables had poor sensitivities and specificities in detecting disease progression. The correlation of inter-eye parameters was moderate; correlation with disease progression was weak. Conclusion In line with our previous study, IOP data obtained during a single visit (outpatient or inpatient monitoring) make for a poor diagnostic tool, no matter the method deployed. Glaucoma progression and perfusion pressure in left and right eyes correlated weakly to moderately with each other.
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Affiliation(s)
- Mohamad Dakroub
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Raoul Verma-Fuehring
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Vaia Agorastou
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Julian Schön
- Institute for Artificial Intelligence and Knowledge Systems, Department of Informatics, University of Würzburg, Würzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Frank Puppe
- Institute for Artificial Intelligence and Knowledge Systems, Department of Informatics, University of Würzburg, Würzburg, Germany
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany. .,Artemis Eye Centers of Frankfurt, Hanauer Landstraße 147-149, 60314, Frankfurt, Germany.
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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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Merola RV, Cronemberger S, Veloso AW, Diniz-Filho A. Twenty-four hours intraocular pressure in keratoconic eyes assessed by applanation tonometry and Tono-Pen AVIA. Int J Ophthalmol 2022; 15:52-58. [PMID: 35047356 DOI: 10.18240/ijo.2022.01.08] [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: 03/27/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, r s=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, r s=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, r s=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.
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Affiliation(s)
- Rafael Vidal Merola
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Sebastião Cronemberger
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Artur William Veloso
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Alberto Diniz-Filho
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
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Wu Y, Szymanska M, Hu Y, Fazal MI, Jiang N, Yetisen AK, Cordeiro MF. Measures of disease activity in glaucoma. Biosens Bioelectron 2021; 196:113700. [PMID: 34653715 DOI: 10.1016/j.bios.2021.113700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness globally which significantly affects the quality of life and has a substantial economic impact. Effective detective methods are necessary to identify glaucoma as early as possible. Regular eye examinations are important for detecting the disease early and preventing deterioration of vision and quality of life. Current methods of measuring disease activity are powerful in describing the functional and structural changes in glaucomatous eyes. However, there is still a need for a novel tool to detect glaucoma earlier and more accurately. Tear fluid biomarker analysis and new imaging technology provide novel surrogate endpoints of glaucoma. Artificial intelligence is a post-diagnostic tool that can analyse ophthalmic test results. A detail review of currently used clinical tests in glaucoma include intraocular pressure test, visual field test and optical coherence tomography are presented. The advanced technologies for glaucoma measurement which can identify specific disease characteristics, as well as the mechanism, performance and future perspectives of these devices are highlighted. Applications of AI in diagnosis and prediction in glaucoma are mentioned. With the development in imaging tools, sensor technologies and artificial intelligence, diagnostic evaluation of glaucoma must assess more variables to facilitate earlier diagnosis and management in the future.
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Affiliation(s)
- Yue Wu
- Department of Surgery and Cancer, Imperial College London, South Kensington, London, United Kingdom; Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom.
| | - M Ihsan Fazal
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - M Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom; The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom; Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
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12
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Olawoye O, Azuara-Blanco A, Chan VF, Piyasena P, Crealey GE, O'Neill C, Congdon N. A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa. Ophthalmic Epidemiol 2021; 29:328-338. [PMID: 34372742 DOI: 10.1080/09286586.2021.1939887] [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] [Indexed: 10/20/2022]
Abstract
To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.
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Affiliation(s)
- Olusola Olawoye
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,School of Optometry, College of Health Sciences, University of Kwa-Zulu Natal (Ving Fai Chan)
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,College of Health Sciences, University of Kwa-Zulu Natal, South Africa
| | - Prabhath Piyasena
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Grainne E Crealey
- J.E. Cairns School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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13
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Zimmermann M, Giers BC, Beck A, Bell K, Zimmermann H, Hechtner M, Hoffmann EM, Pfeiffer N, Lorenz K. Short- and long-term agreement and reproducibility of 48-hours intraocular pressure measurements in glaucoma patients. BMC Ophthalmol 2021; 21:262. [PMID: 34154547 PMCID: PMC8218517 DOI: 10.1186/s12886-021-02003-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Glaucomatous eyes often show strong intraocular pressure (IOP) fluctuations and individual measurements at different time points are necessary for personalized therapy. To survey IOP variations 48-hours diurnal and nocturnal IOP measurements were performed on two consecutive days. Aims of this study were to investigate the short-term repeatability of 48-hours measurements within one patient’s IOP profile and long-term repeatability between two separate IOP profiles of the same patient. Methods A retrospective cohort study was performed evaluating data of 90 glaucoma patients in a German university medical center between 2006 and 2013. All patients underwent two separate diurnal IOP profiles of 48 h. IOP was measured at 8 am, 2 pm, 6 pm, 9 pm using Goldmann applanation tonometry and at 12 midnight using Perkins tonometry in supine position on two consecutive days. Intraclass correlation coefficients (ICC) were calculated to evaluate agreement for the same time points (each time point agreement) and for consecutive measurements within the IOP profiles (between time point agreement). ICC ≤ 0.4 was defined as poor agreement, 0.4–0.75 as moderate and ≥ 0.75 as excellent. Differences between time points were investigated by Bland Altman plots. Results Each time point measurements of profile 1 showed moderate to excellent agreement (ICCs 0.62–0.93). There was a moderate to excellent agreement for measurements between time points of profile 1 (ICCs day one 0.57–0.86, day two 0.71–0.90). Profile 2 was performed at a median interval of 12.0 months (quartiles 11.0 to 21.0). Each time point agreements within profile 2 showed ICCs from 0.23 to 0.81. It showed moderate to excellent agreement for changes between time points (ICCs 0.53–0.94). Day two demonstrated ICCs from 0.74 to 0.88. Long term IOP repeatability (over both pressure profiles) showed moderate to good agreement (ICCs 0.39–0.67). Conclusions Short and long-term agreement of IOP measurements evaluated by diurnal IOP profiles is moderate to good. Due to mostly moderate agreements, which we believe represent IOP fluctuations, we conclude that it is necessary to perform 48-hours IOP profiles to gain a better overview of the individual IOP fluctuations.
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Affiliation(s)
- Marion Zimmermann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Anna Beck
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Bell
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Herwig Zimmermann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marlene Hechtner
- University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katrin Lorenz
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
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14
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Chikasirimobi TG, Ndinyo M, Ondieki MN, Miti I, Ejiochi-Iyoke NJ, Osuagwu UL, Zeried FM, Agho K, Ogbuehi KC, Mashige KP. A comparison of postural and diurnal variations in intraocular pressure using the iCare rebound tonometer and Perkins applanation tonometer in admitted adults in Kenya. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Elevated intraocular pressure (IOP) remained the most important known risk factor for glaucoma.Aim: To compare the postural and diurnal IOP variations using the iCare rebound tonometer (RT) and Perkins applanation tonometer (PAT).Setting: Kakamega County Hospital, Kenya.Methods: Elevated intraocular pressure measurements were taken by two (masked) examiners with two devices in the morning (06:00–09:00), midday (12:00–15:00) and evening (18:00–21:00), in the sitting followed by supine positions in one randomly selected eye of 24 oculo-visual healthy hospital-admitted patients. Effects of the time of the day and position of the body within and between devices were analysed with the Statistical Package for Social Sciences.Results: The mean IOP measured by the RT ranged from 6 mmHg to 24 millimetres of mercury (mmHg) in the sitting position and from 10 mmHg to 26 mmHg in the supine position. The mean IOP measured using PAT ranged from 6 mmHg to 21 mmHg in the sitting position and from 8 mmHg to 24 mmHg in the supine position. The IOP measured by both devices significantly varied with position (p 0.05). Perkins applanation tonometer on average gave a significantly higher IOP (1.7 mmHg [p = 0.003] and 1.3 mmHg [p = 0.034]) at 06:00 compared to that at 12:00 and 18:00, respectively. The IOP readings with the RT were on average 2.2 mmHg and 3.0 mmHg higher at 06:00 compared to that at 12:00 and 18:00, respectively (p 0.0005).Conclusion: Significant reductions were observed in postural and diurnal IOPs in the sitting positions and in the afternoon, respectively. Diurnal IOP variations were slightly higher when measured by RT compared to when measured by PAT.
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15
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Jasien JV, Samuels BC, Johnston JM, Downs JC. Effect of Body Position on Intraocular Pressure (IOP), Intracranial Pressure (ICP), and Translaminar Pressure (TLP) Via Continuous Wireless Telemetry in Nonhuman Primates (NHPs). Invest Ophthalmol Vis Sci 2021; 61:18. [PMID: 33074300 PMCID: PMC7585393 DOI: 10.1167/iovs.61.12.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Recent retrospective clinical studies and animal experiments have suggested that cerebrospinal fluid pressure (CSFP) is important in glaucoma, acting through the translaminar pressure (TLP = IOP − CSFP), which directly affects the optic nerve head. In this study, IOP and intracranial pressure (ICP; a surrogate of CSFP) were measured at various body positions to quantify the determinants of TLP. Methods We have developed an implantable wireless pressure telemetry system based on a small piezoelectric sensor with low temporal drift. Telemetry transducers were placed in the anterior chamber to measure IOP and in the brain parenchyma at eye height to measure ICP. IOP was calibrated against anterior cannulation manometry, and ICP/CSFP was calibrated against an intraparenchymal Codman ICP Express microsensor. We measured IOP, ICP, and TLP = IOP − ICP continuously at 200 Hz in three male nonhuman primates (NHPs) in three trials; pressures were then averaged for 30 seconds per body position. Relative change of IOP, ICP, and TLP from the supine (baseline) position to the seated, standing, and inverted positions were quantified. Results TLP changed significantly and instantaneously from the supine to seated (+14 mm Hg), supine to standing (+13 mm Hg) and supine to inverted (−12 mm Hg) positions (P < 0.05). There was no significant TLP change for supine to prone. ICP showed greater relative change than IOP. Conclusions TLP change due to body position change is driven more by ICP/CSFP than IOP. IOP, ICP, and TLP variability, coupled with telemetry, should allow us to test the hypotheses that IOP, ICP, or TLP fluctuations contribute independently to glaucoma onset or progression.
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Affiliation(s)
- Jessica V Jasien
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brian C Samuels
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James M Johnston
- Department of Neurosurgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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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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Comparison of Tono-Pen Avia and Handheld Applanation Tonometry in Primary Congenital Glaucoma. J Glaucoma 2021; 30:e227-e230. [PMID: 33596019 DOI: 10.1097/ijg.0000000000001820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Tono-Pen AVIA (TPA) intraocular pressure (IOP) values are different from those taken with handheld Goldmann applanation tonometer (GAT) in primary congenital glaucoma (PCG). These differences indicate both tonometers cannot be used interchangeably for measuring IOP in PCG. PURPOSE The aim was to compare IOP measurements obtained using TPA and a handheld version of GAT in children with PCG. MATERIALS AND METHODS Forty-two eyes from 23 patients were evaluated for central corneal thickness (CCT), axial length, biomicroscopy and IOP measurement with TPA and a handheld GAT under inhalation anesthesia. After 1 eye from each patient was randomized, paired the Student t-test and the Pearson correlation were used for analysis. Generalized linear mixed model was used to estimate the difference between tonometers. RESULTS Mean age of children was 28.3±20.5 months. Mean axial length was 24.89±3.33 mm and mean CCT was 605.9±81.0 µm. Mean IOP was 22.1±9.6 for TPA and 14.0±4.5 mm Hg for GAT. There was a significant difference of 8.1±6.9 mm Hg between TPA IOP and GAT IOP (P<0.001). Each 6 months increase in age was associated with 1.32 mm Hg reduction in the difference between tonometers (P=0.002) and each 1 mm Hg higher of mean GAT IOP was associated with -0.73 mm Hg in the difference between TPA and GAT (P=0.002). Also, for every 20 µm increase in CCT an increase of 1.16 mm Hg in the difference between both devices was expected (P=0.003), after adjustment for potentially confounding variables. CONCLUSION There is a significant difference between TPA IOP and GAT IOP in PCG. The difference between TPA and GAT in PCG is influenced by CCT, age and GAT IOP value.
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18
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Review of the measurement and management of 24-hour intraocular pressure in patients with glaucoma. Surv Ophthalmol 2020; 65:171-186. [DOI: 10.1016/j.survophthal.2019.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
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Sánchez Pavón I, Cañadas P, Martin R. Repeatability and agreement of intraocular pressure measurement among three tonometers. Clin Exp Optom 2020; 103:808-812. [PMID: 31943335 DOI: 10.1111/cxo.13043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Elevated intraocular pressure (IOP) is one of the causes of irreversible optic nerve head damage and visual field loss. It is often measured with applanation tonometers but the use of rebound tonometry devices has been proposed as an alternative to assess IOP. Rebound tonometers have also been proposed as a method for patients to measure their own intraocular pressure (that is, self-tonometry). The purpose of this study was to determine the intrasession repeatability and the agreement of the IOP measurement with two rebound measuring principle tonometers, ICare ic100 and ICare Home with Perkins tonometer. METHODS This study involved 27 healthy volunteers (18 to 30 years old). We performed three consecutive IOP measurements with ICare Home, ICare ic100, and Perkins. The means of the three measurements from each device were calculated. Repeatability and agreement were defined according to the British Standards Institute and the International Organization for Standardization. The agreement was assessed using the method described by Bland and Altman, where 95 per cent of the differences or limits of agreement were between 1.96 standard deviations of the mean difference. RESULTS All tonometers showed close measurements (Perkins 15.34 ± 3.45 mmHg, range 10.00-24.00; ICare ic100 15.40 ± 4.06 mmHg, range 9.67-23.33; and ICare Home 14.22 ± 4.72 mmHg, range 7.33-24.00). The co-efficient of variation (CV) and within-subject standard deviation (Sw) was low for ICare ic100 and Perkins (close to 6.30 per cent and one) with higher values for ICare Home (CV = 9.55% and Sw = 1.33). The intraclass correlation co-efficient showed values higher than 0.96 for all tonometers. The difference between both rebound tonometers was statistically significant (p = 0.03). CONCLUSION The ICare ic100 tonometer provides repeatable IOP measurements close to the measurements of the Perkins IOP (good agreement); however, ICare Home provides less repeatable values, showing worse agreement with the Perkins tonometer in healthy subjects.
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Affiliation(s)
- Irene Sánchez Pavón
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain.,Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain
| | - Pilar Cañadas
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain.,Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Ocular Surface Group, IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain
| | - Raúl Martin
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain.,Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain.,School of Health Professions, Plymouth University, Plymouth, UK
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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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21
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Intraocular pressure measurement after corneal transplantation. Surv Ophthalmol 2019; 64:639-646. [DOI: 10.1016/j.survophthal.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/20/2022]
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Lanza M, Rinaldi M, Carnevale UAG, di Staso S, Sconocchia MB, Costagliola C. Analysis of differences in intraocular pressure evaluation performed with contact and non-contact devices. BMC Ophthalmol 2018; 18:233. [PMID: 30176825 PMCID: PMC6122572 DOI: 10.1186/s12886-018-0900-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate differences of intraocular pressure (IOP) measurements performed with Goldmann applanation tonometer (GAT), dynamic contour tonometer (DCT), rebound tonometry (RT), Ocular Response Analyzer (ORA) and Corvis ST (CST) in eyes screened for refractive surgery. Methods One eye, only the right one, of 146 patients was included in this study. Each participant was submitted to a corneal analysis with Scheimpflug camera and IOP evaluation with GAT, DCT, RT, ORA and CST. Differences in IOP values obtained thanks to each instruments were compared and then correlations between these discrepancies and morphological features such as mean keratometry (MK) and central corneal thickness (CCT) provided by Pentacam were studied. Software used to run statistical evaluations was SPSS, version 18.0. Results Study participants had a mean age of 33.1 ± 9.2 years old. IOP values observed in this study were 15.97 ± 2.47 mmHg (GAT), 17.55 ± 2.42 mmHg (DCT), 17.49 ± 2.08 mmHg (RT), 18.51 ± 2.59 mmHg (ORA) and 18.33 ± 2.31 mmHg (CST). The mean CCT was 560.23 ± 31.00 μm, and the mean MK was 43.33 ± 1.35 D. GAT provided significant lower values in comparison to all other devices. DCT and RT gave significantly lower intermediate IOP values than those measured with ORA and CST. All the IOP measures and the differences between devices were significantly correlated with CCT. Conclusions According to our data, although our findings should be confirmed in further studies, GAT tonometer cannot be used interchangeably with DCT, RT, ORA and CST.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università della Campania, Luigi Vanvitelli, Via de Crecchio 16, 80100, Naples, Italy.
| | - Michele Rinaldi
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università della Campania, Luigi Vanvitelli, Via de Crecchio 16, 80100, Naples, Italy
| | - Ugo Antonello Gironi Carnevale
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università della Campania, Luigi Vanvitelli, Via de Crecchio 16, 80100, Naples, Italy
| | - Silvio di Staso
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Bifani Sconocchia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università della Campania, Luigi Vanvitelli, Via de Crecchio 16, 80100, Naples, Italy
| | - Ciro Costagliola
- Department of Medicine and Healthy Sciences, Università del Molise, Campobasso, Italy
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Tonometers-which one should I use? Eye (Lond) 2018; 32:931-937. [PMID: 29456251 DOI: 10.1038/s41433-018-0040-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/08/2022] Open
Abstract
Although several factors are known to play a role in the development and progression of glaucoma, intraocular pressure (IOP) remains the only modifiable risk factor. Medical and surgical treatments for glaucoma both aim to reduce IOP to minimize disease progression. Tonometry is therefore an essential element of the ophthalmological exam. There are several types of tonometers available currently. These range from well-established instruments that have been in clinical use for decades to new devices, which are the result of recent technological advances. The various instruments have advantages and disadvantages that affect their suitability for a given setting, purpose, and patient population. In this review, we aim to describe the most commonly available tonometers today along with their advantages, disadvantages, and applicability.
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McCafferty S, Levine J, Schwiegerling J, Enikov ET. Goldmann and error correcting tonometry prisms compared to intracameral pressure. BMC Ophthalmol 2018; 18:2. [PMID: 29301514 PMCID: PMC5753488 DOI: 10.1186/s12886-017-0668-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 12/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background Compare Goldmann applanation tonometer (GAT) prism and correcting applanation tonometry surface (CATS) prism to intracameral intraocular pressure (IOP), in vivo and in vitro. Methods Pressure transducer intracameral IOP was measured on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically to 10, 20, and 40 mmHg. Simultaneously, IOP was measured using a Perkins tonometer with a standard GAT prism and a CATS prism at each of the intracameral pressures. Statistical comparison was made between true intracameral pressures and the two prism measurements. Differences between the two prism measurements were correlated to central corneal thickness (CCT) and corneal resistance factor (CRF). Human cadaver eyes were used to assess measurement repeatability. Results The CATS tonometer prism measured closer to true intracameral IOP than the GAT prism by 1.7+/−2.7 mmHg across all pressures and corneal properties. The difference in CATS and GAT measurements was greater in thin CCT corneas (2.7+/−1.9 mmHg) and low resistance (CRF) corneas (2.8+/−2.1 mmHg). The difference in prisms was negligible at high CCT and CRF values. No difference was seen in measurement repeatability between the two prisms. Conclusion A CATS prism in Goldmann tonometer armatures significantly improve the accuracy of IOP measurement compared to true intracameral pressure across a physiologic range of IOP values. The CATS prism is significantly more accurate compared to the GAT prism in thin and less rigid corneas. The in vivo intracameral study validates mathematical models and clinical findings in IOP measurement between the GAT and CATS prisms.
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Affiliation(s)
- Sean McCafferty
- Department of Ophthalmology, Intuor Technologies, University of Arizona- College of Medicine, University of Arizona- College of Optical Science, LLC 6422 E. Speedway Blvd. Suite 100, Tucson, AZ, 85710, USA. .,Department of Ophthalmology, University of Arizona- College of Medicine, 6422 E. Speedway Blvd. Suite 100, Tucson, AZ, 85710, USA. .,Department of Aerospace and Mechanical, University of Arizona-College of Engineering, 1130 N. Mountain Ave, Tucson, AZ, 85721, USA. .,, Tucson, USA.
| | - Jason Levine
- Department of Ophthalmology, University of Arizona- College of Medicine, 6422 E. Speedway Blvd. Suite 100, Tucson, AZ, 85710, USA.,, Tucson, USA
| | - Jim Schwiegerling
- Department of Ophthalmology, University of Arizona- College of Medicine, 6422 E. Speedway Blvd. Suite 100, Tucson, AZ, 85710, USA.,Department of Aerospace and Mechanical, University of Arizona-College of Engineering, 1130 N. Mountain Ave, Tucson, AZ, 85721, USA
| | - Eniko T Enikov
- Department of Ophthalmology, University of Arizona-College of Optical Science, University of Arizona-College of Medicine, 1630 E. University Blvd, Tucson, AZ, 85719, USA
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Turner DC, Samuels BC, Huisingh C, Girkin CA, Downs JC. The Magnitude and Time Course of IOP Change in Response to Body Position Change in Nonhuman Primates Measured Using Continuous IOP Telemetry. Invest Ophthalmol Vis Sci 2017; 58:6232-6240. [PMID: 29228251 PMCID: PMC5724553 DOI: 10.1167/iovs.17-22858] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the effect and time course of body position changes on IOP in nonhuman primates. Methods We recorded continuous bilateral IOP measurements with a wireless telemetry implant in three rhesus macaques in seven different body positions. IOP measurements were acquired in the seated-upright, standing, prone, supine, right and left lateral decubitus positions (LDPs), and head-down inverted positions. Continuous IOP was recorded for 90 seconds in each position before returning to a supine reference position until IOP stabilized; measurements were averaged after IOP stabilized at each position. Results Head-down inversion increased IOP an average of 8.9 mm Hg, compared to the supine reference. In the LDP, IOP decreased an average of 0.5 mm Hg in the nondependent eye (i.e., the higher eye), while the fellow dependent (i.e., lower) eye increased an average of 0.5 mm Hg, compared to supine reference. Standing and seated positions decreased IOP 1.5 and 2.2 mm Hg, respectively, compared with supine reference. IOP changes occurred within 4 to 15 seconds of a body position change, and timing was affected by the speed at which body position was changed. Compared to the IOP in the supine position, the IOP in the inverted, prone, and seated positions was significantly different (P = 0.0313 for all). The IOP in the standing position was not statistically different from the IOP in the supine position (P = 0.094). In addition, the IOP was significantly different between the nondependent eye and the dependent eye in the LDPs compared to the supine position (P = 0.0313). Conclusions Body position has a significant effect on IOP and those changes persist over time.
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Affiliation(s)
- Daniel C Turner
- Department of Vision Sciences, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brian C Samuels
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Carrie Huisingh
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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McCafferty S, Levine J, Schwiegerling J, Enikov ET. Goldmann applanation tonometry error relative to true intracameral intraocular pressure in vitro and in vivo. BMC Ophthalmol 2017; 17:215. [PMID: 29178849 PMCID: PMC5702103 DOI: 10.1186/s12886-017-0608-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Goldmann applanation tonometry (GAT) error relative to intracameral intraocular pressure (IOP) has not been examined comparatively in both human cadaver eyes and in live human eyes. Futhermore, correlations to biomechanical corneal properties and positional changes have not been examined directly to intracameral IOP and GAT IOP. METHODS Intracameral IOP was measured via pressure transducer on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically on each patient alternately to 10, 20, and 40 mmHg. IOP was measured using a Perkins tonometer in the supine position on 58 eyes and upright on a subset of 8 eyes. Twenty one (21) fresh human cadaver globes were Intracamerally IOP adjusted and measured via pressure transducer. Intracameral IOP ranged between 5 and 60 mmHg. IOP was measured in the upright position with a Goldmann Applanation Tonometer (GAT) and supine position with a Perkins tonometer. Central corneal thickness (CCT) was also measured. RESULTS The Goldmann-type tonometer error measured on live human eyes was 5.2 +/-1.6 mmHg lower than intracameral IOP in the upright position and 7.9 +/- 2.3 mmHg lower in the supine position (p < .05). CCT also indicated a sloped correlation to error (correlation coeff. = 0.18). Cadaver eye IOP measurements were 3.1+/-2.5 mmHg lower than intracameral IOP in the upright position and 5.4+/- 3.1 mmHg in the supine position (p < .05). CONCLUSION Goldmann IOP measures significantly lower than true intracameral IOP by approximately 3 mmHg in vitro and 5 mmHg in vivo. The Goldmann IOP error is increased an additional 2.8 mmHg lower in the supine position. CCT appears to significantly affect the error by up to 4 mmHg over the sample size.
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Affiliation(s)
- Sean McCafferty
- Intuor Technolgies, LLC, 6422 E. Speedway Blvd. Tucson, Suite 100, Tucson, AZ, 85710, USA. .,Department of Ophthalmology, University of Arizona College of Medicine, 655 n alvernon, Tucson, AZ, 85710, USA. .,University of Arizona College of Optical Science, 1630 E. University Blvd., Tucson, AZ, 85719, USA. .,Arizona Eye Consultants, 6422 E. Speedway Blvd. Tucson, Suite 100, Tucson, AZ, 85710, USA.
| | - Jason Levine
- Department of Ophthalmology, University of Arizona College of Medicine, 655 n alvernon, Tucson, AZ, 85710, USA.,Arizona Eye Consultants, 6422 E. Speedway Blvd. Tucson, Suite 100, Tucson, AZ, 85710, USA
| | - Jim Schwiegerling
- Department of Ophthalmology, University of Arizona College of Medicine, 655 n alvernon, Tucson, AZ, 85710, USA.,University of Arizona College of Optical Science, 1630 E. University Blvd., Tucson, AZ, 85719, USA
| | - Eniko T Enikov
- Department of Mechanical and Aerospace, University of Arizona College of Engineering, 1130 N. Mountain Ave., Tucson, AZ, 85721, USA
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Mizumoto K, Gosho M, Iwaki M, Zako M. Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy. Clin Ophthalmol 2017; 11:1643-1650. [PMID: 28979094 PMCID: PMC5602464 DOI: 10.2147/opth.s139874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly. Conclusion No significant disorders in ocular structural and functional parameters were found until long after RALP.
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Affiliation(s)
- Kyoichi Mizumoto
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masayoshi Iwaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masahiro Zako
- Department of Ophthalmology, Asai Hospital, Seto, Aichi, Japan
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Termühlen J, Gottschalk A, Eter N, Hoffmann EM, Van Aken H, Grenzebach U, Prokosch V. Does general anesthesia have a clinical impact on intraocular pressure in children? Paediatr Anaesth 2016; 26:936-41. [PMID: 27377361 DOI: 10.1111/pan.12955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reliable measurement of intraocular pressure (IOP) is crucial in pediatric patients with suspected glaucoma. General anesthesia (GA) is usually needed in infants to allow a thorough examination. However, anesthesia itself may influence IOP, depending on the type used and the depth of sedation. The purpose of this study was to evaluate the normal distribution of IOP during GA in healthy children and to analyze differences in IOP relative to the anesthetics used and the measurement time point. METHODS Approval for this observational study was received from the local institutional review boards and written informed consent was obtained from the children's parents. A total of 100 pediatric patients with no history of glaucoma scheduled for nonintraocular surgery underwent general anesthesia, induced with sevoflurane (s) or propofol (p) and maintained with either sevoflurane with remifentanil (S) or propofol with remifentanil (P). The patients were grouped to one of four subgroups (sS, sP, pP, pS) depending on the anesthetics used during induction and maintenance. Hemodynamic parameters and IOP were measured in both eyes at four defined time points: before anesthesia induction (M1); in apnea immediately after induction and before insertion of a laryngeal mask airway (M2); in deep anesthesia during mechanical ventilation (M3); and after extubation (M4), using a handheld Perkins applanation tonometer. Differences in IOP in both eyes during the measurement periods were analyzed using multivariate repeated-measures analysis of variance and Tukey-HSD as a posthoc test with statistical significance set at P < 0.05. Pearson correlation coefficient was used to investigate further relationships between heart rate, systolic blood pressure, and IOP. RESULTS General anesthesia reduced IOP significantly. The mean IOP was normally distributed, with a mean of 7.4 ± 2.89 mmHg at M1. It decreased significantly to a minimum of 5.6 ± 3.04 mmHg (P < 0.01) at M2 and increased significantly to 7.2 ± 2.51 mmHg (P < 0.01) at M3 and again to 8.4 ± 3.72 mmHg (P = 0.03) at M4. All four subgroups (sS, sP, pP, pS) showed comparable decreases in IOP between M1 and M2. During deep anesthesia (M3) and during reversal (M4), the IOP increased again in all groups. During reversal (M4), however, the sS group had a significantly lower IOP than the pP group (P = 0.001) and sP group (P = 0.02). There were no correlations between changes in IOP and gender, age, or type of surgery. CONCLUSIONS Sevoflurane and propofol, both in combination with remifentanil, significantly lower IOP in children. Individual IOP levels rise and fall during anesthesia, depending on the time point of measurement. The lowest IOP can be measured immediately after induction of anesthesia. This needs to be taken into account when measuring IOP in children.
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Affiliation(s)
- Julia Termühlen
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Antje Gottschalk
- Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, Muenster University Hospital, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, Mainz University Hospital, Mainz, Germany
| | - Hugo Van Aken
- Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, Muenster University Hospital, Muenster, Germany
| | - Ulrike Grenzebach
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Mainz University Hospital, Mainz, Germany
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Li Y, Carpenter CR, Nicholson K, Milne WK. Diagnostic accuracy of the iCare rebound tonometer compared to the Perkins applanation tonometer in assessing intraocular pressure in rural patients. Diagnosis (Berl) 2015. [DOI: 10.1515/dx-2015-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background: Vision health is recognized as a critical unmet need in North America. The ocular morbidity associated with glaucoma results from increased intraocular pressure (IOP) and early detection is crucial for the management of glaucoma. Our objective was to find a diagnostically accurate screening tool for intraocular hypertension that can be used in rural communities. We sought to validate the diagnostic accuracy of the iCare rebound tonometer against the gold standard Perkins applanation tonometer (PAT) in measuring IOP.
Methods: Patients from two rural communities in Ontario, Canada visiting their optometrists for routine appointments had their IOP measured by a non-contact tonometer (NCT), an iCare rebound tonometer, and a Perkins applanation tonometer (PAT). Values of sensitivity, specificity, and likelihood ratios for a positive and negative result were calculated for the iCare and the NCT.
Results: Complete data was collected from 209 patients. Overall, the iCare tonometer had high levels of validity, as compared to the gold standard PAT. The iCare tonometer displayed excellent sensitivity of 98.3% (90–99%, 95% CI) and excellent negative likelihood ratio of 0.024 (0.0088–0.066, 95% CI) which is useful for ruling out intraocular hypertension.
Conclusions: The iCare tonometer is a reasonably valid tool for detecting elevated IOP. Its ease of use, simplicity, and accessibility makes it a good screening tool to improve eye health in rural areas.
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Affiliation(s)
- Yifan Li
- Schulich School of Medicine and Dentistry, Western University – Windsor Program, Windsor, ON, Canada
| | - Christopher R. Carpenter
- Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Resende AF, Yung ES, Waisbourd M, Katz LJ. Monitoring intra ocular pressure in glaucoma: current recommendations and emerging cutting-edge technologies. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1100539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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