Journal List > J Korean Ophthalmol Soc > v.55(1) > 1009926

Lee, Kim, Kim, and Kim: Comparison of Intraocular Pressure Measured by Non-Contact Tonometer, Rebound Tonometer, Tono-Pen, and Goldmann Applanation Tonometer

Abstract

Purpose

To compare the level of accuracy of intraocular pressure (IOP) measurements attained by non-contact tonometer (NCT), rebound tonometer (RT) Icare®, and Tono-Pen (TONO-PEN AVIA®), using Goldmann Applanation tonometer (GAT) as a reference value and to explore their clinical usefulness.

Methods

In a prospective study of 71 normal eyes, IOP was measured with NCT, RT, Tono-Pen and GAT. The IOP values of were then compared between the eyes.

Results

RT showed statistically most significant agreement with the GAT [ICC 0.811, 95%CI 0.712-0.878]. In analysis of Bland-Altman plots, NCT showed the smallest mean bias (+0.2 mm Hg) and widest CI (95%CI; ±5.05 mm Hg), RT showed relatively small mean bias (-0.7 mm Hg) and narrowest CI (95%CI; ±3.75 mm Hg).

Conclusions

There was a significant agreement between the RT and the GAT measurements. We expect RT to be considered as a reliable alternative when IOP measurement with GAT is not feasible.

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Figure 1.
Bland-Altman plots of difference versus the mean plot illustrating the intersessional repeatability of IOP measurements with the Icare tonometer. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation.
jkos-55-47f1.tif
Figure 2.
Bland-Altman plots of agreement between Goldmann applanation tonometer and noncontact tonometer for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer val-vue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation.
jkos-55-47f2.tif
Figure 3.
Bland-Altman plots of agreement between Goldmann applanation tonometer and Icare for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer valvue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation.
jkos-55-47f3.tif
Figure 4.
Bland-Altman plots of agreement between Goldmann applanation tonometer and Tono-Pen for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer valvue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation.
jkos-55-47f4.tif
Figure 5.
Incidence of absolute value for IOP differences between noncontact tonometer, Tono-Pen, or Icare and Goldmann applanation tonometer (considered as a reference) measurements.
jkos-55-47f5.tif
Table 1.
Demographic characteristics of study subjects (n = 71)
Sex  
  Male 32 (45.1%)
  Female 39 (54.9%)
Age 59.41 ± 15.85
NCT 13.44 ± 3.09
Icare 14.23 ± 2.86
Tono-Pen 15.65 ± 3.42
GAT 13.56 ± 3.33

Values are presented as mean ± SD.

GAT = goldmann applanation tonometer; NCT = noncontact tonometer.

Table 2.
Intraclass Correlation Coefficient (ICC) of IOP measurements using different tonometers comparing with GAT as standard
  ICC 95%CI
NCT 0.679 0.530-0.788
Icare 0.811 0.712-0.878
Tono-Pen 0.749 0.625-0.837

NCT = noncontact tonometer.

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