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Abstract
Purpose
To evaluate changes in intraocular pressure (IOP) according to position using a portable rebound tonometer.
Methods
We measured the IOP values of 20 healthy volunteers (40 eyes) in the sitting, supine, right lateral decubitus and left decubitus positions with a portable rebound tonometer, and then analyzed using the Wilcoxon signed rank test. IOP in sitting position was also measured with a non-contact tonometer and a Goldmann applanation tonometer, and analyzed with Kruskal-Wallis test and Spearman correlation analysis. Agreement among the 3 tonometers was calculated using the Bland-Altman method.
Results
The IOP measured with rebound tonometer in the supine position was significantly higher than in the sitting position (p = 0.002). However, there was no significant difference in IOP between the supine and decubitus positions. In the decubitus position, there was no significant difference in IOP between the dependent and non-dependent eyes. IOP measurement using the rebound tonometer showed positive correlation with that of the noncontact and Goldmann applanation tonometers.
Conclusions
In normal subjects, IOP measurement obtained with a rebound tonometer in the supine position was significantly higher than in the sitting position, but there was no significant difference in IOP between the supine and decubitus positions. A rebound tonometer may be useful for patients whose intraocular pressure measurement with Goldmann applanation tonometer or non-contact tonometer is impossible. When using a portable rebound tonometer in bed-ridden or pediatric patients, we should pay attention to the interpretation of IOP in the supine position.
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Figure 1.
Comparison of intraocular pressures according to body position with rebound tonometer (*p < 0.05, Wilcoxon signed rank test).
Figure 2.
Comparison of intraocular pressure (IOP) measured with non-contact tonometer and Icare rebound tonometer (r = 0.636, p = 0.000). IOP = intraocular pressure; RB = Icare rebound tonometer; NCT = non-contact tonometer.
Figure 3.
Comparison of intraocular pressure measured with Goldmann applanation tonometer and Icare rebound tonometer (r = 0.662, p = 0.000). IOP = intraocular pressure; RB = Icare rebound tonometer; GAT = Goldmann applanation tonomter.
Figure 4.
Bland-Altman plot. The differences between IOP measured by RB and NCT are plotted against the mean of the two measurements. IOP = intraocular pressure; RB = rebound tonometer; NCT = non-contact tonometer; SD = standard deviation.
Figure 5.
Bland-Altman plot. The differences between IOP measured by RB and GAT are plotted against the mean of the two measurements. IOP = intraocular pressure; RB = rebound tonometer; GAT = Goldmann applanation tonomter; SD = standard deviation.
Table 1.
Demographic data, IOP measurements (mm Hg) with 3 tonometers
Table 2.
Intraocular pressure measurements with rebound tonometer during postural change
| Right eye (mm Hg) | Left eye (mm Hg) | p-value* | |
|---|---|---|---|
| Sitting | 15.85 ± 2.93 | 15.79 ± 2.89 | 0.718 |
| Supine | 16.91 ± 3.09 | 16.80 ± 3.14 | 0.862 |
| Right lateral decubitus | 16.75 ± 3.12 | 16.71 ± 2.61 | 0.968 |
| Left lateral decubitus | 16.62 ± 2.87 | 16.98 ± 2.79 | 0.698 |
Table 3.
Statistical comparison of intraocular pressure between different body position
| Position |
p-value* |
|||
|---|---|---|---|---|
|
Right lateral decubitus |
Left lateral decubitus |
|||
| Right eye (dependent eye) | Left eye | Right eye | Left eye (dependent eye) | |
| Supine | ||||
| Right eye | 0.616 | 0.398 | ||
| Left eye | 0.121 | 0.331 | ||
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