Comparison of Portable Tonometers and Goldmann Applanation Tonometer for Intraocular Pressure Measurement

Hyun Ho Jung; Jung Won Park; Sang Woo Park

doi:10.3341/jkos.2014.55.1.102

Journal List > J Korean Ophthalmol Soc > v.55(1) > 1009724

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jung, Park, and Park: Comparison of Portable Tonometers and Goldmann Applanation Tonometer for Intraocular Pressure Measurement

Original Article

J Korean Ophthalmol Soc 2014;55(1):102-109.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.102

Comparison of Portable Tonometers and Goldmann Applanation Tonometer for Intraocular Pressure Measurement

Hyun Ho Jung, MD, Jung Won Park, MD, Sang Woo Park, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwang, Korea

Address reprint requests to Sang Woo Park, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea, Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: exo70@naver.com

Received 2 August 201316 August 2013 Accepted 31 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the intraocular pressure (IOP) measured by portable rebound tonometer and TonoPen applanation tonometer with pressure measured by Goldmann applanation tonometer (GAT) and analyze the factors affecting IOP disagreement between tonometers.

Methods

In a prospective study of 463 eyes, IOP was measured with Icare Pro^® rebound tonometer, TonoPen AVIA^® applanation tonometer, and GAT. Bland-Altman plot, intraclass correlation coefficient, Pearson’s correlation analysis, and multiple regression analysis were performed to evaluate the agreement of IOP measured by each tonometer and the factors affecting the measurements.

Results

The IOP values measured by Icare Pro^® and TonoPen AVIA^® were consistently higher than those measured by GAT, but showed no significant differences with those measured by GAT (p = 0.307 and 0.114, respectively). In Bland-Altman plot, the IOP values measured by Icare Pro^® and TonoPen AVIA^® exhibited excellent agreement with those measured by GAT. Both Icare Pro^®/GAT and TonoPen AVIA^®/GAT differences increased with younger age (p = 0.041 and 0.049, respectively) and higher central corneal thickness (p = 0.019 and 0.035, respectively).

Conclusions

IOPs measured by portable Icare Pro^® rebound tonometer and TonoPen AVIA^® applanation tonometer were significantly correlated with IOP measured by GAT. Therefore, such instruments can be useful when measuring IOP with GAT is difficult. However, central corneal thickness and age should be considered when measuring IOP with portable tonometers.

Keywords: Goldmann applanation tonometer, Icare Pro^®, rebound tonometer, Intraocular pressure, TonoPen^®

References

1. Comparison of glaucomatous progression between untreated pa-tients with normal-tension glaucoma and patients with therapeuti-cally reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998; 126:487–97.

2. The Advanced Glaucoma Intervention Study (AGIS): 7. The rela-tionship between control of intraocular pressure and visual field deterioration. The AGIS Investigators. Am J Ophthalmol. 2000; 130:429–40.

3. Kass MA, Heuer DK, Higginbotham EJ. . The Ocular Hyper- tension Treatment Study: a randomized trial determines that top-ical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120:701–13. discussion 829-30.

4. Leske MC, Heijl A, Hyman L. . EMGT Group. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114:1965–72.

5. Kontiola A.A new electromechanical method for measuring intra-ocular pressure. Doc Ophthalmol. 1996-1997; 93:265–76.

6. Kanngiesser HE, Kniestedt C, Robert YC.Dynamic contour ton-ometry: presentation of a new tonometer. J Glaucoma. 2005; 14:344–50.

7. Luce DA.Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg. 2005; 31:156–62.

8. Iliev ME, Goldblum D, Katsoulis K. . Comparison of rebound tonometry with Goldmann applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol. 2006; 90:833–5.

9. Cook JA, Botello AP, Elders A. et al. Surveillance of Ocular Hypertension Study Group. Systematic review of the agreement of tonometers with Goldmann applanation tonometry. Ophthalmology. 2012; 119:1552–7.

10. Kotecha A, White ET, Shewry JM, Garway-Heath DF. The relative effects of corneal thickness and age on Goldmann applanation ton-ometry and dynamic contour tonometry. Br J Ophthalmol. 2005; 89:1572–5.

11. Broman AT, Congdon NG, Bandeen-Roche K, Quigley HA.Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure. J Glaucoma. 2007; 16:581–8.

12. Frenkel RE, Hong YJ, Shin DH.Comparison of the Tono-Pen to the Goldmann applanation tonometer. Arch Ophthalmol. 1988; 106:750–3.

13. Iester M, Mermoud A, Achache F, Roy S.New Tonopen XL: com-parison with the Goldmann tonometer. Eye (Lond). 2001; 15(Pt 1):52–8.

14. Brusini P, Salvetat ML, Zeppieri M. . Comparison of ICare ton-ometer with Goldmann applanation tonometer in glaucoma patients. J Glaucoma. 2006; 15:213–7.

15. Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, Garcia- Sanchez J.Reproducibility and clinical evaluation of rebound tonometry. Invest Ophthalmol Vis Sci. 2005; 46:4578–80.

16. Danias J, Kontiola AI, Filippopoulos T, Mittag T.Method for the noninvasive measurement of intraocular pressure in mice. Invest Ophthalmol Vis Sci. 2003; 44:1138–41.

17. Jablonski KS, Rosentreter A, Gaki S. . Clinical use of a new position-independent rebound tonometer. J Glaucoma. 2013; 22:763–7.

18. Ehlers N, Hansen FK, Aasved H.Biometric correlations of corneal thickness. Acta Ophthalmol (Copenh). 1975; 53:652–9.

19. Whitacre MM, Stein R.Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993; 38:1–30.

20. Chihara E.Assessment of true intraocular pressure: the gap be-tween theory and practical data. Surv Ophthalmol. 2008; 53:203–18.

21. Pakrou N, Gray T, Mills R. . Clinical comparison of the Icare tonometer and Goldmann applanation tonometry. J Glaucoma. 2008; 17:43–7.

22. Poostchi A, Mitchell R, Nicholas S. . The iCare rebound ton-ometer: comparisons with Goldmann tonometry, and influence of central corneal thickness. Clin Experiment Ophthalmol. 2009; 37:687–91.

23. Martinez-de-la-Casa JM, Garcia-Feijoo J, Vico E. . Effect of corneal thickness on dynamic contour, rebound, and goldmann tonometry. Ophthalmology. 2006; 113:2156–62.

24. Halkiadakis I, Stratos A, Stergiopoulos G. . Evaluation of the Icare-ONE rebound tonometer as a self-measuring intraocular pressure device in normal subjects. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1207–11.

25. Bhartiya S, Bali SJ, Sharma R. . Comparative evaluation of TonoPen AVIA, Goldmann applanation tonometry and non-contact tonometry. Int Ophthalmol. 2011; 31:297–302.

26. Rosentreter A, Jablonski KS, Mellein AC. . A new rebound tonometer for home monitoring of intraocular pressure. Graefes Arch Clin Exp Ophthalmol. 2011; 249:1713–9.

27. Sakamoto M, Kanamori A, Fujihara M. . Assessment of IcareONE rebound tonometer for self-measuring intraocular pressure. Acta Ophthalmol. 2013.

28. Kim KN, Jeoung JW, Park KH. . Comparison of the new re-bound tonometer with Goldmann applanation tonometer in a clin-ical setting. Acta Ophthalmol. 2013; 91:e392–6.

29. Hessemer V, Rössler R, Jacobi KW.Tono-pen, a new position-in-dependent tonometer. Comparison with the Goldmann tonometer by applanation measurement]. Klin Monbl Augenheilkd. 1988; 193:420–6.

30. Rao A, Kumar M, B P, Varshney G. Relationship of central corneal thickness and intraocular pressure by iCare rebound tonometer. J Glaucoma. 2012.

31. Dohadwala AA, Munger R, Damji KF.Positive correlation be-tween Tono-Pen intraocular pressure and central corneal thickness. Ophthalmology. 1998; 105:1849–54.

32. Mok KH, Wong CS, Lee VW.Tono-Pen tonometer and corneal thickness. Eye (Lond). 1999; 13(Pt 1):35–7.

33. Bhan A, Browning AC, Shah S. . Effect of corneal thickness on intraocular pressure measurements with the pneumotonometer, Goldmann applanation tonometer, and Tono-Pen. Invest Ophthalmol Vis Sci. 2002; 43:1389–92.

34. Kim NR, Kim CY, Kim H. . Comparison of goldmann applana-tion tonometer, noncontact tonometer, and TonoPen XL for intra-ocular pressure measurement in different types of glaucomatous, ocular hypertensive, and normal eyes. Curr Eye Res. 2011; 36:295–300.

35. Jorge JM, González-Méijome JM, Queirós A. . Correlations between corneal biomechanical properties measured with the ocu-lar response analyzer and ICare rebound tonometry. J Glaucoma. 2008; 17:442–8.

36. Chui WS, Lam A, Chen D, Chiu R.The influence of corneal prop-erties on rebound tonometry. Ophthalmology. 2008; 115:80–4.

37. Weinreb RN, Toris CB, Gabelt BT. . Effects of prostaglandins on the aqueous humor outflow pathways. Surv Ophthalmol. 2002; 47(Suppl 1):S53–64.

38. Harasymowycz PJ, Papamatheakis DG, Ennis M. et al. Travoprost Central Corneal Thickness Study Group. Relationship between travoprost and central corneal thickness in ocular hypertension and open-angle glaucoma. Cornea. 2007; 26:34–41.

Figure 1.

Analysis of variance between mean intraocular pressure values measured by different tonometers. GAT = goldmann applanation tonometer; ICare = Icare Pro® rebound tonometer; TonoPen = TonoPen AVIA® applanation tonometer.

Figure 2.

Bland-Altman plots between different tonometers. The solid line indicatesmean difference of both tonometers. The dotted lines are 95% of limits of agreement. (A) GAT and ICare. (B) GAT and TonoPen. GAT = goldmann applanation tonometer; ICare = Icare Pro® rebound tonometer; TonoPen = TonoPen AVIA® applanation tonometer; SD = standard deviation.

Figure 3.

Scatterplots and regression lines between different tonometers. (A) GAT and ICare. (B) GAT and TonoPen. (C) ICare and TonoPen. GAT = goldmann applanation tonometer; ICare = Icare Pro® rebound tonometer; TonoPen = TonoPen AVIA® applanation tonometer.

Table 1.

Subject characteristics

Age (Years)	54.1 ± 18.5
Range	20 to 81
Sex (Male : Female)	260 : 203
Diagnosis (number)	463
Normal tension glaucoma	98
Primary open angle glaucoma	86
Normal	279
Systemic disease (Number)
DM	125
HTN	118
Spherical equivalent (D)	-3.5 ± 3.1
IOP (mm Hg)
GAT	14.65 ± 3.36
Icare Pro® rebound tonometer	15.14 ± 3.38
Tonopen AVIA® applanation tonometer	15.71 ± 3.45
Central corneal thickness (μm)	543.1 ± 35.3
Range	450 to 629
Axial length (mm)	23.8 ± 2.2
Range	21.4 to 30.8

Values are presented as mean ± SD.

IOP = intraocular pressure; GAT = goldmann applanation tonometer.

Table 2.

Distribution of differences between IOP measurements by Goldmann applanation tonometer, Icare Pro® rebound tonometer and TonoPen AVIA® applanation tonometer

Differences	\|IOP_{GAT -}IOP_{ICare Pro}®\|	\|IOP_{GAT -}IOP_{TonoPen AVIA}®\|	\|IOP_{ICare Pro}®_-IOP_{TonoPen AVIA}®\|
≤1.0	61.12 (283)	54.86 (254)	48.60 (225)
1.0-2.0	24.19 (112)	25.05 (116)	22.68 (105)
2.0-3.0	7.78 (36)	9.72 (45)	12.53 (58)
3.0-4.0	2.81 (13)	4.75 (22)	6.70 (31)
4.0-5.0	2.59 (12)	2.59 (12)	3.46 (16)
≥5.0	1.51 (7)	3.02 (14)	6.05 (28)

Data are expressed as % (numbers).

IOP = intraocular pressure; IOP_GAT = IOP by goldmann applanation tonometer; IOP_IcarePro® = IOP by Icare Pro® rebound tonometer; IOP_{TonoPen AVIA}® = IOP by TonoPen AVIA® applanation tonometer.

Table 3.

Correlations between central corneal thickness and IOP measured by tonometers

	R	p-value
IOP_GAT	0.255	0.001
IOP_{Icare Pro}®	0.236	0.007
IOP_{TonoPen AVIA}®	0.201	0.028

Pearson’s correlation analysis for coefficient correlation analysis. IOP = intraocular pressure; IOP_GAT = IOP by goldmann applanation tonometer; IOP_IcarePro® = IOP by Icare Pro® rebound tonometer; IOP_{TonoPen AVIA}® = IOP by TonoPen AVIA® applanation tonometer.

Table 4.

Simple linear regression analysis of factors affecting IOP disagreement between tonometers

	R²	p-value
\|IOP_{Icare Pro}® - IOP_GAT\|
Age	0.510	0.037
Spherical equivalent	0.001	0.662
IOP_GAT value	0.016	0.597
Central corneal thickness	0.621	0.023
Axial length	0.011	0.309
\|IOP_{TonoPen AVIA}® - IOP_GAT\|
Age	0.380	0.045
Spherical equivalent	0.000	0.838
IOP_GAT value	0.000	0.962
Central corneal thickness	0.459	0.041
Axial length	0.007	0.317

R² = coefficient of determination; IOP = intraocular pressure; IOP_GAT = IOP by goldmann applanation tonometer; IOP_IcarePro® = IOP by Icare Pro® rebound tonometer; IOP_{TonoPen AVIA}® = IOP by TonoPen AVIA® applanation tonometer.

Table 5.

Multiple regression analysis of factors affecting IOP disagreement between tonometers

	Unstandardized Coefficient β	Partial correlation coefficient	p-value	95% CI
\|IOP_{Icare Pro}® - IOP_GAT\|
Age	-0.039	-0.263	0.041	-0.058 to -0.02
Central corneal thickness	0.020	0.305	0.019	0.008 to 0.032
\|IOP_{TonoPen AVIA}® - IOP_GAT\|
Age	-0.028	-0.155	0.049	-0.041 to -0.015
Central corneal thickness	0.015	0.271	0.035	0.004 to 0.26

IOP = intraocular pressure; IOP_GAT = IOP by goldmann applanation tonometer; IOP_IcarePro® = IOP by Icare Pro® rebound tonometer; IOP_{TonoPen AVIA}® = IOP by TonoPen AVIA® applanation tonometer.

Table 6.

Comparison of mean IOP disagreements between normal IOP range group and high or low IOP group by Goldmann applanation tonometer

	10 < IOP_GAT ≤ 21	IOP_GAT ≤ 10 or IOP_GAT> 21	p-value
Mean \|IOP_{Icare Pro}® - IOP_GAT\|	1.11 ± 1.21	2.10 ± 1.73	0.002
Mean \|IOP_{TonoPen AVIA}® - IOP_GAT\|	1.68 ± 1.64	2.24 ± 2.39	0.049
Mean \|IOP_{TonoPen AVIA}® - IOP_{Icare Pro}®\|	1.62 ± 1.39	2.44 ± 2.20	0.034

Values are presented as mean ± SD.

IOP = intraocular pressure; IOP_GAT = IOP by goldmann applanation tonometer; IOP_IcarePro® = IOP by Icare Pro® rebound tonometer; IOP_{TonoPen AVIA}® = IOP by TonoPen AVIA® applanation tonometer.

TOOLS

Similar articles