Comparison of Dynamic Contour Tonometry and Goldmann Applanation Tonometry in Relation to Central Corneal Thickness

Min Kyo Kim; Si Yoon Park; Chan Yun Kim; Ji Hyun Kim

doi:10.3341/jkos.2015.56.9.1392

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Kim, Park, Kim, and Kim: Comparison of Dynamic Contour Tonometry and Goldmann Applanation Tonometry in Relation to Central Corneal Thickness

Original Article

J Korean Ophthalmol Soc 2015;56(9):1392-1399.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1392

Comparison of Dynamic Contour Tonometry and Goldmann Applanation Tonometry in Relation to Central Corneal Thickness

Min Kyo Kim, M.D^1,², Si Yoon Park, M.D², Chan Yun Kim, M.D, PhD², Ji Hyun Kim, M.D^1,

¹Siloam Eye Hospital, Seoul, Korea

²The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Ji Hyun Kim, MD Siloam Eye Hospital, #181 Deungchon-ro, Gangseo-gu, Seoul 07668, Korea Tel: 82-2-2650-0880, Fax: 82-2-2650-0895 E-mail: jhkim32@daum.net

Received 20 March 201511 May 2015 Accepted 10 July 2015

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

In this study we compared the intraocular pressures (IOPs) measured using dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) and investigated the correlation between central corneal thickness (CCT) and IOP.

Methods

In a prospective study, 178 eyes of 91 subjects with glaucoma and glaucoma suspect were enrolled. IOP was meas-ured using DCT and GAT and CCT was measured using ultrasound pachymetry. Each eye was classified into 1 of 3 groups ac-cording to their CCT: low CCT (Group A; CCT < 525 μ m), normal CCT (Group B; 525 ≤ CCT < 561 μ m), and high CCT (Group C; CCT ≥ 561 μ m). In each group, we investigated the correlation between CCT and IOP measurement using GAT and DCT.

Results

A significant correlation was found between CCT and IOP measured using GAT ( p < 0.001), but not between CCT and IOP measured using DCT ( p = 0.108) in all patients. Subgroup analysis showed that CCT affected IOP measured with GAT only in Group A ( p = 0.027) and IOP measured with DCT was not affected by CCT in all 3 groups.

Conclusions

IOP measured using GAT and DCT were significantly affected by CCT, especially when the CCT was low. CCT may have no effect on DCT thus, IOP measured using DCT is more reliable than GAT in patients with thin corneas.

Keywords: Central corneal thickness, Dynamic contour tonometry, Glaucoma, Goldmann applanation tonometry

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Figure 1.

Pearson correlation of intraocular pressure measure-ments obtained by Goldmann applanation tonometer (GAT) and Dynamic contour tonometer (DCT) (r = 0.791, p < 0.001).

Figure 2.

Bland-Altman plot of the difference between Goldmann applanation tonometer (GAT) and Dynamic con-tour tonometry (DCT) against the mean of GAT and DCT. IOP = intraocular pressure.

Figure 3.

Pearson correlation of the difference between Dynamic contour tonometry (DCT) and Goldmann applanation ton-ometer (GAT) with CCT (r = -0.272, p < 0.001). IOP = in-traocular pressure; CCT = central corneal thickness.

Table 1.

Patient demographics

	Overall (n = 178)	Group A (n = 59)	Group B (n = 59)	Group C (n = 60)	p-value
Sex					0.353^∗
Male	80 (44.94)	25 (42.37)	23 (38.98)	32 (53.33)
Female	98 (55.06)	34 (57.63)	36 (61.02)	28 (46.67)
Age (years)	59.80 ± 14.49	59.41 ± 13.57	60.85 ± 14.28	59.15 ± 15.71	0.791^†
Dx					0.031^∗
POAG	86 (48.31)	26 (44.07)	22 (37.29)	38 (63.33)
NTG	54 (30.34)	22 (37.29)	19 (32.20)	13 (21.67)
GS	38 (21.35)	11 (18.64)	18 (30.51)	9 (15.00)
CCT (μ m)	545.15 ± 36.36	504.54 ± 14.55	545.36 ± 9.61	584.88 ± 20.33	<0.001^†
GAT1 (mm Hg)^‡	14.4 ± 3.8	12.7 ± 2.9	14.9 ± 3.8	15.7 ± 4.0	<0.001^†
GAT2 (mm Hg)^‡	14.7 ± 3.8	12.9 ± 3.0	15.2 ± 3.7	16.0 ± 4.0	<0.001^†
DCT1 (mm Hg)^‡	17.7 ± 3.2	16.6 ± 2.9	18.1 ± 3.3	18.2 ± 3.2	0.012^†
DCT2 (mm Hg)^‡	17.5 ± 3.1	16.7 ± 3.0	17.9 ± 3.2	18.1 ± 3.1	0.032^†
OPA1 (mm Hg)^§	2.5 ± 0.9	2.2 ± 0.8	2.4 ± 0.8	2.9 ± 1.0	<0.001^†
OPA2 (mm Hg)^§	2.5 ± 1.0	2.1 ± 0.8	2.5 ± 1.1	2.8 ± 1.0	0.001^†
AXL (mm)	24.26 ± 1.84	24.52 ± 1.46	23.91 ± 1.41	24.31 ± 2.46	0.280^†
MD (dB)	-6.43 ± 7.02	-7.28 ± 7.23	-5.46 ± 6.35	-6.62 ± 7.47	0.371^†
No. of Mx (n)	1.0 ± 0.9	0.9 ± 0.6	0.9 ± 1.0	1.1 ± 1.1	0.383^†

Values are presented as mean ± SD unless otherwise indicated. Group A is CCT<525 μ m, Group B is 525 μ m ≤ CCT < 561 μ m and Group C is 561 μ m ≤ CCT. Dx = types of glaucoma; POAG = primary open-angle glaucoma; NTG = normotensive glaucoma; GS = glaucoma suspect; CCT = central corneal thickness; GAT = Goldmann applanation tonometer; DCT = Dynamic contour tonometry; OPA = ocular pulse amplitude; AXL = axial length; MD = mean deviation; No. of Mx = number of medications.

^∗ Chi-square test;

^† One-way analysis of variance;

^‡ First and second intraocular pressure measured by Goldmann applanation tonometry, dynam-ic contour tonometry;

^§ First and second ocular pulse amplitude measured by dynamic contour tonometry.

Table 2.

Reproducibility and repeatability of each intraocular measurement by Goldmann applanation tonometry and dynamic con-tour tonometry

	Mean ± SD (mm Hg)	ICC	CV (%)	CR (mm Hg)	RR (%)
GAT	14.6 ± 3.8	0.981 (95% CI; 0.975-0.986)	3.78	±1.4	0.10
DCT	17.6 ± 3.2	0.958 (95% CI; 0.943-0.968)	3.73	±1.8	0.10

Values are presented as mean ± SD unless otherwise indicated. ICC = intraclass correlation coefficient; CV = coefficient of variation; CR = coefficient of repeatability; RR = relative repeatability; GAT = Goldmann applanation tonometry; DCT = dynamic contour tonometry.

Table 3.

Correlation of types of glaucoma, CCT, axial length, MD, and number of medications with the difference between DCT and GAT

	Dx	CCT	AXL	MD	No. of Mx
△ IOP (DCT-GAT)
p-value	0.403^∗	<0.001^†	0.133^†	0.287^†	0.940^†
r	-	-0.272	-0.130	-0.082	0.006

DCT = Dynamic contour tonometry; GAT = Goldmann applanation tonometer; Dx = types of glaucoma; CCT = central corneal thickness; AXL = axial length; MD = mean deviation; No. of Mx = number of medications; △ IOP (DCT-GAT) = the difference between DCT and GAT.

^∗ One-way analysis of variance;

^† Pearson correlation.

Table 4.

Partial correlation of intraocular pressure measured by GAT and DCT with CCT

Overall	Group A^∗	Group B^†	Group C^‡
GAT-CCT
p-value	<0.001	0.027	0.348	0.703
r	0.289	0.290	-0.126	0.051
DCT-CCT
p-value	0.108	0.689	0.399	0.237
r	-0.121	-0.054	0.113	-0.156

GAT = Goldmann applanation tonometry; DCT = dynamic contour tonometry; CCT = central corneal thickness.

^∗ CCT < 525 μ m;

^† 525 μ m ≤ CCT ≤ 561 μ m;

^† CCT > 561 μ m.

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