Journal List > J Korean Ophthalmol Soc > v.56(1) > 1010308

Kim, Lee, and Yoo: Reliability Comparison of Rebound Tonometer at the Upright and Supine Position

Abstract

Purpose

Rebound tonometer has been used to measure the intraocular pressure (IOP) in the supine as well as normal upright positions. We investigated the reliability of IOP measurements using the rebound tonometer in the upright and supine positions.

Methods

IOP was measured in 30 patients (60 eyes) with open-angle glaucoma who had no history of ocular surgery and no anterior segment pathology, in both the upright and supine positions using rebound tonometer (IcarePRO; Icare Finland Oy, Finland). The average IOP value after 6 measurements was recorded. We measured IOP repeatedly until 3 reliable values within normal limits of the measurement’s variation were obtained. We calculated the intraclass correlation coefficient (ICC), coefficient of variation, and number of repeated measurements necessary to obtain 3 reliable IOP values in each position as measured by one examiner.

Results

ICC values for IOP measurements were 0.852 (95% confidence interval [CI], 0.784-0.903; p < 0.001) in the upright position and 0.684 (95% CI, 0.563-0.784; p < 0.027) in the supine position. Coefficient of variation was 8.7 ± 0.1% in the upright position and 24.0 ± 0.1% in the supine position. An average of 3.3 times of repeated measurements in the upright position and 6.2 times in the supine position were necessary to obtain 3 reliable IOP values within the normal range of standard deviation.

Conclusions

When measuring IOP using the IcarePRO rebound tonometer, the measurement reliability was different between the upright and supine positions. Reproducibility of IOP measurements was lower in the upright than the supine position.

References

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Table 1.
Demographic characteristics of study subjects
Parameters Values
Eyes (n) 60
Age (years) 56.9 ± 13.9
Sex (M:F) 17:13
Keratometric value (diopter) 43.7 ± 1.5
Central corneal thickness (µm) 540.0 ± 29.6
GAT (mm Hg) 12.8 ± 3.3
IRT in sitting (mm Hg) 14.1 ± 3.5
IRT in supine (mm Hg) 17.9 ± 3.7

Values are presented as mean ± SD unless otherwise indicated. GAT = goldmann applanation tonometer; IRT = IcarePro rebound tonometer.

Table 2.
Comparison of intraocular pressure measurement value’s reliability at each position which was measured by one examiner
  Sitting position (n = 60) Supine position (n = 60)
ICC (95% CI, p-value) 0.852 (0.784 to 0.903, p < 0.001) 0.684 (0.563 to 0.784, p < 0.001)
COV (%) 8.7 ± 0.1 24.0 ± 0.1
No. of repeated measurements for 3.3 ± 1.1 6.2 ± 2.2
3 reliable IOP (mean ± SD)    

ICC = intraclass correlation coefficients; CI = confidence interval; COV = coefficient of variation; IOP = intraocular pressure; SD = standard deviation; No = number.

Reliable IOP means IOP value which is within normal limit of variation.

Table 3.
Comparison of intraocular pressure measurement value’s reliability at each position which was measured by 2 examiners
  Sitting position (n = 30) Supine position (n = 30)
ICC (95%-CI, p-value) 0.913 (0.827 to 0.958, p < 0.001) 0.746 (0.530 to 0.871, p < 0.001)

ICC = intraclass correlation coefficients; CI = confidence interval.

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