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.
References
1. Krieglstein G, Langham ME. Influence of body position on the intraocular pressure of normal and glaucomatous eyes. Ophthalmologica. 1975; 171:132–45.
2. Kiuchi T, Motoyama Y, Oshika T. Relationship of progression of visual field damage to postural changes in intraocular pressure in patients with normaltension glaucoma. Ophthalmology. 2006; 113:2150–5.
3. Gudmundson LE. The pneumatonograph and Perkins' tonometer. A clinical study of the reproducibility in glaucomatous eyes. Acta Ophthalmol (Copenh). 1984; 62:731–8.
4. Nakakura S, Mori E, Yamamoto M. . Intradevice and Interdevice Agreement Between a Rebound Tonometer, Icare PRO, and the Tonopen XL and Kowa Hand-held Applanation Tonometer When Used in the Sitting and Supine Position. J Glaucoma. 2013 Oct 17; [Epub ahead of print].
5. Fernandes P, Díaz-Rey JA, Queirós A. . Comparison of the ICare rebound tonometer with the Goldmann tonometer in a normal population. Ophthalmic Physiol Opt. 2005; 25:436–40.
6. Sahin A, Niyaz L, Yildirim N. Comparison of the rebound tonometer with the Goldmann applanation tonometer in glaucoma patients. Clin Experiment Ophthalmol. 2007; 35:335–9.
7. 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.
8. Yücel AA, Stürmer J, Gloor B. [Comparison of tonometry with the Keeler air puff noncontact tonometer "Pulsair" and the Goldmann applanation tonometer]. Klin Monbl Augenheilkd. 1990; 197:329–34.
9. Gräf M, Wassill H, Dick B. [A new site-independent tonometer (ProTon) in comparison with the Goldmann applanation ton-ometer]. Klin Monbl Augenheilkd. 1995; 206:255–61.
10. Schweier C, Hanson JV, Funk J, Töteberg-Harms M. Repeatability of intraocular pressure measurements with Icare PRO rebound, Tono-Pen AVIA, and Goldmann tonometers in sitting and reclining positions. BMC Ophthalmol. 2013; 13:44.
11. Jablonski KS, Rosentreter A, Gaki S. . Clinical use of a new po-sition-independent rebound tonometer. J Glaucoma. 2013; 22:763–7.
12. Kontiola AI, Goldblum D, Mittag T, Danias J. The induction/impact tonometer: a new instrument to measure intraocular pressure in the rat. Exp Eye Res. 2001; 73:781–5.
13. Davies LN, Bartlett H, Mallen EA, Wolffsohn JS. Clinical evaluation of rebound tonometer. Acta Ophthalmol Scand. 2006; 84:206–9.
14. Prashar A, Guggenheim JA, Erichsen JT. . Measurement of intraocular pressure (IOP) in chickens using a rebound tonometer: quantitative evaluation of variance due to position inaccuracies. Exp Eye Res. 2007; 85:563–71.
15. Schild AM, Rosentreter A, Hermann MM. . [Comparison of Rebound tonometry versus Perkins tonometry in the supine glaucoma patient]. Klin Monbl Augenheilkd. 2011; 228:125–9.
16. Takenaka J, Mochizuki H, Kunihara E. . Evaluation of rebound tonometer for measuring intraocular pressure at deviated angle and position. Curr Eye Res. 2011; 36:422–8.
17. Takenaka J, Mochizuki H, Kunihara E. . Intraocular pressure measurement using rebound tonometer for deviated angles and positions in human eyes. Curr Eye Res. 2012; 37:109–14.
18. Moreno-Montañés J, Gosende I, Caire J. . Comparation of the new rebound tonometer IOPen and the Goldmann tonometer, and their relationship to corneal properties. Eye (Lond). 2011; 25:50–6.
19. Muttuvelu DV, Baggesen K, Ehlers N. Precision and accuracy of the ICare tonometer - Peripheral and central IOP measurements by rebound tonometry. Acta Ophthalmol. 2012; 90:322–6.
Table 1.
Table 2.
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) |