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Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers.
Ophthalmology 2010; 117(4):730-7O

Abstract

OBJECTIVE

To examine the repeatability and reproducibility of intraocular pressure (IOP) measurements obtained with the Goldmann applanation tonometer (GAT), the Pascal dynamic contour tonometer (DCT; Swiss Microtechnology AG, Port, Switzerland), and the Reichert Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY). A secondary objective was to assess agreement between the devices.

DESIGN

Evaluation of technology.

PARTICIPANTS

One hundred participants; a mixture of glaucoma suspects, patients, and control volunteers.

METHODS

The IOP measurements were obtained with the GAT, DCT, and ORA by 2 of 3 experienced clinicians. Keratometry (CC) measurements were made using the IOLMaster (Carl Zeiss Meditech, AG, Jena, Germany). Three ORA corneal compensated IOP (IOPcc) measurements were obtained before the instillation of anesthesia, after which 2 GAT IOP and 3 DCT IOP measurements were obtained in a randomized order. Central corneal thickness (CCT) was measured using an ultrasound pachymeter. The average ORA corneal response factor (CRF) and the average DCT ocular pulse amplitude (OPA) were determined. Intraobserver variability was calculated by the repeatability coefficient. Interobserver variability (measurement reproducibility) and device agreement were calculated by Bland-Altman analysis (mean difference [bias] and 95% limits of agreement [LoA]). The effect of corneal characteristics (CC, CCT, and CRF) on the IOP measurement differences between tonometers also was determined.

MAIN OUTCOME MEASURES

Repeatability and reproducibility of the GAT, DCT, and ORA IOPcc and agreement between tonometers.

RESULTS

The repeatability coefficients for GAT, DCT, and ORA were 2.2, 2.3, and 4.3 mmHg, respectively. The intraobserver variability of ORA measurements was shown to be significantly associated with OPA and to a lesser degree with the quality of ORA waveform scans. The interobserver bias (95% LoA) was -0.8 (+/-3.9) mmHg for GAT -0.2 (+/-2.8) mmHg for DCT and -0.3 (+/-3.9) mmHg for ORA IOPcc. On average, GAT under-read both DCT and ORA IOP measurements by approximately 2 mmHg. The IOP measurement differences were better predicted by CRF than CCT.

CONCLUSIONS

The DCT shows excellent measurement precision, displaying the best repeatability and reproducibility of the 3 tonometers. Corneal stiffness, as defined using CRF, was associated significantly with agreement between devices. The IOP measurements with each device are not interchangeable.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Authors+Show Affiliations

Glaucoma Research Unit, The National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. aachalkotecha@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20122737

Citation

Kotecha, Aachal, et al. "Intraocular Pressure Measurement Precision With the Goldmann Applanation, Dynamic Contour, and Ocular Response Analyzer Tonometers." Ophthalmology, vol. 117, no. 4, 2010, pp. 730-7.
Kotecha A, White E, Schlottmann PG, et al. Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers. Ophthalmology. 2010;117(4):730-7.
Kotecha, A., White, E., Schlottmann, P. G., & Garway-Heath, D. F. (2010). Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers. Ophthalmology, 117(4), pp. 730-7. doi:10.1016/j.ophtha.2009.09.020.
Kotecha A, et al. Intraocular Pressure Measurement Precision With the Goldmann Applanation, Dynamic Contour, and Ocular Response Analyzer Tonometers. Ophthalmology. 2010;117(4):730-7. PubMed PMID: 20122737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers. AU - Kotecha,Aachal, AU - White,Edward, AU - Schlottmann,Patricio G, AU - Garway-Heath,David F, Y1 - 2010/02/01/ PY - 2009/06/12/received PY - 2009/08/04/revised PY - 2009/09/11/accepted PY - 2010/2/4/entrez PY - 2010/2/4/pubmed PY - 2010/4/9/medline SP - 730 EP - 7 JF - Ophthalmology JO - Ophthalmology VL - 117 IS - 4 N2 - OBJECTIVE: To examine the repeatability and reproducibility of intraocular pressure (IOP) measurements obtained with the Goldmann applanation tonometer (GAT), the Pascal dynamic contour tonometer (DCT; Swiss Microtechnology AG, Port, Switzerland), and the Reichert Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY). A secondary objective was to assess agreement between the devices. DESIGN: Evaluation of technology. PARTICIPANTS: One hundred participants; a mixture of glaucoma suspects, patients, and control volunteers. METHODS: The IOP measurements were obtained with the GAT, DCT, and ORA by 2 of 3 experienced clinicians. Keratometry (CC) measurements were made using the IOLMaster (Carl Zeiss Meditech, AG, Jena, Germany). Three ORA corneal compensated IOP (IOPcc) measurements were obtained before the instillation of anesthesia, after which 2 GAT IOP and 3 DCT IOP measurements were obtained in a randomized order. Central corneal thickness (CCT) was measured using an ultrasound pachymeter. The average ORA corneal response factor (CRF) and the average DCT ocular pulse amplitude (OPA) were determined. Intraobserver variability was calculated by the repeatability coefficient. Interobserver variability (measurement reproducibility) and device agreement were calculated by Bland-Altman analysis (mean difference [bias] and 95% limits of agreement [LoA]). The effect of corneal characteristics (CC, CCT, and CRF) on the IOP measurement differences between tonometers also was determined. MAIN OUTCOME MEASURES: Repeatability and reproducibility of the GAT, DCT, and ORA IOPcc and agreement between tonometers. RESULTS: The repeatability coefficients for GAT, DCT, and ORA were 2.2, 2.3, and 4.3 mmHg, respectively. The intraobserver variability of ORA measurements was shown to be significantly associated with OPA and to a lesser degree with the quality of ORA waveform scans. The interobserver bias (95% LoA) was -0.8 (+/-3.9) mmHg for GAT -0.2 (+/-2.8) mmHg for DCT and -0.3 (+/-3.9) mmHg for ORA IOPcc. On average, GAT under-read both DCT and ORA IOP measurements by approximately 2 mmHg. The IOP measurement differences were better predicted by CRF than CCT. CONCLUSIONS: The DCT shows excellent measurement precision, displaying the best repeatability and reproducibility of the 3 tonometers. Corneal stiffness, as defined using CRF, was associated significantly with agreement between devices. The IOP measurements with each device are not interchangeable. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/20122737/Intraocular_pressure_measurement_precision_with_the_Goldmann_applanation_dynamic_contour_and_ocular_response_analyzer_tonometers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(09)01067-7 DB - PRIME DP - Unbound Medicine ER -