Objective:To assess the agreement of tonometers available for clinical practice with Goldmann Applanation Tonometer, the most commonly accepted reference device. Design:A systematic review and meta-analysis of directly comparative studies assessing the agreement of one or more tonometers with the reference tonometer (GAT). Participants:A total of 11,582 participants (15,525 eyes) were included in analyses from 102 studies.Methods: Summary 95% limits of agreement were produced for each comparison.Main Outcome measures: Agreement, recordability and reliability.Results: A total of 102 studies, including 130 paired comparisons involving 11,582 participants (15,525 eyes) were included representing eight tonometers (Dynamic Contour Tonometer, Non-contact Tonometer [NCT], Ocular Response Analyser, Ocuton S, Perkins, Rebound Tonometer, Transpalpebral and Tonopen). The agreement (95% limits) appeared to vary across tonometers; 0.2 mmHg (-3.8 to 4.3 mmHg) for NCT to 2.7 mmHg (-4.1 to 9.6 mmHg) for Ocuton S. The estimated proportion within 2mmHg of GAT ranged from 33% (Ocuton S) to 66% and 59% (NCT and Perkins respectively). Substantial inter-and intra-observer variability was observed for all tonometers.Conclusions: NCT or Perkins tonometers appear to achieve a measurement closest to GAT. However, there was substantial variability in measurements both within and between studies.

Dermoscopy and artificial intelligence performed equally well for diagnosis of melanocytic skin lesions. There was no significant difference in the diagnostic performance of various dermoscopy algorithms. The three-point checklist, the seven-point checklist and Menzies score had better diagnostic odds ratios than the others; however, these results need to be confirmed by a large-scale high-quality population-based study.

The OHTS-EGPS risk prediction equation has predictive utility, but further validation in a population-based setting is needed.