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.

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