Can Corneal Biomechanical Properties Explain Difference in Tonometric Measurement in Normal Eyes?

Dey, Ashim; David, Rathini Lilian; Asokan, Rashima; George, Ronnie

doi:10.1097/opx.0000000000001175

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…Over time, investigators have reported comparison studies in which TP reveal IOP greater than, equal to, and less than IOPs measured by the current gold standard GAT. [3–28]…”

Section: Introductionmentioning

confidence: 99%

“…This variability and inconsistencies in reported studies have resulted in a confused professional literature. The variability has been explained by differences in research study designs, [3] research methods applied, [4] statistical approaches used to analyze IOP measurements, [5,6] eye biomechanics, [7,8] diurnal variations of IOP, [9] body positions in which measurements were taken (sitting or supine), [10,11] age of subjects, [12–14] ethnicity of subjects, [15] central corneal thickness (CCT), [7,16–21,29] cornea shape, [22] level of training and skill of eye care professional making the measurements (ophthalmologist, technician), [23,24] subjectivity of GAT measurements, [25,26] and fundamental principles of physics underlying the differences in how IOP are measured by the TP or GAT procedure. [7,22,27,28,30]…”

Section: Introductionmentioning

confidence: 99%

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International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis

Keller

2023

Medicine

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Background: Investigate intraocular pressure (IOP), as measured by Tono-Pen (TP) and Goldmann applanation tonometry (GAT), in healthy adults. Provide an updated synthesis of multinational, primary studies, reported during the 10-year period 2011 to 2021 and offer an evidence-based benchmark, against which IOP can be evaluated across subject variables and pathologies. Three primary research questions are investigated: Is there a statistically significant difference between IOP measured by TP and GAT? If yes, is the difference clinically significant? Is measurement of IOP affected by the country or setting location, in which the measurements are made? Methods: An aggregate meta-analysis was conducted on 22 primary studies, from 15 different countries. IOP measurements were made from each healthy adult subject, with both the TP and GAT. Primary studies were identified and data extracted according to recommended preferred reporting items for systematic reviews and meta-analysis protocol guidelines. Meta-analysis summary results are reported as the point estimate of the raw mean difference of IOP. Results: Meta-analysis reveals a statistically significant difference in raw mean differences in IOP, when measured by TP and GAT, in the healthy adult population. Tono-Pen IOP measurements are higher than GAT IOP measurements. The point estimate for the summary effect size = −0.73 mm Hg, P = .03. The prediction interval for the true effect size, in 95% of all comparable populations, is −4.03 to 2.58 mm Hg. There is no clinically significance difference in IOP when measured by TP and GAT. Meta-regression analysis reveals statistically significant differences in measurement of IOP by countries, R2 analog = 0.75, P = .001. There is no statistically significant difference in measurement of IOP as a function of measurement location setting, R2 analog = −0.17, P = .65. Conclusions: IOP measured by TP are marginally higher compared to GAT, in the healthy adult population. However, from a clinical practice perspective, TP and GAT produce similar IOP measurements. There is evidence of significant variabilities in IOP measurements as a function of country. IOP measurements collected in a research laboratory setting are similar to IOP collected in a clinical setting. Results have implications for the primary care physician requiring a portable, inexpensive, reliable, and easily administered instrument to assess IOP.

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“…Over time, investigators have reported comparison studies in which TP reveal IOP greater than, equal to, and less than IOPs measured by the current gold standard GAT. [3–28]…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis

Keller

2023

Medicine

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“…Compared to GAT, the current gold standard, TP demonstrated varying results in different populations, with MD varying from -0.27 to 1.63 mmHg and the range of 95% LOA from 4.88 to 16.34 mmHg in normal subjects. 3,5,26,29,33,35 For glaucoma patients, especially uncontrolled individuals with elevated IOP, MD could be as high as 6.8 (range of 95% LOA = 25.9 mmHg). 25 A systematic review denoted that only 48% of the results from TP were within 2 mmHg from GAT value.…”

Section: Chapter 5 Discussionmentioning

confidence: 99%

Repeatability, reproducibility, agreement, and safety of tono-pen tip cover for intraocular measurement using latex and polyethylene wrap

Suvannachart¹

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Background: Tono-Pen® is a regularly used device. A tip cover is needed to prevent damage to the transducer tip and patient-to-patient contamination. Ocufilm® (OF), latex disposable tip cover, is costly and able to cause allergic reactions. Objective: To evaluate repeatability, reproducibility, and agreement of intraocular pressure measurement with Tono-Pen® using OF and polyethylene wrap tip cover (PE) in human eyes. Materials and Methods: This is a cross-sectional, experimental study. For the right eyes, 4 measurements using PE were done by two raters (A and B) in random order to assess intra-rater repeatability and inter-rater reproducibility. For left eyes, 4 measurements were done by rater A using both PE and OF in random order to assess intra-rater repeatability and agreement. Results: A total of 128 participants were recruited. The mean difference in mmHg (95% limits of agreement, intraclass correlation coefficient) was -0.34 (-3.04 to 2.36, 0.93) for repeatability of PE by rater A in the right eyes, -0.33 (-3.01 to 2.36, 0.93) for repeatability of PE by rater A in the left eyes, -0.02 (-2.88 to 2.83, 0.92) for repeatability of PE by rater B, 0.36 (-3.34 to 4.07, 0.90) for inter-rater reproducibility of PE, -0.42 (-2.75 to 1.91, 0.95) for repeatability of OF by rater A, and -0.71 (-5.18 to 3.76, 0.83) for agreement between both tip covers. The only complication was punctate epithelial erosion. No sight-threatening complications and allergic reactions were found. Cost minimization analysis found that PE had approximately 8-time decreased cost compare to OF. Conclusions: For intraocular pressure measurement with Tono-Pen, PE demonstrated acceptable repeatability, reproducibility, and agreement with OF with a good safety profile.

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Ocular Rigidity and Tonometry

Mohamed-Noriega

Barton

2021

Ocular Rigidity, Biomechanics and Hydrodynamics of the Eye

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Can Corneal Biomechanical Properties Explain Difference in Tonometric Measurement in Normal Eyes?

Abstract: There was good agreement between GAT and other tonometers, but was not good enough for them to be used interchangeably. A combination of CH and CRF may better explain the variability between GAT and tonometers.

Cited by 7 publications

References 40 publications

International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis

International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis

Repeatability, reproducibility, agreement, and safety of tono-pen tip cover for intraocular measurement using latex and polyethylene wrap

Ocular Rigidity and Tonometry

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