Evaluation of some factors affecting the agreement between the Proview Eye Pressure Monitor and the Goldmann applanation tonometer measurements

Abstract

Background: Our aim was to examine whether training level and ocular factors could account for part of the difference in intraocular pressure (IOP) measured using the Goldmann applanation tonometer (GAT) and Proview Eye Pressure Monitor (PPT). Methods: One hundred and nineteen individuals (238 eyes) were enrolled in the study. The mean age was 35.8 years (range 21 to 79). All study participants obtained IOP measurements using the PPT after hearing instructions on how to perform PPT. Glaucoma patients obtained additional IOP measurements using PPT after viewing an instructional video and after 30 days of home use. IOP was also measured using the GAT at each experimental session. Results: The difference in IOP measured by the GAT and the PPT was 0.55 ± 3.38 mmHg, 0.17 ± 3.79 mmHg and ‐1.30 ± 3.79 mmHg for myopic, emmetropic and hypermetropic groups, respectively, which were statistically significant (ANCOVA; p = 0.014). The difference in IOP between GAT and PPT was not significantly different for measurements obtained after verbal instructions, instructional video or after 30 days of home use (Repeated‐ANCOVA; p = 0.30). The overall agreement between the GAT and the PPT was poor. Intra‐class correlation coefficient was 0.575, and the 95% confidence interval (CI) of agreement was ‐6.93 to +6.73 mmHg. Conclusion: There was a small systematic difference in IOP measured by the GAT and PPT when comparing the different refraction groups; however, this level of difference between the groups is unlikely to be of clinical significance. The level of training in using the PPT did not influence its measurements. The limits of agreement between the PPT and the GAT were wide and long‐term use of PPT did not improve its agreement.

Surveillance for ocular hypertension: an evidence synthesis and economic evaluation.

“…In total, 10 studies 124,127,137,138,168,176,178,191,198,208 (50%) reported individual measures taken within 1 hour. In 12 studies (60%) the same clinical data were available for interpretation as would be available in clinical practice 124,127,133,137,138,158,162,168,172,177,205,207 and it was reported that the examiner(s) were masked to the results. 124,125,158,162,168,172,[176][177][178]205,207,208 In seven studies 125,127,172,177,178,205,208 (35%) the tonometers used were calibrated.…”

“…In the Tai and colleagues study 125 the mean IOP difference between the phosphene tonometer and GAT was 4.3 mmHg for patients with the lowest IOP (< 10 mmHg), 0.4 mmHg for patients with IOP within the normal range (10-20 mmHg), -2.7 mmHg for patients with higher IOP (20-30mmHg) and -6.1 mmHg for patients with severe OHT (IOP > 30 mmHg). Gunvant and colleagues 133 carried out a similar subgroup analysis of mean IOP difference by categorising patients as either healthy or glaucomatous, but this is not directly equivalent to an IOP subgroup analysis. Only two 133,138 studies reported CCT results, both of which presented results in relation to the IOP difference between GAT and transpalpebral tonometry.…”

“…Approaches varied between studies although the data were generally favourable. Two studies 133,136 reported on practicality from a clinical perspective, with one criticising the subjectivity of patient perception of the phosphene. One study 207 suggested that the tonometer was 'easy to use' .…”

“…Eight studies 125,133,[136][137][138]172,205,207 reported on acceptability and/or practicality. Approaches varied between studies although the data were generally favourable.…”

“…Twenty studies 124,125,127,133,[136][137][138]158,162,164,168,172,[176][177][178]191,198,205,207,208 enrolling 1509 participants (2091 eyes) compared transpalpebral tonometer with GAT. Figure 45 summarises the quality assessment for these studies.…”