Meta-analysis of the concordance of Icare^® PRO–based rebound and Goldmann applanation tonometry in glaucoma patients

Abstract

Background: The Icare® PRO rebound tonometer is being promoted as a patient-friendly device for glaucoma detection and monitoring, allowing rapid and accurate intraocular pressure measurement avoiding anaesthesia. The aim of this systematic review was to examine the concordance of Icare® PRO and Goldmann applanation tonometry in glaucoma patients. Methods: The German and English literature research was carried out using PubMed and Cochrane Library between January 2010 and March 2018. Method comparison trials in a paired sample study design were identified. Search criteria were ‘Icare PRO’, ‘Rebound’, ‘Goldmann’ and ‘Applanation’. Adult patients with glaucoma of any aetiology were included. The intraindividual intraocular pressure deviation between Icare® PRO and Goldmann applanation tonometry (mm Hg) served as primary endpoint, parameterized by the reported mean differences. For each study, an asymptotic 95% confidence interval was derived. The overall intraocular pressure meta-difference (Icare® PRO-Goldmann applanation tonometry) and 95% confidence interval were estimated using the random effect model. Result: Of 147 publications, 6 studies (672 eyes) were included after reviewing. Four studies showed an intraocular pressure underestimation by the Icare® PRO, two an overestimation. The meta-difference (Icare® PRO-Goldmann applanation tonometry = −0.14 mm Hg; 95% confidence interval: (−0.43 mm Hg; 0.15 mm Hg)) indicated a non-significant, clinically irrelevant mean deviation (p = 0.335). The devices showed good agreement, but there was a strong heterogeneity between the studies (I² = 77%): two studies presented a significant difference (Icare® PRO-Goldmann applanation tonometry), however, with deviations in opposite directions. Conclusion: Although the manufacturer advertises the Icare® PRO as a ‘tonometer with superior accuracy’, the present review could neither confirm nor deny considerable agreement between Goldmann applanation tonometry and Icare® PRO in glaucomatous patients.

A deep dive into the latest European Glaucoma Society and Asia-Pacific Glaucoma Society guidelines and their relevance to India

“…A meta-analysis of six studies showed no significant difference in the intraindividual IOP deviation between ICare® PRO and GAT. [ 16 ] Results from another meta-analysis of studies comparing tonometers (dynamic contour tonometer, noncontact tonometer (NCT), ocular response analyzer, Ocuton S, hand-held applanation tonometer (HAT), rebound tonometer, trans palpebral tonometer, and Tono-pen®) with the GAT was hampered by poor reporting from the studies. However, it concluded that NCT and HAT were comparable to GAT.…”

Comparison of the effectiveness and safety of travoprost and latanoprost for the management of open‑angle glaucoma given as an evening dose

“…According to the manufacturer, Icare ® PRO is a high-precision tonometer; however, the present study used the Goldman Applanation Tonometer for measuring IOP. There is a lack of agreement regarding the accuracy of the Icare ® PRO tonometer, while the reports for the Goldman Applanation Tonometer are consistent and provide an improved interpretation of the IOP-lowering effect of anti-glaucoma medication (25). Clinicians should be aware of the limitations of their labeled devices used in experimental studies.…”

Comparative Study of Intraocular Pressure Measurements with Airpuff, iCare and Goldmann Applanation Tonometers

“…16 Airpuff tonometer and a recently introduced iCare tonometer are some alternatives which can be used to measure IOP in challenging cases. 17 In a recent study by Demirci et al 16 , measurements by rebound tonometer, non-contact airpuff tonometer and Goldmann applanation tonometer were compared in three groups of healthy subjects based upon the age i.e. group 1 (7 -17 years), group 2 (18 -40 years) and group 3 (41 -75 years).…”