Comparison of dynamic contour tonometry with goldmann applanation tonometry

PURPOSE: The dynamic contour tonometer (DCT; Pascal tonometer) is a novel tonometer designed to measure intraocular pressure (IOP) independent of corneal properties. The purpose of this study was a comparison of the DCT with the Goldmann applanation tonometer (GAT) with respect to mean of IOP readings, the influence of ocular structural factors on IOP readings, and both intra- and interobserver variability, in a large group of healthy subjects. METHODS: In a prospective study of 228 eyes, IOP measurements by GAT and DCT were compared, and the effects of central corneal thickness (CCT), corneal curvature, axial length, and anterior chamber depth were analyzed. To evaluate intra- and interobserver variability, IOP was measured in eight eyes by four observers. RESULTS: There was a high concordance between the IOP readings obtained by DCT and GAT. However, IOP readings were consistently higher with DCT than with GAT (median difference: +1.7 mm Hg, interquartile range [25th-75th percentile] = 0.8-2.7 mm Hg). In contrast to GAT, multivariable regression analysis showed no significant effect of corneal thickness, corneal curvature, astigmatism, anterior chamber depth, and axial length on DCT readings. For repeated measurements the intraobserver variability was 0.65 mm Hg for the DCT and 1.1 mm Hg for the GAT (P = 0.008). Interobserver variability was 0.44 mm Hg for the DCT and 1.28 mm Hg for the GAT (P = 0.017). CONCLUSIONS: IOP measurements by DCT are highly concordant with IOP readings obtained from GAT but do not vary in CCT and have a lower intra- and interobserver variability. DCT seems to be an appropriate method of tonometry for routine clinical use.     

Comparison of dynamic contour tonometry and goldmann applanation tonometry in glaucoma patients and healthy subjects

PURPOSE: To investigate the agreement in the measurement of intraocular pressure (IOP) obtained by dynamic contour tonometry PASCAL (DCT-PASCAL) and Goldmann applanation tonometry (GAT) in glaucoma eyes and healthy eyes with different central corneal thickness (CCT). DESIGN: Prospective cross-sectional study. METHODS: In a randomized order, three consecutive IOP measurements were performed on 197 eyes of 107 subjects by one examiner using both DCT-PASCAL and GAT on all eyes. Furthermore, ultrasonic pachymetry was performed. The Spearman correlation coefficient (r) was determined to compare IOP readings between DCT-PASCAL and GAT. Regression-based Bland and Altman analysis was used to evaluate agreement between the instruments. RESULTS: Mean IOP values obtained by both instruments were significantly correlated in healthy and glaucoma eyes (all healthy eyes [n = 66]: r = 0.8, P < .001, all glaucoma eyes [n = 131]: r = 0.96, P < .001). Neither GAT nor DCT-PASCAL showed a significant correlation with CCT (GAT: all eyes: r = 0.009, P = .9, DCT-PASCAL: all eyes: r = -0.05, P = .5). Bland and Altman analysis revealed the existence of proportional bias. Thus, 95% limits of agreement between the instruments varied with the actual IOP measurement. CONCLUSIONS: DCT-PASCAL and GAT revealed a strong correlation in IOP measurements between glaucoma and healthy eyes. However, the analysis of agreement indicated some discrepancies between the instruments. Measurements with both GAT and DCT-PASCAL were not correlated with central corneal thickness.     

Comparison of dynamic contour tonometry and goldmann applanation tonometry in deep lamellar and penetrating keratoplasties

PURPOSE: To compare the measurements of intraocular pressure (IOP) with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in eyes with corneal graft and to evaluate the influence of corneal thickness (CCT), corneal curvature (CC), and astigmatism on these methods. DESIGN: Prospective, observational cross-sectional study. METHODS: Eighteen eyes of 18 patients after penetrating keratoplasty (PKP) and 14 eyes of 14 patients after deep lamellar keratoplasty (DLKP) underwent IOP evaluation with DCT and GAT, and measurements of CCT, CC, and astigmatism. Bland-Altman plots were used to evaluate the agreement between tonometers. Multivariate regression analysis was used to evaluate the influence of ocular structural factors and running suture on IOP measurements obtained with both tonometers. RESULTS: IOP values obtained by DCT and GAT were strongly correlated in all eyes (r = .91; P < .001). DCT values measured 2.5 +/- 1.7 mm Hg higher than GAT readings (P < .001). A reduction of the mean IOP difference between DCT and GAT with an increase in IOP values (P < .001) was found. Regression analysis showed no effect of CCT, CC, astigmatism, and running suture on both DCT and GAT readings, either in DLKP or in PKP eyes. CONCLUSIONS: We found a good overall correlation between both tonometers but the agreement between instruments differs in high or low IOP ranges. The wide and varying 95% limits of agreement between DCT and GAT indicates that DCT provides IOP measurements on deep lamellar and penetrating keratoplasties which can be used in the clinical practice.     

Clinical comparison of pascal dynamic contour tonometry and goldmann applanation tonometry in asymmetric open-angle glaucoma

PURPOSE: To investigate and compare the relationships between glaucomatous visual field loss and intraocular pressure (IOP) as measured by both Pascal dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT). PATIENTS AND METHODS: All primary open-angle glaucoma and normal tension glaucoma patients seen between July 2005 and June 2006 with at least 2 sets of good-quality, bilateral DCT and GAT measurements were retrospectively identified. Additional inclusion criteria required that all subjects had repeatable, asymmetric glaucomatous visual field loss that corresponded with asymmetric glaucomatous optic neuropathy. After mean IOP values were computed and visual fields were scored using Advanced Glaucoma Intervention Study (AGIS) criteria, paired-eye comparisons were conducted using right versus left eyes and higher versus lower AGIS-score eyes. RESULTS: Sixty-seven (42 primary open-angle glaucoma, 25 normal tension glaucoma) subjects met all criteria for study inclusion. Per paired t test, mean DCT-IOP was significantly higher in the higher AGIS-score eyes compared with the lower AGIS-score eyes (16.3 vs. 15.5 mm Hg, P=0.004), whereas GAT-IOP was not significantly different in these same eyes (14.5 vs. 14.4 mm Hg, P=0.56). Mean IOP difference between the 2 methods was significantly larger in higher versus lower AGIS-score eyes (P<0.001), and 72% of the subjects demonstrated larger intermethod IOP differences in their higher AGIS-score eye compared with their lower AGIS-score eye (P<0.001; 95% confidence interval: 0.59-0.82). Multivariate linear regression analysis revealed that AGIS-score differences between eyes were independently associated with both intermethod IOP differences between eyes (P=0.004) and central corneal thickness (CCT) differences between eyes (P=0.04). CCT, however, was not associated with intermethod IOP differences within or between eyes. CONCLUSIONS: These findings suggest that DCT-IOP is correlated with glaucomatous damage, and moreover, DCT-IOP is more closely related to extent of glaucoma damage than is GAT-IOP. The most likely explanation for these results is that GAT-IOP systematically underestimates IOP compared with DCT-IOP. Our findings also support the hypothesis that corneal biomechanical factors other than CCT are major confounders of applanation tonometry measurements.     

Comparison of intraocular pressure measured by Pascal dynamic contour tonometry and Goldmann applanation tonometry

AIMS: To compare the intraocular pressure (IOP) measurements obtained using the Pascal dynamic contour tonometer (PDCT) with the standard Goldmann applanation tonometer (GAT) and to correlate these with central corneal thickness (CCT) in patients with normal corneas. METHODS: A prospective, masked, comparative case series of 116 eyes from patients attending a glaucoma clinic. IOP was measured with PDCT by one examiner and with GAT by a masked, independent examiner. A mean of six CCT readings was used for analysis. RESULTS: IOP measured by the two instruments correlated significantly (r=0.77; P<0.0001). IOP measured by GAT correlated strongly with CCT (r=0.37, P=0.0001) whereas the relationship between IOP measured by PDCT and CCT approached significance (r=0.17, P=0.073). The differences between GAT and PDCT measured IOP also correlated strongly with CCT (r=0.37, P<0.0001). The 95% limits of agreement between GAT and PDCT were +/-4.2 mmHg. Dividing the eyes into three groups on the basis of CCT, demonstrated those in the thickest tertile showed a poorer agreement between instruments and the GAT measured significantly higher IOP in this group (P=0.003) while the PDCT showed no significant differences with different CCTs (P=0.37). CONCLUSION: Demonstration of the relative independence of PDCT IOP measurements from CCT supports a potential clinical role for this instrument, particularly for subjects with CCT outside the normal range.     

Theoretical basis of goldmann applanation tonometry

For more than 50 years Goldmann applanation tonometry has been the internationally accepted method for measuring intraocular pressure. In Goldmann applanation tonometry, however, some basic physical properties are oversimplified and the method has some flaws and restrictions. This paper is intended to promote the understanding of the methodological basis of Goldmann applanation tonometry and describes the most important factors influencing the measurement of intraocular pressure (e. g., corneal thickness, corneal radius, axial length and corneal morphology). Furthermore, the basic principles of other commonly used tonometer devices will be discussed. New developments are anticipated that will measure the true intraocular pressure more accurately than Goldmann applanation tonometry.     

Intraocular pressure and ocular pulse amplitude using dynamic contour tonometry and contact lens tonometry

Background

The new Ocular Dynamic Contour Tonometer (DCT), investigational device supplied by SMT (Swiss Microtechnology AG, Switzerland) allows simultaneous recording of intraocular pressure (IOP) and ocular pulse amplitude (OPA). It was the aim of this study to compare the IOP results of this new device with Goldmann tonometry. Furthermore, IOP and OPA measured with the new slitlamp-mounted DCT were compared to the IOP and OPA measured with the hand-held SmartLens^®, a gonioscopic contact lens tonometer (ODC Ophthalmic Development Company AG, Switzerland).

Methods

Nineteen healthy subjects were included in this study. IOP was determined by three consecutive measurements with each of the DCT, SmartLens^®, and Goldmann tonometer. Furthermore, OPA was measured three times consecutively by DCT and SmartLens^®.

Results

No difference (P = 0.09) was found between the IOP values by means of DCT (mean: 16.6 mm Hg, median: 15.33 mm Hg, SD: +/- 4.04 mm Hg) and Goldmann tonometry (mean: 16.17 mm Hg, median: 15.33 mm Hg, SD: +/- 4.03 mm Hg). The IOP values of SmartLens^® (mean: 20.25 mm Hg, median: 19.00 mm Hg, SD: +/- 4.96 mm Hg) were significantly higher (P = 0.0008) both from Goldmann tonometry and DCT. The OPA values of the DCT (mean: 3.08 mm Hg, SD: +/- 0.92 mm Hg) were significantly lower (P = 0.0003) than those obtained by SmartLens^® (mean: 3.92 mm Hg, SD: +/- 0.83 mm Hg).

Conclusions

DCT was equivalent to Goldmann applanation tonometry in measurement of IOP in a small group of normal subjects. In contrast, SmartLens^® (contact lens tonometry) gave IOP readings that were significantly higher compared with Goldmann applanation tonometer readings. Both devices, DCT and SmartLens^® provide the measurement of OPA which could be helpful e.g. for the management of glaucoma.

     

The effect of corneal edema on dynamic contour and goldmann tonometry

PURPOSE: To determine the effect of contact lens-induced corneal edema on measurements of intraocular pressure (IOP) using the Pascal dynamic contour tonometer (DCT), compared with the Goldmann tonometer. METHODS: Thirty young healthy subjects (23.0 +/- 3.0 years) were recruited from the student population at the University of New South Wales. Thick hydroxyethyl methacrylate contact lenses were worn monocularly for 2 hours under closed-eye conditions to induce corneal edema via hypoxia. IOP (Goldmann and Pascal DCT), ocular pulse amplitude (OPA), and central corneal thickness (CCT) were measured in both eyes before and after lens wear. Paired t-tests, Pearson correlation, and Bland-Altman plots were used to identify changes in, and relationships between, these parameters resulting from corneal edema. RESULTS: Lens wear resulted in statistically significant changes in CCT (+48.3 +/- 14.4 microm, p < 0.001), Goldmann IOP (+1.5 +/- 2.8 mm Hg, p = 0.007), and Pascal DCT IOP (-0.7 +/- 1.1 mm Hg, p = 0.001) but not OPA (0.0 +/- 0.3 mm Hg, p = 0.721, two-tailed paired t-test). The Pascal DCT provided IOP readings that were 1.3 +/- 2.0 mm Hg higher than the Goldmann IOP readings when hydration was normal, but the Goldmann tonometer provided readings that were 0.8 +/- 2.5 mm Hg higher than the Pascal DCT readings when the cornea was edematous. The variation between the two instruments was weakly correlated to the change in CCT (r = -0.261, p = 0.044). CONCLUSIONS: Contact lens-induced corneal edema caused a small underestimation error in IOP measurements by the Pascal DCT, and an overestimation error in Goldmann tonometry measurements. The OPA measurement provided by the Pascal DCT is insensitive to corneal edema-induced changes in corneal properties.     

Comparison of dynamic contour tonometry and Goldmann applanation tonometry following penetrating keratoplasty

Objective: To evaluate dynamic contour tonometry (DCT) versus Goldmann applanation tonometry (GAT) intraocular pressure (IOP) measurements in eyes that underwent penetrating keratoplasty (PKP).Design: Prospective, cross-sectional, observational study.Participants: Thirty-one eyes of 28 patients were examined after PKP.Methods: All eyes had undergone PKP with interrupted sutures. The postoperative period was more than 1 year for 25 eyes and less than 1 year for 6. Sutures were removed based on corneal topography and refraction. IOP was measured by both DCT and GAT methods and was correlated to the number of remaining sutures.Results: IOP readings were successfully obtained in 25/31 (80.6%) with DTC and in 21/31 (67.7%) with GAT (p = 0.25). In eyes with fewer than 4 remaining sutures, both methods were successful. In eyes with more than 4 sutures, the success rates of DCT and GAT were 66.7% and 44.4%, respectively (p = 0.18). In PKPs with a postoperative period of more than 1 year, the success rates of DCT and GAT were 96% and 84%, respectively (p = 0.16). In 20 eyes, both methods measured the IOP. The mean IOP obtained by DCT (16.6 [SD 2.8] mm Hg) was higher than the mean IOP obtained from GAT (15.1 [SD 3.6] mm Hg). The IOPs from the 2 instruments correlated significantly (p < 0.05) and the mean difference was 1.5 mm Hg.Conclusions: The success rate in measuring IOP with DCT and GAT did not show any statistically significant difference. Both methods were less effective measuring the IOP after recent PKPs and regrafts. However, DCT seemed to be superior to GAT in corneas with more than 4 remaining sutures and in PKPs performed more than 1 year earlier. The absolute values of IOP were higher with DCT than with GAT.     

Comparison of dynamic contour tonometry with Goldmann applanation tonometry in glaucoma practice

Purpose: To compare intraocular pressure (IOP) readings taken using dynamic contour tonometry (DCT) with IOP readings taken with Goldmann applanation tonometry (GAT) in eyes with glaucoma or ocular hypertension. Methods: The present study included 100 eyes in 100 patients with glaucoma or ocular hypertension. After pachymetry DCT and GAT were performed. Intraocular pressures as measured with DCT and GAT were compared with one another and with central corneal thickness (CCT). Results: Mean DCT IOP measurements (20.1 ± 4.3 mmHg) were significantly (p < 0.001) higher than GAT IOP values (17.9 ± 4.7 mmHg). The mean difference between DCT and GAT measurements was 2.1 mmHg (range ? 3.4 to 9.7 mmHg). The difference followed a normal distribution. Measurements made with DCT and GAT correlated significantly with one another (Spearman’s rho = 0.761, p < 0.001). Neither GAT nor DCT measurements showed a significant correlation with CCT (537 ± 39 μm, range 458–656 μm). Multivariate regression analysis has shown that the difference between DCT and GAT is influenced significantly by ocular pulse amplitude (r = ? 0.334, p = 0.001) and it is not influenced by CCT (r = ? 0.106, p = 0.292). Conclusions: In eyes with glaucoma or ocular hypertension, DCT facilitates suitable and reliable IOP measurements which are in good concordance with GAT readings. Variation in CCT cannot by itself explain the differences in measurements taken with DCT and GAT in a number of eyes.     

PASCAL动态轮廓眼压计与Goldmann压平眼压计在非青光眼人群中眼压测量值的比较及一致性分析

目的探讨在不同的中央角膜厚度(CCT)下PASCAL动态轮廓眼压计(DCT)与Goldmann压平眼压计(GAT)眼压(IOP)测量值的相关性,评价两者测量值的一致性及临床上两种眼压计测量值相互替换的可能性。方法非青光眼病例87例(168只眼)分别用DCT和GAT进行眼压测量,两种仪器的测量顺序随机。同时,用NIDEK UP-1000型角膜测厚仪测量CCT。DCT与GAT眼压测量值的相关性采用Spearson双变量相关分析,Bland-Altman分析法评价两种仪器IOP测量值的一致性。结果 (1)在不同的角膜厚度下DCT与GAT测得的IOP值均显著相关(CCT≤520μm,n=24,r=0.67,P<0.001;520μm580μm,n=44,r=0.61,P<0.001)。(2)DCT眼压测量值与CCT不相关(r=0.14,P=0.08),GAT眼压测量值与CCT显著相关(r=0.59,P<0.001)。(3)Bland-Altman一致性分析显示两种仪器的差值的均值为-0.9mm Hg,一致性界限为(-5.6 mm Hg,3.9 mm Hg)。结论 (1)在不同的角膜厚度下DCT与GAT的眼压测量值均显著相关。(2)DCT眼压测量值与CCT值不相关,GAT眼压测量值与CCT值显著相关。(3)一致性分析显示两者测量值的一致性界限跨度较宽,二者的IOP值不可简单地相互代替。     

Intraocular pressure difference in Goldmann applanation tonometry versus Perkins hand-held applanation tonometry in overweight patients

Objective

To analyze the increase in intraocular pressure (IOP) caused by anatomic and physiologic factors in overweight patients when using Goldmann applanation tonometry.

Design

A prospective cohort study.

Participants

Seventy average-weight individuals who had no difficulties with IOP measurements at the slit lamp and 12 obese patients with suspected glaucoma who could position the head at the slit lamp only with great effort participated.

Intervention

The authors compared IOP values between slit-lamp-mounted Goldmann applanation tonometry and Perkins hand-held tonometry.

Main outcome measure

The difference in Goldmann and Perkins IOP measurements was examined.

Results

In the group of obese patients, the mean IOP was 20.9 ± 2.28 mmHg (mean ± standard deviation; range, 18–26 mmHg) for the right eye and 21.4 ± 3.16 mmHg (range, 16–28 mmHg) for the left eye when determined by Goldmann tonometry and 16.3 ± 2.39 mmHg (range, 13–20 mmHg) for the right eye and 16.3 ± 2.42 (range, 11–19 mmHg) for the left eye when determined by Perkins tonometry. The mean decrease was 4.5 ± 1.3 mmHg (range, 3–7 mmHg) for the right eye and 4.9 ± 1.9 mmHg (range, 2–9 mmHg) for the left eye. In the control group, the mean difference between the two types of tonometers for the right eye was 0.34 ± 0.69 mmHg and for the left eye was 0.33 ± 0.82 mmHg. Patients who had a falsely elevated IOP on Goldmann tonometry had an average body mass index of 34 ± 3.82 (range, 28.5–41.9); most were female (5:1 ratio).

Conclusion

The authors believe simultaneous breath-holding and thorax compression, with subsequent increase in venous pressure, may be a causative factor for transitory elevations of IOP. Perkins tonometry in obese patients may help avoid a false diagnosis of glaucoma caused by transitory elevations in IOP.     

动态轮廓眼压计与Goldmann压平眼压计及非接触眼压计测量眼压的对比研究

目的探讨动态轮廓眼压计(DCT)与Goldmann压平眼压计(GAT)及非接触眼压计(NCT)测量眼压的准确性,并比较三种眼压计测量结果与中央角膜厚度(CCT)的相关性。设计前瞻性、比较性病例系列。研究对象连续选取90例(90眼)10~76岁正常人。方法采用KONAN非接触式角膜内皮镜测量CCT后,对所有入选者单眼以随机顺序采用Pascal型DCT、GAT及Topcon型NCT测量眼压。测量结果两两比较,并将眼压值与CCT进行直线回归分析。主要指标眼压值,Pearson相关系数。结果 90例正常人DCT眼压平均值(17.33±2.71 mm Hg)明显高于GAT(14.27±2.81 mm Hg)(P=0.000)及NCT(14.67±2.93 mm Hg)(P=0.000),平均差异分别为(3.06±2.01)mm Hg和(2.67±2.20)mm Hg;GAT与NCT之间平均差异为(-0.39±2.29)mm Hg(P=0.105)。DCT与GAT眼压值之间相关系数r=0.736(P=0.000);与NCT眼压值之间相关系数r=0.699(P=0.000)。GAT、NCT眼压值与CCT均明显相关(r=0.370,P=0.000;r=0.508,P=0.000);DCT眼压值与CCT无明显相关性(r=0.051,P=0.639)。DCT和GAT的差值与年龄无明显相关性(r=0.064,P=0.052)。结论 DCT测量的眼压值虽高于GAT及NCT,但不受CCT的影响,可能较GAT和NCT测量的眼压值更接近真实值。     

A comparison between Goldmann applanation tonometry and dynamic contour tonometry after photorefractive keratectomy

Background

The intraocular pressure (IOP) could be measured by both Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). Although these two methods have been discussed widely after laser-assisted sub-epithelial keratectomy (LASIK), there is little data in the cases undergoing photorefractive keratectomy (PRK). We aimed to compare the changes of IOP measurements obtained by GAT and DCT after PRK for myopia/myopic astigmatism.

Methods

This prospective study enrolled 77 candidates (154 eyes) for PRK to correct myopia or myopic astigmatism and 30 matched patients (30 eyes) with myopia or myopic astigmatism who served as controls. Changes of the IOP measurements (ΔIOP) obtained by GAT and DCT before and at 6 months after PRK in the operated eyes, and at baseline and 6 months later in the controls, were documented. Changes of the central corneal thickness (ΔCCT) were determined in the same fashion.

Results

The mean IOP readings obtained by DCT were comparable before and at 6 months after procedure (18.34 ± 3.03 mmHg and 17.87 ± 2.61 mmHg respectively, p?=?0.41); whereas the mean IOP reading obtained by GAT decreased significantly 6 months postoperatively (17.92 ± 3.63 mmHg and 16.25 ± 2.66 mmHg, p?<?0.001). A significant correlation was present between the ΔIOP obtained by GAT and ΔCCT (r?=?0.61, p?<?0.001). Similar correlation was not significant between the DCT-obtained ΔIOP and the ΔCCT (r?=?0.07, p?=?0.44). The mean ΔIOP obtained by GAT was significantly higher in the operated eyes than in the controls (?1.54?±?1.45 vs 0.07?±?0.44 mmHg, p?=?0.02). The mean DCT-obtained ΔIOP was just marginally insignificant between the operated and nonoperated eyes (?0.63?±?0.59 vs 0.02?±?0.38 mmHg respectively; p?=?0.09).

Conclusions

The authors recommend DCT after PRK in the cases with myopia or myopic astigmatism