Corneal biomechanical properties in normal‐tension glaucoma

Purpose: To investigate the intraocular pressure (IOP) and corneal biomechanical properties of normal and normal‐tension glaucoma (NTG) eyes. Methods: This study included 83 normal and 83 NTG eyes. We measured corneal‐compensated IOP (IOPcc), Goldmann‐correlated IOP (IOPg), corneal resistance factor (CRF), corneal hysteresis (CH) and central corneal thickness (CCT) three times each for normal and NTG eyes using an Ocular Response Analyzer (ORA). Results: No significant difference in CCT was seen between normal eyes (541.4 ± 26.8 μm) and NTG eyes (535.4 ± 24.9 μm; p = 0.16). IOPcc was significantly higher in NTG eyes (16.1 ± 2.6 mmHg) than in normal eyes (15.1 ± 2.9 mmHg; p = 0.01), while IOPg was significantly lower in NTG eyes (14.1 ± 2.7 mmHg) than in normal eyes (15.1 ± 3.0 mmHg; p = 0.04). CRF and CH were significantly lower in NTG eyes (CRF, 8.9 ± 1.5 mmHg; CH, 9.2 ± 1.3 mmHg) than in normal eyes (CRF, 10.6 ± 1.4 mmHg; CH, 10.8 ± 1.3 mmHg; p < 0.0001 each). Conclusion: IOPcc was significantly higher in NTG eyes than in normal eyes. The ORA may be useful for distinguishing between the IOPcc of NTG eyes with normal IOP and that of normal eyes. In addition, the ORA enables CRF and CH to be measured in vivo, and weakness of the lamina cribrosa may be clinically inferred from the fact that CRF and CH were reduced in NTG eyes in our study. Low CRF and CH may be clues to the pathology of NTG.     

相干光断层扫描仪检测正常人及青光眼患者中央角膜厚度

目的探讨相干光断层扫描仪(OCT)测量正常人、原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)、高眼压症(OHT)患者的中央角膜厚度(CCT)。方法采用OCT3测量正常人143例(143只眼)、POAG患者36例(36只眼)、NTG患者39例(39只眼)及OHT患者40例(40只眼)的CCT,并进行单因素4水平设计定量资料的方差分析;用线性回归方法分析正常人CCT与Goldmann压平眼压测量值的相关关系;对OCT测量CCT观察者间和观察者内的一致性进行类内相关系数(ICC)分析。结果正常组、POAG组、NTG组及OHT组的平均CCT值分别为(523.66±32.13)μm、(530.92±27.32)μm、(506.92±21.49)μm及(573.13±27.39)μm。POAG组与正常人组的平均CCT值差异无统计学意义(P=0.099);OHT组的平均CCT值大于其他各组,均P<0.01;NTG组的平均CCT值小于其他各组,均P<0.01。正常组CCT与眼压值呈正相关(r=0.318,R2=0.101,P<0.01)。OCT测量CCT的测量者间和测量者内的ICC值分别为0.995和0.996。结论OCT可以准确地测量CCT;NTG患者平均CCT比正常人薄,而OHT患者比正常人厚;CCT可以影响Goldmann压平眼压计的测量值,但贡献率较小。(中华眼科杂志,2006,42:199-203)     

Association between corneal hysteresis and central corneal thickness in glaucomatous and non‐glaucomatous eyes

Purpose: We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non‐glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). Methods: Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non‐glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open‐angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. Results: Mean (± standard deviation [SD]) age was 59.2 ± 14.2 years in the non‐glaucoma group and 62.4 ± 9.8 years in the glaucoma group. Mean (± SD) GAT IOP was 15.7 ± 2.65 mmHg and 16.38 ± 2.73 mmHg in the non‐glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (± SD) CH was 10.97 ± 1.59 mmHg in the non‐glaucoma and 8.95 ± 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non‐glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. Conclusions: Corneal hysteresis was significantly lower in eyes with treated POAG than in non‐glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non‐glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non‐glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma.     

Corneal biomechanics measured with the ocular response analyser in patients with unilateral open‐angle glaucoma

Purpose: To evaluate the relationship between biomechanical properties of the cornea and intraocular pressure (IOP) and the role of biomechanical properties in eyes of patients with unilateral primary open‐angle glaucoma (POAG). Methods: The biomechanical properties of corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with the ocular response analyser (ORA). In an experimental setting, three human donor eyes with Schiotz‐tonometry‐controlled IOP were investigated. In addition, a series of patients with unilateral POAG were evaluated. Main outcome measures were CH, CRF, corneal‐compensated IOP (IOPcc), standard automated perimetry parameters mean defect (MD) and pattern standard deviation, central corneal thickness, Goldmann applanation tonometry (GAT), and cup‐to‐disc ratio. Results: A highly significant linear correlation between CH and the corneal‐compensated IOP (IOPcc, r = ?0.926; p < 0.001) was found. The correlation between IOP_CC and CRF was not significant (r = 0.335; p = 0.08). In total, 36 eyes of 18 patients with unilateral POAG were examined. Regarding uncorrected CH (mean 7.73 ± 1.46 mmHg glaucomatous eye and 9.28 ± 1.42 mmHg fellow eye), there was a highly significant difference between both eyes. This difference disappears, when CH was corrected for IOP (9.44 ± 3.78 mmHg and 9.97 ± 3.22 mmHg, respectively). Conclusions: Corneal hysteresis but not corneal resistance factor is dependent on IOP. In patients with unilateral POAG, IOP is higher in the affected eye. When CH is corrected for IOP, corneal biomechanical properties do not differ in both eyes of patients with unilateral POAG.     

Intraocular pressure and ocular pulse amplitude comparisons in different types of glaucoma using dynamic contour tonometry

PURPOSE: To compare the intraocular pressures (IOP) and ocular pulse amplitudes (OPA) in patients with different types of glaucoma, ocular hypertension (OHT), and normal controls (NC) using dynamic contour tonometry (DCT) and the goldmann applanation tonometry (GAT). METHODS: 906 eyes of 501 adult patients in the following five groups were included in this cross-sectional study: primary open angle glaucoma (POAG), normal tension glaucoma (NTG), Pseudoexfoliative Glaucoma (PXG), OHT, and NC. The following tests were performed simultaneously during a single visit: IOP using DCT and GAT; OPA using DCT and central corneal thickness (CCT) using ultrasound pachymetry. Mixed effects regression models were used to compare the DCT and GAT IOP measurements in the five groups; the effect of CCT on IOP and the relationship between OPA and IOP within each group. RESULTS: DCT consistently had higher IOP values than GAT in POAG, PXG, NTG, and controls (p < 0.001) but not in OHT (p = 0.84). DCT IOP did not change while GAT IOP showed a non-significant increase (p = 0.09) with increased corneal thickness in each group. OPA was found to be highest in OHT (3.61 mmHg) and lowest in the control group (2.86 mmHg) and significantly increased with IOP in all groups. CONCLUSIONS: DCT measures an IOP that is significantly higher than GAT IOP in glaucoma and control subjects but not in ocular hypertensives. Furthermore, the DCT may measure an IOP that is independent of the CCT, which may not be true for the GAT, which increases with the CCT. OPA was highest in OHT and may be affected by the IOP.     

Corneal biomechanical properties in primary open angle glaucoma and normal tension glaucoma

PURPOSE: To determine and compare the corneal biomechanical properties between eyes with primary open angle glaucoma (POAG) and eyes with normal tension glaucoma (NTG). PATIENTS AND METHODS: Prospective cross-sectional study. Consecutive eligible POAG and NTG patients attending the Glaucoma Clinic had assessment of their corneal biomechanical properties-corneal hysteresis (CH) and corneal resistance factor (CRF)-using the Ocular Response Analyzer by an observer masked to the diagnosis. Exclusion criteria included previous intraocular surgery, corneal pathology, inflammatory connective tissue disease, and refraction of 5-dimensional or over. If both eyes were eligible, then the right eye was used for analysis. The main outcome measures were corneal hysteresis and CRF measurements. Data analysis was performed using the t test and general linear model. RESULTS: Eighty-one patients (80 whites) were analyzed. Forty had NTG, whereas 41 had POAG. Thirty-five were females. There was a statistically significant difference in mean CH (NTG 9.6+/-1.3 mm Hg; POAG 9.0+/-1.4 mm Hg; P=0.01), but not in mean CRF (NTG 9.9+/-1.4; POAG 10.8+/-1.7; P=0.06). The highest recorded Goldmann applanation intraocular pressure (IOP) was statistically significantly associated with lower CH (P=0.01) and higher CRF (P=0.02). CONCLUSIONS: There was a small but statistically significant difference in the mean CH between POAG and NTG (CH was higher in NTG). The highest recorded Goldmann applanation IOP was also statistically significantly correlated with lower CH and higher CRF, suggesting that alterations to the corneal biomechanical properties may occur as a result of chronic raised IOP in POAG.     

Central corneal thickness in primary open angle glaucoma, pseudoexfoliative glaucoma, ocular hypertension, and normal population

PURPOSE: This study was designed to determine the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by applanation tonometer in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 125 subjects were included in the study. Twenty-six had primary open angle glaucoma (POAG), 25 had pseudoexfoliative glaucoma (PXG), 24 had ocular hypertension (OHT), and 50 of them were normal. IOP values were measured by Goldmann applanation tonometer whereas CCT values were measured by ultrasonic pachymeter. RESULTS: CCT values in the OHT group (595.75+/-22.52 microm) were greater than the CCT values of the POAG group (539.92+/-21.50 microm), the PXG group (526.28+/-31.73 microm), and the normal group (533.96+/-29.25 microm) (p<0.05). Eight patients who were diagnosed with OHT showed IOP values of 21 mm Hg or lower with corrected IOP values according to CCT. CONCLUSIONS: Increased CCT may lead to falsely high values of IOP measured with Goldmann applanation tonometer. In this study, when IOP values of the OHT group were redefined according to the formulae regarding the CCT, the authors noted that one third of them were normal. Determination of the CCT in OHT cases is crucial since it has great impact on IOP values, measured with applanation tonometer, which is the main parameter in the diagnosis and follow-up of glaucoma.     

Estudio comparativo entre tonómetros Goldmann y ORA en pacientes recién diagnosticados de GPAA o HTO,sin tratamiento

Background and objectiveThe corneal biomechanical properties in naïve, untreated glaucoma and ocular hypertension (OHT) eyes is interesting, because it may be a source of error in intraocular pressure (IOP) measurements by Goldmann applanation tonometer (GAT) and ocular response analyzer (ORA).The main objective of this study was to evaluate the IOP values obtained using GAT and the ORA, in primary open angle glaucoma (POAG) and in OHT untreated eyes.Material and methodsObservational, masked, cross sectional observational study. Newly diagnosed, untreated POAG and OHT eyes were included.ResultsFifty-one POAG and 34 OHT eyes were analyzed. We found that IOPcc (IOP corneal-compensated) was significantly higher than GAT IOP in POAG (P=.0002) while we did not find any significant difference between both tonometers in OHT (P=.1).ConclusionsGAT seems to underestimate the real IOP in untreated POAG eyes and it seems to be quite accurate in OHT eyes.     

角膜生物参数对青光眼患者眼压测量影响的研究

目的:探讨角膜生物参数对青光眼患者眼压测量的影响。方法:对80例121眼青光眼患者进行眼反应分析仪(ocular response analyzer,ORA)与Goldmann压平眼压计(Goldmann applanation tonometer,GAT)测量,并用先进的OrbscanⅡ眼前节分析系统测量中央角膜厚度(central corneal thickness,CCT)。结果:平均矫正眼压(IOPcc)值17.41±5.62mmHg;平均GAT值15.76±6.06mmHg;IOPcc与角膜滞后性(cornealhysteresis,CH)有相关性(P=0.000;r=-0.236);IOPcc与GAT显著相关(P=0.000;r=0.857);IOPcc与CCT无相关性。结论:对已经诊断的青光眼患者,平均IOPcc值高于平均GAT值;随着CH的降低,IOPcc值有升高的趋势;且IOPcc值不受CCT值的影响。     

Measurement of intraocular pressure in LASIK and LASEK patients using the Reichert Ocular Response Analyzer and Goldmann applanation tonometry

PURPOSE: To determine the efficacy of the Reichert Ocular Response Analyzer (ORA) to measure intraocular pressure (IOP) following corneal laser refractive surgery. METHODS: Intraocular pressure was measured using Goldmann applanation tonometry preoperatively and 3 months following LASIK and LASEK for all levels of myopia and low levels of hyperopia. In LASIK eyes, 120-microm flaps were cut using the Hansatome XP. The ORA was used to measure Goldmann correlated IOP and corneal compensated IOP 3 months postoperatively. Postoperative central corneal thickness, hysteresis, and corneal curvature were assessed to determine their relationship with postoperative change in Goldmann applanation tonometry IOP. Efficacy of ORA IOP measurement was analyzed by comparing Goldmann applanation tonometry IOP with Goldmann correlated IOP. RESULTS: LASEK was performed on 35 eyes, and LASIK was performed on 90 eyes. In the LASIK group, mean Goldmann applanation tonometry IOP decreased 3.7+/-2.3 mmHg postoperatively (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.06) from postoperative ORA Goldmann correlated IOP (10.2+/-2.1 mmHg). In the LASEK group, mean Goldmann applanation tonometry IOP decreased 3.9+/-2.3 mmHg (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.6) from postoperative ORA Goldmann correlated IOP (10.7+/-2.5 mmHg). Postoperative decrease in Goldmann applanation tonometry IOP did not correlate with age, ablation depth, pre- and postoperative central corneal thickness or corneal hysteresis, or postoperative decrease in corneal curvature. CONCLUSIONS: Intraocular pressure measurements were similar using both the ORA Goldmann correlated IOP and Goldmann applanation tonometry following keratorefractive surgery.     

Der Einfluss von kornealer Hysterese und kornealem Resistenzfaktor auf die Messung des intraokularen Drucks

BACKGROUND: The influence of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) has been discussed extensively in recent years. The problem, however, has not been solved so far. In addition to CCT there are probably further biomechanical properties that play a role in IOP measurement. We wanted to find out whether these properties are related to Goldmann applanation tonometry (GAT), noncontact tonometry (NCT), or CCT. MATERIAL AND METHODS: Biomechanical properties of the cornea such as corneal hysteresis (CH) and corneal resistance factor (CRF) can be measured with the Ocular Response Analyzer (ORA, Reichert Ophthalmic Instruments, Depew, NY, USA). Furthermore, a corneal compensated IOP (IOPcc) is given. We examined 156 normal eyes of 80 patients who did not show corneal pathology nor glaucoma. In each eye GAT, NCT, and ORA data as well as CCT were measured. Data were statistically analyzed with respect to agreement and the influence of CH and CRF on IOP measurement. RESULTS: In our patients the following average values were calculated: GAT 14.8+/-3.0 mmHg, NCT 16.4+/-3.9 mmHg, IOPcc 16.2+/-4.1 mmHg, CH 10.6+/-2.3 mmHg, CRF 10.9+/-2.4 mmHg, and CCT 557+/-36 microm. IOPcc was not related to CCT in normal eyes and the only IOP value related to CH (p<0.01). CRF, however, was related to GAT and NCT values (p<0.01). DISCUSSION: In our group of normal eyes IOPcc, i.e., the value that is adjusted by measurement of viscoelastic properties of the cornea, in contrast to GAT and NCT does not depend on central corneal thickness. Corneal hysteresis and corneal resistance factor provide further information about biomechanical properties of the cornea beyond central corneal thickness.     

Novel pressure-to-cornea index in glaucoma

BACKGROUND: Several conversion tables and formulas have been suggested to correct applanation intraocular pressure (IOP) for central corneal thickness (CCT). CCT is also thought to represent an independent glaucoma risk factor. In an attempt to integrate IOP and CCT into a unified risk factor and avoid uncertain correction for tonometric inaccuracy, a new pressure-to-cornea index (PCI) is proposed. METHODS: PCI (IOP/CCT(3)) was defined as the ratio between untreated IOP and CCT(3) in mm (ultrasound pachymetry). PCI distribution in 220 normal controls, 53 patients with normal-tension glaucoma (NTG), 76 with ocular hypertension (OHT), and 89 with primary open-angle glaucoma (POAG) was investigated. PCI's ability to discriminate between glaucoma (NTG+POAG) and non-glaucoma (controls+OHT) was compared with that of three published formulae for correcting IOP for CCT. Receiver operating characteristic (ROC) curves were built. RESULTS: Mean PCI values were: Controls 92.0 (SD 24.8), NTG 129.1 (SD 25.8), OHT 134.0 (SD 26.5), POAG 173.6 (SD 40.9). To minimise IOP bias, eyes within the same 2 mm Hg range between 16 and 29 mm Hg (16-17, 18-19, etc) were separately compared: control and NTG eyes as well as OHT and POAG eyes differed significantly. PCI demonstrated a larger area under the ROC curve (AUC) and significantly higher sensitivity at fixed 80% and 90% specificities compared with each of the correction formulas; optimum PCI cut-off value 133.8. CONCLUSIONS: A PCI range of 120-140 is proposed as the upper limit of "normality", 120 being the cut-off value for eyes with untreated pressures or=22 mm Hg. PCI may reflect individual susceptibility to a given IOP level, and thus represent a glaucoma risk factor. Longitudinal studies are needed to prove its prognostic value.     

Comparison of the corneal biomechanical properties with the Ocular Response Analyzer® (ORA) in African and Caucasian normal subjects and patients with glaucoma

Purpose: To compare corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer^® tonometer (ORA) between (i) African normals and treated primary open‐angle glaucoma (POAG) patients and (ii) between normals and treated POAG Caucasians. To analyse the correlation of CH and CRF with visual field (VF) defects in the two groups. Methods: This comparative study included 59 African (29 (POAG), 30 normals) and 55 Caucasians (30 POAG and 25 normals) subjects. Goldmann applanation tonometry (GAT) and ORA measurements were performed in a randomized sequence. Visual field was tested with the Swedish interactive threshold algorithms standard strategy of the Humphrey perimeter. Hoddap classification was used to estimate the severity of VF defects. Results: Primary open‐angle glaucoma Africans were younger than POAG Caucasians (p < 0.001). Goldmann applanation tonometry and central corneal thickness (CCT) did not differ significantly between the four subgroups. African normals had lower CH than Caucasian controls (p < 0.001). CH was 9.2 ± 1.1 and 8.3 ± 1.7 mmHg respectively in POAG Caucasians and Africans (p < 0.001). African controls had higher ORA corneal‐compensated intraocular pressure (IOPcc) than Caucasian controls (p < 0.001). Primary open‐angle glaucoma Africans had higher IOPcc values than Caucasian POAGs (p < 0.001). CH and IOPcc were associated with race (p < 0.001) but not with CCT. Based on mean deviation values (MD), POAG Africans had more severe VF defects. CH was correlated with MD (r = 0.442; p = 0.031) and severity of VF defects only in POAG Africans (r = ?0.464; p = 0.013). Conclusions: African normal subjects and POAG patients had an altered CH, which is associated with a significant underestimation of GAT IOP. This may potentially contribute to the earlier development and greater severity of glaucoma damage in Africans compared with Caucasians at diagnosis.     

Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure

PURPOSE: To estimate the relationships between ocular parameters and tonometrically measured intraocular pressure (IOP), to determine the influence of ocular parameters on different instrument measurements of IOP, and to evaluate the association of ocular parameters with a parameter called hysteresis. METHODS: Patients presenting at a glaucoma clinic were recruited for this study. Subjects underwent IOP measurement with the Goldmann applanation tonometer (GAT), the TonoPen, and the Reichert Ocular Response Analyzer (ORA), and also measurements of central corneal thickness (CCT), axial length, corneal curvature, corneal astigmatism, central visual acuity, and refractive error. Chart information was reviewed to determine glaucoma treatment history. The ORA instrument provided a measurement called corneal hysteresis. The association between measured IOP and the other ocular characteristics was estimated using generalized estimating equations. RESULTS: Among 230 patients, IOP measurements from the TonoPen read lowest, and ORA read highest, and GAT measurements were closest to the mean IOP of the 3 instruments. In a multiple regression model adjusting for age, sex, race, and other ocular characteristics, a 10 microm increase in CCT was associated with an increase of 0.79 mm Hg measured IOP in untreated eyes (P<0.0001). Of the 3 tonometers, GAT was the least affected by CCT (0.66 mm Hg/10 mum, P<0.0001). Hysteresis was significantly correlated with CCT with a modest correlation coefficient (r=0.20, P<0.0007). CONCLUSIONS: Among parameters related to measured IOP, features in addition to CCT, such as hysteresis and corneal curvature, may also be important. Tonometric instruments seem to be affected differently by various physiologic characteristics.     

Bestimmung viskoelastischer Hornhauteigenschaften (korneale Hysterese) bei Patienten mit primärem Offenwinkelglaukom

Background

The ocular response analyzer (ORA) uses an air-pressure-triggered, dynamic, bi-directional corneal applanation method to measure biomechanical parameters of the cornea. Corneal hysteresis (CH) is defined as the difference in intraocular pressure recorded during inward and outward applanation. CH is therefore an indicator for the viscoelastic properties of the cornea.

Patients and methods

CH was recorded in non-glaucoma patients (80 eyes) as well as in patients with primary open angle glaucoma (POAG, 82 eyes). The correlation between CH and central corneal thickness (CCT) was analyzed.

Results

Mean CH was 10.6±2.2 mmHg in the non-glaucoma group and 9.3±2.2 mmHg in patients with POAG (p<0.01). CH and CCT showed a positive correlation in non-POAG patients, however no such correlation was found in the POAG group.

Conclusion

Patients with POAG show an alteration of biomechanical corneal parameters with a significant decrease in corneal hysteresis. A positive correlation between CH and CCT, which was seen in the non-glaucoma group could not be detected in the POAG group.     

Age-dependency of ocular parameters: a cross sectional study of young and elderly healthy subjects

Purpose

To investigate the effect of aging on ocular parameters, including intraocular pressure (IOP), measured with different tonometry methods in healthy young (HY) and healthy elderly (HE) subjects and to study the effect of corneal parameters on tonometry methods.

Methods

In this prospective, cross-sectional study, fifty eyes of 50 HY subjects (28 females, 22–31 years of age) and 43 eyes of 43 HE subjects (22 females, 64–79) were included. IOP was measured with four tonometry methods in a standardized order: ocular response analyser (ORA), dynamic contour tonometry (DCT), applanation resonance tonometry (ART) and Goldmann applanation tonometry (GAT). Other measurements included axial length (AL), central corneal thickness (CCT), corneal curvature (CC), anterior chamber volume (ACV), corneal hysteresis (CH) and corneal resistance factor (CRF).

Results

The mean IOP (HY/HE; mmHg?±?standard deviation (SD)) was 12.2?±?2.2/14.1?±?3.5 with GAT. IOP was significantly higher (difference?±?standard error) in HE compared to HY measured with an ORA (+3.1 mmHg?±?0.6), GAT (+1.9?±?0.6) and DCT (+1.6?±?0.6). No significant difference was found in IOP measured with ART. CH and ACV were significantly lower in HE compared to HY. There was no difference between the groups in CCT, CC, AL or CRF. No tonometry method was dependant on CCT or CC.

Conclusions

IOP measured with an ORA and via DCT and GAT was higher in HE compared to HY Swedish subjects, while IOP measured with ART did not differ between the groups. In these homogeneous groups, tonometry methods were independent of CCT and CC.

     

Correlations between corneal hysteresis, intraocular pressure, and corneal central pachymetry

PURPOSE: To analyze the correlation between corneal hysteresis (CH) measured with the Ocular Response Analyzer (ORA, Reichert) and ultrasonic corneal central thickness (CCT US) and intraocular pressure measured with Goldmann applanation tonometry (IOP GA). SETTING: Bordeaux 2 University, Ophthalmology Department, Bordeaux, France. METHODS: This study comprised 498 eyes of 258 patients. Corneal hysteresis, corneal resistance factor (CRF), and IOP corneal-compensated (IOPcc) were provided by the ORA device; CCT US and IOP GA were also measured in each eye. The study population was divided into 5 groups: normal (n = 122), glaucoma (n = 159), keratoconus (n = 88), laser in situ keratomileusis (LASIK) (n = 78), and photorefractive keratectomy (n = 39). The Pearson correlation was used for statistical analysis. RESULTS: Corneal hysteresis was not strongly correlated with IOP or CCT US. The mean CH in the LASIK (8.87 mm Hg) and keratoconus (8.34 mm Hg) groups was lower than in the glaucoma (9.48 mm Hg) and normal (10.26 mm Hg) groups. The lower the CH, the lower its correlation with IOPcc and IOP GA. A CH higher than the CRF was significantly associated with the keratoconus and post-LASIK groups. CONCLUSIONS: Corneal hysteresis, a new corneal parameter, had a moderate dependence on IOP and CCT US. Weaker corneas could be screened with ORA parameters, and low CH could be considered a risk factor for underestimation of IOP. The CCT US should continue to be considered a useful parameter.     

Hornhautdickenunabhängige Methoden der Messung des Augeninnendrucks

Introduction

Goldmann applanation tonometry (GAT) has been the gold standard for measuring intraocular pressure (IOP) for about 50 years. However, it depends on central corneal thickness (CCT) and is, therefore, prone to being incorrect. Dynamic contour tonometry (DCT) has recently been introduced to measure IOP independently of CCT; however, DCT is costly and difficult. IOP measurement using the ocular response analyzer (ORA) offers noncontact tonometry with declaration of the corneal-compensated IOP (IOPcc), which takes corneal hysteresis (CH) into account and is supposed to be independent of CCT.

Patients and methods

Using the ORA instrument, IOPcc was determined in 192 glaucoma eyes and 59 nonglaucoma eyes. Subsequently, measurement by DCT and GAT was performed. IOP measurements were compared and analyzed with respect to CCT and CH.

Results

Average values were as follows: IOPcc, 18.38±6.3 mmHg; GAT, 14.69±4.5 mmHg; DCT, 15.17±3.9 mmHg; CH, 9.96±2.5 mmHg; CCT, 552±57 μm. Neither CCT nor CH differed between the two groups. There was a positive correlation between GAT and CCT that did not exist for IOPcc and DCT values. However, IOPcc and DCT differed significantly in Bland–Altman analysis (p<0.01). Furthermore, these two IOP values differed significantly with respect to CH and the level of IOP.

Conclusion

Because IOPcc is not a primarily measured variable but also takes CH into account, a direct comparison of DCT and IOPcc values is not acceptable, and a simple correction factor may not be valid.     

角膜厚度与高眼压症及青光眼的眼压

目的 探讨高眼压症、正常眼压性青光眼、原发性开角型青光眼患者及正常人的角膜厚度差异,分析角膜厚度与眼压间的关系,以及角膜厚度的测定对各型青光眼的诊断意见。方法 用超声波角膜测厚仪检测７３例（７３只眼）高眼压症、７９例（７９只眼）正常人的中央角膜厚度,并将其测定结果进行比较。回顾性分析每只青光眼治疗前的最高眼压（Ｇｏｌｄｍａｎｎ）,包括２４ｈ眼压曲线,用Ｅｈｌｅｒ法通过中央角膜厚度对眼压进行校正。结     

Ocular response analyser measurements and central corneal thickness in ocular rosacea patients

Rosacea is a chronic cutaneous disorder which is known to cause inflammation and increased proteolytic activity on the ocular surface that might lead to corneal biomechanical alterations. The aim of this study is to evaluate the corneal biomechanical properties of ocular rosacea patients and compare the measurements with healthy individuals as measured with Reichert ocular response analyser (ORA). Besides full eye examination [best corrected visual acuity (BCVA), intraocular pressure (IOP) measured with Goldmann applanation tonometry (IOP-G)], central corneal thickness (CCT), and ORA [corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated IOP (IOPcc), Goldmann correlated IOP (IOPg)] measurements of 30 eyes of 15 ocular rosacea patients (study group) and 30 eyes of 15 healthy individuals (control group) were performed. For comparisons paired t test was used. Mean age of study group was 45.26 ± 11.65 (range 25 and 63) and control group was 45.00 ± 8.91 (range 26 and 58) years (p = 0.865). No significant difference in BCVA, CCT, IOP-G, IOPcc was detected among groups. However, IOPg, CH, and CRF in the study group were significantly lower than in the control group (p = 0.013, p = 0.013, p = 0.009, respectively). IOPg, CH, and CRF parameters of ocular rosacea patients were significantly lower than normal individuals. These differences and their probable clinical reflections that might effect making decisions in conditions such as glaucoma should be investigated in larger number of patients.