Abstract
Purpose
The purpose of this study was to compare the reliability of the ‘gold standard’ Goldmann applanation tonometer (GAT), with that of the ocular response analyser (ORA), and the dynamic contour tonometer (DCT).
Patients and methods
A total of 694 subjects were recruited to participate from the TwinsUK (UK Adult Twin Registry) at St Thomas’ Hospital, London. Intraocular pressure (IOP) was measured using GAT, ORA, and the DCT. The agreement between the three methods was assessed using the Bland–Altman method. Repeatability coefficients and coefficient of variation between first and second readings of the same eye were used to assess reliability.
Results
Mean age was 57.5 years (SD, 13.1; range, 16.1–88.5). The mean IOPs, calculated using the mean of two readings from the right eye were as follows: Goldmann (GAT), 14.1±2.8 mm Hg; IOPg (ORA), 15.9±3.2 mm Hg; IOPcc (ORA), 16.6±3.2 mm Hg; and DCT, 16.9±2.7 mm Hg. The 95% limits of agreement were for ORA (IOPcc): GAT, −2.07 to 7.18 mm Hg; for DCT: GAT, −0.49 to 6.21 mm Hg; and for DCT: ORA (IOPcc), −3.01 to 4.85 mm Hg. Coefficients of variation for the three tonometers were GAT, 8.3%; ORA, 8.2%; DCT, 6.3%. The repeatability coefficients were 3.4 mm Hg for GAT, 3.57 mm Hg for ORA and 3.09 mm Hg for DCT. GAT and ORA (IOPg) readings showed a positive correlation with central corneal thickness (P<0.005).
Conclusions
This study found similar reliability in all three tonometers. Bland–Altman plots showed the three instruments to have 95% limits of agreement outside the generally accepted limits, which means they are not interchangeable. GAT measurements were found to be significantly lower than the two newer instruments.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Quigley HA . Number of people with glaucoma worldwide. Br J Ophthalmol 1996; 80: 389–393.
Rochtchina E, Mitchell P, Wang JJ . Relationship between age and intraocular pressure: the Blue Mountains Eye Study. Clin Experiment Ophthalmol 2002; 30: 173–175.
Chang TC, Congdon NG, Wojciechowski R, Muñoz B, Gilbert D, Chen P et al. Determinants and heritability of intraocular pressure and cup-to-disc ratio in a defined older population. Ophthalmology 2005; 112: 1186–1191.
Foster PJ, Buhrmann R, Quigley HA, Johnson GJ . The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002; 86: 238–242.
Elmallah MK, Asrani SG . New ways to measure intraocular pressure. Curr Opin Ophthalmol 2008; 19: 122–126.
Brubaker RF . Tonometry and corneal thickness. Arch Ophthalmol 1999; 117: 104–105.
Ehlers N, Bramsen T, Sperling S . Applanation tonometry and central corneal thickness. Acta Ophthalmol (Copenh) 1975; 53: 34–43.
Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002; 120: 714–720.
Herndon LW . Measuring intraocular pressure-adjustments for corneal thickness and new technologies. Curr Opin Ophthalmol 2006; 17: 115–119.
Luce DA . Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg 2005; 31: 156–162.
Shah S, Laiquzzaman M, Cunliffe I, Mantry S . The use of the Reichert ocular response analyser to establish the relationship between ocular hysteresis, corneal resistance factor and central corneal thickness in normal eyes. Cont Lens Anterior Eye 2006; 29: 257–262.
Kanngiesser HE, Kniestedt C, Robert YC . Dynamic contour tonometry: presentation of a new tonometer. J Glaucoma 2005; 14: 344–350.
Carbonaro F, Andrew T, Mackey DA, Spector TD, Hammond CJ . The heritability of corneal hysteresis and ocular pulse amplitude: a twin study. Ophthalmology 2008; 115: 1545–1549.
Healey P, Carbonaro F, Taylor B, Spector TD, Mitchell P, Hammond CJ . The heritability of optic disc parameters: a classic twin study. Invest Ophthalmol Vis Sci 2008; 49: 77–80.
Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
Bland JM, Altman DG . Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135–160.
Lam A, Chen D, Chiu R, Chui WS . Comparison of IOP Measurements Between ORA and GAT in Normal Chinese. Optom Vis Sci 2007; 84: 909–914.
Pepose JS, Feigenbaum SK, Qazi MA, Sanderson JP, Roberts CJ . Changes in corneal biomechanics and intraocular pressure following LASIK using static, dynamic, and noncontact tonometry. Am J Ophthalmol 2007; 143: 39–47.
Martinez-de-la-Casa JM, Garcia-Feijoo J, Fernandez-Vidal A, Mendez-Hernandez C, Garcia-Sanchez J . Ocular response analyzer versus Goldmann applanation tonometry for intraocular pressure measurements. Invest Ophthalmol Vis Sci 2006; 47: 4410–4414.
Erdurmus M, Totan Y, Hepsen IF, Yagci R . Comparison of dynamic contour tonometry and noncontact tonometry in ocular hypertension and glaucoma. Eye 2008; 23 (3): 663–668.
Francis BA, Hsieh A, Lai MY, Chopra V, Pena F, Azen S et al. Effects of corneal thickness, corneal curvature, and intraocular pressure level on Goldmann applanation tonometry and dynamic contour tonometry. Ophthalmology 2007; 114: 20–26.
Kotecha A, Elsheikh A, Roberts CR, Zhu H, Garway-Heath DF . Corneal thickness- and age-related biomechanical properties of the cornea measured with the ocular response analyzer. Invest Ophthalmol Vis Sci 2006; 47: 5337–5347.
Medeiros FA, Weinreb RN . Evaluation of the influence of corneal biomechanical properties on intraocular pressure measurements using the ocular response analyzer. J Glaucoma 2006; 15: 364–370.
Klein BE, Klein R, Linton KL . Intraocular pressure in an American community. The Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 1992; 33: 2224–2228.
Martinez-de-la-Casa JM, Garcia-Feijoo J, Vico E, Fernandez-Vidal A, Benitez del Castillo JM, Wasfi M et al. Effect of corneal thickness on dynamic contour, rebound, and Goldmann tonometry. Ophthalmology 2006; 113: 2156–2162.
Pache M, Wilmsmeyer S, Lautebach S, Funk J . Dynamic contour tonometry versus Goldmann applanation tonometry: a comparative study. Graefes Arch Clin Exp Ophthalmol 2005; 243: 763–767.
Medeiros FA, Sample PA, Weinreb RN . Comparison of dynamic contour tonometry and goldmann applanation tonometry in African American subjects. Ophthalmology 2007; 114: 658–665.
Punjabi OS, Ho HK, Kniestedt C, Bostrom AG, Stamper RL, Lin SC . Intraocular pressure and ocular pulse amplitude comparisons in different types of glaucoma using dynamic contour tonometry. Curr Eye Res 2006; 31: 851–862.
Barleon L, Hoffmann EM, Berres M, Pfeiffer N, Grus FH . Comparison of dynamic contour tonometry and goldmann applanation tonometry in glaucoma patients and healthy subjects. Am J Ophthalmol 2006; 142: 583–590.
Duggal P, Klein AP, Lee KE, Iyengar SK, Klein R, Bailey-Wilson JE et al. A genetic contribution to intraocular pressure: the beaver dam eye study. Invest Ophthalmol Vis Sci 2005; 46: 555–560.
Schneider E, Grehn F . Intraocular pressure measurement-comparison of dynamic contour tonometry and Goldmann applanation tonometry. J Glaucoma 2006; 15: 2–6.
Boehm AG, Weber A, Pillunat LE, Koch R, Spoerl E . Dynamic contour tonometry in comparison to intracameral IOP measurements. Invest Ophthalmol Vis Sci 2008; 49 (6): 2472–2477.
Kniestedt C, Nee M, Stamper RL . Dynamic contour tonometry: a comparative study on human cadaver eyes. Arch Ophthalmol 2004; 122: 1287–1293.
Kniestedt C, Nee M, Stamper RL . Accuracy of dynamic contour tonometry compared with applanation tonometry in human cadaver eyes of different hydration states. Graefes Arch Clin Exp Ophthalmol 2005; 243: 359–366.
Healey PR, Mitchell P, Smith W, Wang JJ . The influence of age and intraocular pressure on the optic cup in a normal population. J Glaucoma 1997; 6: 274–278.
Klein BE, Klein R, Knudtson MD . Intraocular pressure and systemic blood pressure: longitudinal perspective: the Beaver Dam Eye Study. Br J Ophthalmol 2005; 89: 284–287.
Bonomi L, Marchini G, Marraffa M, Bernardi P, De Franco I, Perfetti S et al. Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology 1998; 105: 209–215.
Wu SY, Leske MC . Associations with intraocular pressure in the Barbados Eye Study. Arch Ophthalmol 1997; 115: 1572–1576.
Shiose Y . Intraocular pressure: new perspectives. Surv Ophthalmol 1990; 34: 413–435.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Carbonaro, F., Andrew, T., Mackey, D. et al. Comparison of three methods of intraocular pressure measurement and their relation to central corneal thickness. Eye 24, 1165–1170 (2010). https://doi.org/10.1038/eye.2010.11
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2010.11
Keywords
This article is cited by
-
The alterations of corneal biomechanics in adult patients with corneal dystrophy
Eye (2023)
-
Comparison of Goldmann applanation and Ocular Response Analyser tonometry: intraocular pressure agreement and patient preference
Eye (2020)
-
Genome-wide analysis of multi-ancestry cohorts identifies new loci influencing intraocular pressure and susceptibility to glaucoma
Nature Genetics (2014)
-
Age variations in intraocular pressure in a cohort of healthy Austrian school children
Eye (2012)
-
The influence of soft contact lenses on the intraocular pressure measurement
Eye (2012)
