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Accuracy of Goldmann, ocular response analyser, Pascal and TonoPen XL tonometry in keratoconic and normal eyes
  1. S P Mollan1,
  2. J S Wolffsohn2,
  3. M Nessim1,
  4. M Laiquzzaman3,
  5. S Sivakumar3,
  6. S Hartley1,3,
  7. S Shah1,2,3
  1. 1
    Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK
  2. 2
    Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, UK
  3. 3
    Heart of England NHS Foundation Trust, Solihull Hospital, Birmingham, UK
  1. Miss S P Mollan, Birmingham and Midland Eye Centre, City Hospital, Birmingham B18 7QH, UK; soozmollan{at}


Aim: The aim of this study was to evaluate the practicality and accuracy of tonometers used in routine clinical practice for established keratoconus (KC).

Methods: This was a prospective study of 118 normal and 76 keratoconic eyes where intraocular pressure (IOP) was measured in random order using the Goldman applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), Reichert ocular response analyser (ORA) and TonoPen XL tonometer. Corneal hysteresis (CH) and corneal resistance factor (CRF), as calculated by the ORA, were recorded. Central corneal thickness (CCT) was measured using an ultrasound pachymeter.

Results: The difference in IOP values between instruments was highly significant in both study groups (p<0.001). All other IOP measures were significantly higher than those for GAT, except for the Goldmann-correlated IOP (average of the two applanation pressure points) (IOPg) as measured by ORA in the control group and the CH-corrected IOP (corneal-compensated IOP value) (IOPcc) measures in the KC group. CCT, CH and CRF were significantly less in the KC group (p<0.001). Apart from the DCT, all techniques tended to measure IOP higher in eyes with thicker corneas.

Conclusion: The DCT and the ORA are currently the most appropriate tonometers to use in KC for the measurement of IOPcc. Corneal factors such as CH and CRT may be of more importance than CCT in causing inaccuracies in applanation tonometry techniques.

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  • Competing interests: All authors declare that he/she has no proprietary or commercial interest in the development or marketing of any instrument. No grants or funds were used for the preparation of this manuscript. The ocular response analyser and Pascal dynamic contour tonometer were given on loan to the department for the purposes of research.

  • Ethics approval: Local ethics committee approval was obtained for this study. The tenets of the Declaration of Helsinki were observed.

  • Patient consent: Obtained.

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