Elsevier

Ophthalmology

Volume 119, Issue 8, August 2012, Pages 1552-1557
Ophthalmology

Original article
Systematic Review of the Agreement of Tonometers with Goldmann Applanation Tonometry

https://doi.org/10.1016/j.ophtha.2012.02.030Get rights and content

Objective

To assess the agreement of tonometers available for clinical practice with the Goldmann applanation tonometer (GAT), the most commonly accepted reference device.

Design

A systematic review and meta-analysis of directly comparative studies assessing the agreement of 1 or more tonometers with the reference tonometer (GAT).

Participants

A total of 11 582 participants (15 525 eyes) were included.

Methods

Summary 95% limits of agreement (LoA) were produced for each comparison.

Main Outcome Measures

Agreement, recordability, and reliability.

Results

A total of 102 studies, including 130 paired comparisons, were included, representing 8 tonometers: dynamic contour tonometer, noncontact tonometer (NCT), ocular response analyzer, Ocuton S, handheld applanation tonometer (HAT), rebound tonometer, transpalpebral tonometer, and Tono-Pen. The agreement (95% limits) seemed to vary across tonometers: 0.2 mmHg (−3.8 to 4.3 mmHg) for the NCT to 2.7 mmHg (−4.1 to 9.6 mmHg) for the Ocuton S. The estimated proportion within 2 mmHg of the GAT ranged from 33% (Ocuton S) to 66% and 59% (NCT and HAT, respectively). Substantial inter- and intraobserver variability were observed for all tonometers.

Conclusions

The NCT and HAT seem to achieve a measurement closest to the GAT. However, there was substantial variability in measurements both within and between studies.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

Directly comparative studies, that is, those that assessed the agreement of 1 or more tonometers, compared with the reference standard tonometer (GAT) in the same group of people (paired data) were included. Clinic (e.g., case-control and cohort design) and population (e.g., cross-sectional) studies were eligible provided they incorporated paired data for the GAT and at least 1 other tonometer that could be used in clinical practice. The following tonometers were not included because they were

Results

A total of 642 titles and abstracts were identified from the search, of which 143 were selected for full text assessment. An additional 46 potentially eligible studies were identified from the reference lists of included studies. In total, full text of 189 studies were assessed. A total of 102 studies (130 paired comparisons) involving 11 582 participants (15 525 eyes) were included in the review. Studies included a variety of individuals: both patient and nondiseased cases, some with treatment

Discussion

We identified a large body of evidence comparing tonometers with the GAT. However, poor reporting limited the assessment of the quality of the included studies and the synthesis of the evidence.

The results of this study suggest that, when compared with the GAT, the NCT was the tonometer with the least amount of variability in IOP. Approximately two thirds of measurements with the NCT were estimated to be within 2 mmHg of the GAT measurement. The second lowest variability was observed for the

Acknowledgment

The authors thank Aachal Kotecha for helpful comments on a draft document on which this article was based.

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Manuscript no. 2011-687.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Funding: This review was part of the Surveillance for Ocular Hypertension study funded by the UK National Institute for Health Research Health Technology Assessment Programme (Project No. 07/46/02). J.C. held a Medical Research Council UK fellowship (G0601938). AA-B was a grantholder on an AstraZeneca (London, UK) funded study of a new medication for glaucoma. The Health Services Research Unit receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. Views and opinions expressed are those of the authors and do not necessarily reflect those of the Chief Scientist Office, National Institute for Health Research Health Technology Assessment Programme, or the Department of Health. None of the funders had a role in the design or conduct of this research.

Group members listed online (available at http://aaojournal.org).

View full text