Comparison of Three Different Tonometers in Eyes with Angle Closure

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Abstract
Supplemental digital content is available in the text. SIGNIFICANCE: Precise measurement of intraocular pressure (IOP) is essential when diagnosing and managing glaucoma. We compared the IOP readings of three different tonometers and analyzed agreement among tonometers in eyes with high IOPs. PURPOSE: The purpose of this study was to compare the IOP readings obtained using a Goldmann applanation tonometer (GAT), a rebound tonometer (RT), and a Tono‐Pen (TP) in angle‐closure eyes with elevated IOP before and after medical IOP‐lowering therapy. METHODS: Twenty‐five eyes of 25 patients with angle closure and IOPs of greater than 30 mmHg were enrolled. Intraocular pressure was measured using RT (iCare Pro), TP (Tono‐Pen XL), and GAT before and after medical treatment. The mean IOP readings of the tonometers were compared before and after treatment. The agreement among the tonometers was assessed via Bland‐Altman analysis. RESULTS: The measurements from 22 eyes of 22 patients were suitable for statistical analyses. Before medical treatment, the mean TP‐IOP was significantly lower than the mean GAT‐IOP (44.0 ± 10.3 vs. 50.4 ± 8.9 mmHg, respectively; P <. 001), but no significant difference was evident between the RT‐IOP and the GAT‐IOP (50.8 ± 10.9 vs. 50.4 ± 8.9 mmHg, respectively; P =. 79). After IOP‐lowering treatment, the mean GAT‐IOP (14.9 ± 4.7 mmHg) did not differ from either the mean RT‐IOP (15.6 ± 4.4 mmHg) or the mean TP‐IOP (15.4 ± 5.0 mmHg; P =. 05 and P =. 18, respectively). The random measurement error among tonometers was greater for high IOP readings. CONCLUSIONS: Compared with RT or GAT, TP underestimated IOP in angle‐closure eyes with a GAT‐IOP of greater than 30 mmHg. Intraocular pressure reading agreement among the three tonometers was lower in eyes with high IOP.

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