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Comparison of the Icare rebound tonometry with the Goldmann applanation tonometry in a pediatric population

https://doi.org/10.1016/j.jaapos.2015.08.009Get rights and content

We report the results of a comparative study at a single center on 214 eyes of 109 pediatric patients in whom IOP was measured using the Icare rebound tonometer and Goldmann applanation tonometry. Measurements from the two modalities demonstrated a correlation coefficient of 0.83 (P < 0.001), with Icare measuring on average 1.38 mm Hg higher. Compared to Goldmann, the Icare was more easily tolerated in the children studied. In 37 eyes that tolerated pachymetry, central corneal thickness was positively correlated with Icare measurements.

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Subjects and Methods

This prospective comparative study was approved by the Institutional Review Board at Children's Mercy Hospital, Kansas City. Consecutive children (under 18 years of age) who presented at the Children's Mercy Hospital eye clinic between 2010 and 2011 were enrolled. Five eye care providers and 10 ophthalmic technicians were involved in data collection. Subjects were excluded if IOP was not measured by both instruments in at least one eye; therefore, children unable to cooperate for GAT were

Results

A total of 119 children were enrolled (mean age, 11.96 ± 2.7 years; range, 7.0-17.0 years), and 214 eyes of 108 children were included in the data analysis. Eleven children who tolerated Icare but not GAT were excluded; 2 children who tolerated Icare in both eyes but GAT in only 1 eye were included only for the eye with both measurements. Fourteen patients (13%) had glaucoma and 3 (2.7%) were glaucoma suspects. The rest of the children were naive to IOP measurements. The GAT tolerance was 90%

Discussion

This prospective study compared IOPs measured by Icare and GAT in a series of 119 consecutive pediatric subjects, in whom Icare tonometry was better tolerated than GAT.

IOP measured by Icare and by GAT correlated consistently. Icare readings were higher than GAT by an average of 1.38 mm Hg. Though statistically significant, this difference was clinically insignificant (within 3 mm Hg) in 72.42% of eyes (155/214). The difference in IOP measurements is likely due to device and not to patient

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    Patients were divided into two groups: normal RBT value ≤24 mm Hg and elevated RBT value >24 mm Hg. The standard of 24 mm Hg was decided based on prior data indicating that RBT usually measures 2–3 mm Hg higher than Goldmann tonometry.6 Within each group, we identified the subset of patients who had a second IOP measurement.

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    2020, Journal of AAPOS
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    Mean IOP in the present study was 15.1 ± 2.5 mm Hg and 15.2 ± 2.5 mm Hg in the right and left eyes, respectively. The normal distribution of IOP in children and its associations with other ocular and nonocular parameters have been examined in previous investigations.1,2,5-14 Some of these studies had limitations such as hospital-based study design and relatively small study cohort.

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    The advent of drop-free rebound tonometry has made it much easier to obtain awake IOP readings in children with glaucoma. The Icare has been compared to Goldmann tonometry and found to measure on average from 1.4–3.3 mm Hg higher than the current gold standard.6,10,11 Previous studies have also shown the feasibility of monitoring IOP in children at home using this technology over a short period.

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