Goldmann applanation tonometry compared with corneal-compensated intraocular pressure in the evaluation of primary open-angle Glaucoma

Abstract

BackgroundTo better understand the role of corneal properties and intraocular pressure (IOP) in the evaluation of primary open-angle glaucoma (POAG); and to determine the feasibility of identifying glaucomatous optic neuropathy (GON) using IOP corrected and uncorrected for corneal biomechanics.MethodsRecords from 1,875 eyes of consecutively evaluated new patients were reviewed. Eyes were excluded if central corneal thickness (CCT) or Ocular Response Analyzer (ORA) measurements were unavailable. Presence or absence of GON was determined based on morphology of the optic disc, rim and retinal nerve fiber layer at the time of clinical examination, fundus photography and Heidelberg Retinal Tomography. Goldmann-applanation tonometry (GAT) in the untreated state was recorded and Goldmann-correlated (IOPg) and corneal-compensated IOP (IOPcc) were obtained using the ORA. Glaucomatous eyes were classified as normal or high-tension (NTG, HTG) using the conventional cutoff of 21 mm Hg. One eligible eye was randomly selected from each patient for inclusion.ResultsA total of 357 normal, 155 HTG and 102 NTG eyes were included. Among NTG eyes, IOPcc was greater than GAT (19.8 and 14.4 mm Hg; p < 0.001) and the difference between IOPcc and GAT was greatest for this subgroup of patients with NTG (p ≤ 0.01). The maximum combined sensitivity and specificity for detection of GON occurred at 20.9 mm Hg for GAT (59%, 90%) and 18.4 mm Hg for IOPcc (85%, 85%) and the area under the curve was greater for IOPcc (0.93 vs. 0.78; p < 0.001).ConclusionsIOPcc may account for measurement error induced by corneal biomechanics. Compared to GAT, IOPcc may be a superior test in the evaluation of glaucoma but is unlikely to represent an effective diagnostic test.

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“…The ocular examination was based on visual acquity control (reading of an optotype from a distance of 5 meters), tonometry with a Goldmann’s applanation tonometer [ 29 ] after application of a local anesthetic (hydrochloric proxymetacaine 0.5%), and fundoscopy after the application of tropicamide solution 0.5% and of the a-adrenergic stimulator phenylefrine in a solution of 5%. The examination was concluded with a control of visual fields in a static perimetry apparatus type Octopus 900 (Haag-Streit, Switzerland).…”

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“…1 Consequently, greater accuracy and less confounding in IOP measurement should have value in the management of most glaucomas. 2 The ideal tonometer in the clinical setting needs to be accurate in normal and disease states, minimally invasive to the patient and ocular surface, suitable to use in all patients including children and uncooperative or wheel-chair bound patients, easy to use by all levels of clinical staff, robust and portable from room to room. No current device fulfills all these criteria.…”

Alterations in Biomechanical Properties of the Cornea After Selective Laser Trabeculoplasty

“…and decrease IOP with different treatment methods (2,3). Goldmann applanation tonometry (GAT) remains the gold standard for IOP measurement, but new methods such as those using ocular response analyzer (ORA) are being developed for more accurate IOP measurements (4)(5)(6). In addition to anti-glaucoma eye drops used to reduce IOP, treatment methods such as selective laser trabeculoplasty have been used in recent years (3,7).…”