Repeatability of intraocular pressure measurements with Icare PRO rebound, Tono-Pen AVIA, and Goldmann tonometers in sitting and reclining positions

Caterina Schweier, James V M Hanson, Jens Funk, Marc Töteberg-Harms, Caterina Schweier, James V M Hanson, Jens Funk, Marc Töteberg-Harms

Abstract

Background: Icare PRO (ICP) is a new Rebound tonometer that is able to measure intraocular pressure (IOP) in both sitting and reclining positions. In this study, the gold standard Goldmann tonometer (GAT) was compared to ICP and Tono-Pen AVIA (TPA). Hypothesis was that repeatability of GAT is superior to ICP and TPA.

Methods: 36 eyes of 36 healthy caucasian individuals, 13 male and 26 females, 17 right and 19 left eyes have been included in this prospective, randomized, cross-sectional study. The study was conducted at a single site (Dept. of Ophthalmology, University Hospital Zurich, Switzerland). Primary outcome measures were Intraclass correlation coefficients (ICC) and coefficients of variation (COV) and test-retest repeatability as visualized by Bland-Altman analysis. Secondary outcome measures were IOP in sitting (GAT, ICP and TPA) and in reclining (ICP and TPA) position.

Results: Mean IOP measured by GAT was 14.9 ± 3.5 mmHg. Mean IOP measured by ICP was 15.6 ± 3.1 mmHg (with TPA 14.8 ± 2.7 mmHg) in sitting and 16.5 ± 3.5 mmHg (with TPA 17.0 ± 3.0 mmHg) in reclining positions. COVs ranged from 2.9% (GAT) to 6.9% (ICP reclining) and ICCs from 0.819 (ICP reclining) to 0.972 (GAT).

Conclusions: Repeatability is good with all three devices. GAT has higher repeatability compared to the two tested hand-held devices with lowest COVs and highest ICCs. IOP was higher in the reclining compared to the sitting position.

Trial registration: The study was registered to the Clinical Trials Register of the US National Institute of Health, NCT01325324.

Figures

Figure 1
Figure 1
Bland-Altman plots to demonstrate repeatability in measuring IOP (mmHg) between reading 1 and 2 with all devices (GAT a, ICP b and c and TPA d and e) and positions (sitting b and d and reclining c and e). Limits of agreement were provided as 1.96-times standard deviation with upper and lower limit of the differences. Units for both axes are mmHg. (GAT = Goldmann-Applanation-Tonometer, ICP = Icare PRO, TPA = Tono-Pen AVIA, SD = Standard deviation, S = sitting, R = reclining).
Figure 2
Figure 2
Bland-Altman plots to demonstrate differences in mean IOP (mmHg) between Goldmann-Applanation-Tonometer and the two hand-held devices separately for both positions (sitting and reclining), Icare PRO (a, b) and Tono-Pen AVIA (c, d). Limits of agreement were provided as 1.96-times standard deviation with upper and lower limit of the differences. Units for both axes are mmHg. (GAT = Goldmann-Applanation-Tonometer, ICP = Icare PRO, TPA = Tono-Pen AVIA, SD = Standard deviation, M = mean, S = sitting, R = reclining).
Figure 3
Figure 3
Bland-Altman plots to demonstrate differences in IOP (mmHg) between sitting and reclining positions within the two hand-held tonometers, Icare PRO (a) and Tono-Pen AVIA (b). Limits of agreement were provided as 1.96-times standard deviation with upper and lower limit of the differences. Units for both axes are mmHg. (ICP = Icare PRO, TPA = Tono-Pen AVIA, SD = Standard deviation, M = mean, S = sitting, R = reclining).

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