How accurate are Goldmann applanation tonometry (GAT) correction equations, and is there an association between glaucoma stage and discordance of GAT and dynamic contour tonometry intraocular pressure readings?
In this cross-sectional case series, GAT measurements were discordant from dynamic contour tonometry measurements in eyes with thin corneas and advanced glaucoma.
In the management of patients with glaucoma, measurement inaccuracy associated with GAT must be taken into account, but GAT correction equations still involve the risk of unpredictable measurement errors.
Accurate determination of intraocular pressure (IOP) is crucial for the diagnosis and management of glaucoma. Objective clinical evaluation of the correction equations for Goldmann applanation tonometry (GAT) is lacking.
To investigate the difference between corrected and conventional GAT and Pascal dynamic contour tonometry (DCT) measurements, as well as the correlation between discordant IOP values and stage of glaucoma.
Design, Setting, and Participants
This prospective cross-sectional case series was conducted at the Department of Ophthalmology, University Hospital Zurich, and Talacker Eye Center between July 1, 2011, and May 31, 2016, among 112 white patients with glaucoma.
Intraocular pressure measurements were performed with GAT and DCT in a randomized order. Goldmann applanation tonometry measurements were modified with 5 correction equations.
Main Outcomes and Measures
The primary end point was degree of concordance between corrected or uncorrected GAT and DCT measurements. The secondary end point was association between discordant IOP measurements and the stage of glaucoma, as assessed by the Glaucoma Severity Score.
Among the 112 patients (67 women and 45 men; mean [SD] age, 66.3 [13.1] years), 63 of the eyes in the study (56.3%) were left eyes and 85 patients (75.9%) were taking ocular antihypertensive medications. Mean (SD) IOP was 20.3 (4.5) mm Hg (95% CI, 19.4-21.1) as measured by DCT and 17.0 [4.1] mm Hg (95% CI, 16.3-17.8) as measured by GAT. The mean (SD) discordance between DCT and GAT measurements was –3.3 (2.0) mm Hg (95% CI, 2.9-3.6). The 5 corrected GAT values ranged from –2.7 to –5.4 mm Hg compared with DCT. The mean (SD) result of the Dresdner correction formula (17.6 [4.1] mm Hg) was closer to the DCT measurement than the original GAT measurement. The mean (SD) Glaucoma Severity Score was 4.7 (3.4) (95% CI, 4.1-5.4). The uncorrected discordance IOPDCT – IOPGAT showed a positive correlation with the Glaucoma Severity Score (rs = 0.33; P < .001) and a negative correlation with central corneal thickness (rs = –0.22; P = .02).
Conclusions and Relevance
In comparison with DCT measurements, these data suggest that GAT values are significantly discordant in eyes with thin corneas and advanced glaucoma. Application of GAT-based correction formulas involves a possible risk of creating an even greater number of unpredictable measurement errors. Hence, we advise with caution, especially pertaining to eyes with thin corneas, to not place reliance on GAT readings, and abandon any correction formula.
clinicaltrials.gov Identifier: NCT01474070.
Josephine Wachtl, Marc Töteberg-Harms, Sonja Frimmel, Malgorzata Roos, Christoph Kniestedt. Correlation Between Dynamic Contour Tonometry, Uncorrected and Corrected Goldmann Applanation Tonometry, and Stage of Glaucoma. JAMA Ophthalmol. 2017;135(6):601–608. doi:10.1001/jamaophthalmol.2017.1012