Central corneal thickness: will one measurement suffice?

OBJECTIVE

To evaluate the measurement of central corneal thickness (CCT) in a cohort of glaucoma patients over a 3-month period. Measurements were then applied to the criteria described in the Ocular Hypertension Treatment Study (OHTS).

DESIGN

Cohort study.

PARTICIPANTS AND METHODS

Fifty-one patients were recruited from a glaucoma clinic at Moorfields Eye Hospital. Central corneal thickness was measured using an ultrasonic handheld pachymeter by a trained observer. Patients' CCTs were measured at 2 consecutive clinic visits.

MAIN OUTCOME MEASURE

Mean central corneal thickness.

RESULTS

The readings showed clear fluctuation over the 3-month period, with a mean difference in corneal thickness of 9.6+/-26.9 microm in the right eye and 19.0+/-29.2 microm in the left eye. In addition, there was a systematic bias towards increased corneal thickness being recorded at the second reading in both eyes. This reached statistical significance in both the right eye (P = 0.02) and the left eye (P = 0.0003). The criteria used to categorize the risk of patients developing glaucoma in the OHTS were then applied to these results. On the basis of the second reading, 32% of eyes required recategorization in both the right and left eyes.

CONCLUSIONS

Measurements of CCT taken within a clinical setting by a trained observer may show significant variability. For CCT to become a valuable addition to the assessment of glaucoma suspects, more than one reading may be required. Failure to do so may result in misclassification and, thus, an inaccurate assignment of risk.