Glaucoma Research Unit, The National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
Ophthalmology. 2010 Apr;117(4):730-7. doi: 10.1016/j.ophtha.2009.09.020. Epub 2010 Feb 1.
To examine the repeatability and reproducibility of intraocular pressure (IOP) measurements obtained with the Goldmann applanation tonometer (GAT), the Pascal dynamic contour tonometer (DCT; Swiss Microtechnology AG, Port, Switzerland), and the Reichert Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY). A secondary objective was to assess agreement between the devices.
Evaluation of technology.
One hundred participants; a mixture of glaucoma suspects, patients, and control volunteers.
The IOP measurements were obtained with the GAT, DCT, and ORA by 2 of 3 experienced clinicians. Keratometry (CC) measurements were made using the IOLMaster (Carl Zeiss Meditech, AG, Jena, Germany). Three ORA corneal compensated IOP (IOPcc) measurements were obtained before the instillation of anesthesia, after which 2 GAT IOP and 3 DCT IOP measurements were obtained in a randomized order. Central corneal thickness (CCT) was measured using an ultrasound pachymeter. The average ORA corneal response factor (CRF) and the average DCT ocular pulse amplitude (OPA) were determined. Intraobserver variability was calculated by the repeatability coefficient. Interobserver variability (measurement reproducibility) and device agreement were calculated by Bland-Altman analysis (mean difference [bias] and 95% limits of agreement [LoA]). The effect of corneal characteristics (CC, CCT, and CRF) on the IOP measurement differences between tonometers also was determined.
Repeatability and reproducibility of the GAT, DCT, and ORA IOPcc and agreement between tonometers.
The repeatability coefficients for GAT, DCT, and ORA were 2.2, 2.3, and 4.3 mmHg, respectively. The intraobserver variability of ORA measurements was shown to be significantly associated with OPA and to a lesser degree with the quality of ORA waveform scans. The interobserver bias (95% LoA) was -0.8 (+/-3.9) mmHg for GAT -0.2 (+/-2.8) mmHg for DCT and -0.3 (+/-3.9) mmHg for ORA IOPcc. On average, GAT under-read both DCT and ORA IOP measurements by approximately 2 mmHg. The IOP measurement differences were better predicted by CRF than CCT.
The DCT shows excellent measurement precision, displaying the best repeatability and reproducibility of the 3 tonometers. Corneal stiffness, as defined using CRF, was associated significantly with agreement between devices. The IOP measurements with each device are not interchangeable.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
评估 Goldmann 压平眼压计（GAT）、Pascal 动态轮廓眼压计（DCT；瑞士微电子技术公司，Port，瑞士）和 Reichert 眼反应分析仪（ORA；Reichert 眼科仪器公司，Buffalo，NY）测量的眼压（IOP）的重复性和可再现性。次要目的是评估设备之间的一致性。
技术评估。
100 名参与者；包括青光眼疑似患者、患者和对照志愿者的混合人群。
由 3 名经验丰富的临床医生中的 2 名使用 GAT、DCT 和 ORA 进行 IOP 测量。使用 IOLMaster（卡尔蔡司医疗技术公司，AG，耶拿，德国）进行角膜曲率（CC）测量。在麻醉前进行 3 次 ORA 角膜补偿眼压（IOPcc）测量，之后以随机顺序进行 2 次 GAT IOP 和 3 次 DCT IOP 测量。使用超声角膜测厚仪测量中央角膜厚度（CCT）。确定平均 ORA 角膜响应因子（CRF）和平均 DCT 眼脉冲振幅（OPA）。通过重复性系数计算观察者内变异性。通过 Bland-Altman 分析（平均差异[偏倚]和 95%一致性界限[LoA]）计算观察者间变异性（测量可再现性）和设备一致性。还确定了角膜特性（CC、CCT 和 CRF）对眼压计之间眼压测量差异的影响。
GAT、DCT 和 ORA IOPcc 的重复性和可再现性以及眼压计之间的一致性。
GAT、DCT 和 ORA 的重复性系数分别为 2.2、2.3 和 4.3mmHg。ORA 测量的观察者内变异性与 OPA 显著相关，与 ORA 波形扫描质量的相关性较小。GAT 的观察者间偏差（95%LoA）为-0.8（+/-3.9）mmHg，DCT 为-0.2（+/-2.8）mmHg，ORA IOPcc 为-0.3（+/-3.9）mmHg。平均而言，GAT 低估了 DCT 和 ORA IOP 测量值约 2mmHg。CRF 比 CCT 更好地预测眼压测量值的差异。
DCT 显示出出色的测量精度，是 3 种眼压计中重复性和可再现性最好的。使用 CRF 定义的角膜硬度与设备之间的一致性显著相关。每个设备的眼压测量值不可互换。
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