Jerrome Selvaraj, Joseph Sanil, Niranjana Balasubramaniam, Arkaprava Majumdar, Lakshmanan Pooludaiyar, Balagiri Sundar, Kumaragurupari Thandavarayan, Vidya S, Senthilkumar Vijayalakshmi A, Krishnadas Subbaiah R
Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.
Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.
Ophthalmol Glaucoma. 2025 May-Jun;8(3):242-256. doi: 10.1016/j.ogla.2024.11.001. Epub 2024 Nov 12.
The systematic review and meta-analysis consolidates the extant body of evidence comparing reliability and agreement between transpalpebral tonometers (TTs) and Goldmann applanation tonometer (GAT).
With a global prevalence of 3.54 percent, glaucoma stands as the second leading cause of preventable blindness. Projections indicate a rise to 111 million cases by 2040. Existing literature presents inconsistent findings while comparing TT and GAT. The derivation of summary estimates assessing their agreement holds significance, given TT's multifaceted applicability in clinical, community, and home settings.
Systematic review was conducted using PubMed, Cochrane Library, and Google Scholar from January 2000 to December 2022. Two reviewers independently evaluated, enumerated, and extracted studies and data based on eligibility criteria. The Quality Assessment for Diagnostic Accuracy Studies checklist was used to assess study quality. The summary measures were pooled using the random-effects model as mean difference (MD), and 95% limits of agreement (LoA). We assessed heterogeneity using the I statistic. The study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42022321693).
A total of 26 methods comparison studies (3577 eyes) were included in the meta-analysis. The overall random-effects MD (TT - GAT) and standard deviation (SD) for intraocular pressure (IOP) were -0.70 ± 4.32 mmHg (95% LoA: -8.74 to 7.33 mmHg). In the subgroup analysis based on index test devices used, Easyton showed the lowest MD, SD, (-0.29 ± 2.35 mmHg), and 95% LoA (-4.90 to 4.32 mmHg). In the univariate meta-regression model, we found that, on average, studies examining normal eyes reported a statistically significant lower MD of 2.67 mmHg (95% confidence interval: 0.27-5.07 mmHg; P = 0.03) between TT and GAT, compared to studies that assessed eyes with mixed ocular condition.
In the current meta-analysis, we found a small MD in the measured IOP between the 2 tonometers. However, given the high heterogeneity and a wider LoA, it is not advisable to use TT interchangeably with GAT.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
本系统评价和荟萃分析整合了现有证据，比较经睑眼压计（TTs）与Goldmann压平眼压计（GAT）之间的可靠性和一致性。
青光眼全球患病率为3.54%，是可预防失明的第二大主要原因。预计到2040年病例数将增至1.11亿例。现有文献在比较TT和GAT时结果不一致。鉴于TT在临床、社区和家庭环境中的多方面适用性，得出评估它们一致性的汇总估计值具有重要意义。
于2000年1月至2022年12月使用PubMed、Cochrane图书馆和谷歌学术进行系统评价。两名评审员根据纳入标准独立评估、列举并提取研究和数据。使用诊断准确性研究质量评估清单评估研究质量。汇总测量值采用随机效应模型合并为平均差（MD）和95%一致性界限（LoA）。我们使用I统计量评估异质性。研究方案已在国际前瞻性系统评价注册库（CRD42022321693）注册。
荟萃分析共纳入26项方法比较研究（3577只眼）。眼压（IOP）的总体随机效应MD（TT - GAT）和标准差（SD）为-0.70±4.32 mmHg（95% LoA：-8.74至7.33 mmHg）。在基于所用指标测试设备的亚组分析中，Easyton的MD、SD最低（-0.29±2.35 mmHg），95% LoA为（-4.90至4.32 mmHg）。在单变量meta回归模型中，我们发现，与评估混合眼部情况的眼睛的研究相比，平均而言，检查正常眼睛的研究报告TT和GAT之间的MD在统计学上显著更低，为2.67 mmHg（95%置信区间：0.27 - 5.07 mmHg；P = 0.03）。
在当前的荟萃分析中，我们发现两种眼压计测量的眼压存在较小的MD。然而，鉴于高异质性和较宽的LoA，不宜将TT与GAT互换使用。
作者对本文讨论的任何材料均无所有权或商业利益。
