Keller William J, Haytac Pinar, Nazarian Taline, Chawla Kareena, Chang Jonghoon
Department of Medical Education, Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL.
College of Optometry, Nova Southeastern University, Fort Lauderdale, FL.
Medicine (Baltimore). 2025 May 2;104(18):e42302. doi: 10.1097/MD.0000000000042302.
Identification of increased intraocular pressure has been conventionally limited by direct, corneal applanation, and indentation measurement procedures, conducted by highly trained eye-care specialists e.g. optometrists and ophthalmologists. This practice greatly limits the numbers of individuals which can and need to be screened, for increased intraocular pressures. Increased intraocular pressure is the second leading cause of preventable, irreversible blindness throughout the world and a major modifiable risk factor for the development and progression of glaucoma. Current screening practices are inadequate, leaving many undetected, resulting in high base-rates of unnecessary and preventable blindness worldwide. Three primary research questions are investigated: Can intraocular pressures be measured through the eyelid, using the Tono-Pen XL tonometer? If yes, can the transpalpebral values be transformed to approximate corneal values? If yes, are the transformed values sufficiently precise, accurate, and reliable to substitute for intraocular pressure values measured directly from the cornea, for screening purposes?. Ninety (n = 90), healthy, young, adults completed measurement of intraocular pressures, from each eye (n = 180 eyes), using the Tono-Pen XL tonometer. Intraocular pressures were measured directly from the cornea and then directly from the closed eyelid. Transpalpebral measurements were transformed by simple linear regression to estimate direct corneal measurements. Transformed values were assessed for accuracy, precision, reliability, and agreement with direct corneal measurements. Findings revealed high accuracy, precision, reliability, and agreement between direct corneal and transpalpebral measurements. Transformed transpalpebral measurements correctly classified 95% and 93% of subjects, within 4 mm Hg or less of direct corneal measurements, when intraocular pressures were measured from the right and left eyes, respectively. Intraocular pressures measured directly from the closed eyelid, using the Tono-Pen XL, can be linearly transformed, using simple linear regression, to estimate intraocular pressure values measured directly from the cornea with high agreement, precision, and reliability, in a healthy, young, adult population. Findings have implications for non-eye-care specialists e.g. primary care physicians, choosing to quickly, accurately, and reliably screen individuals for normal intraocular pressures, without the need to anesthetize the eyes or use expensive, office-bound. equipment.
眼内压升高的识别传统上受限于由训练有素的眼保健专家（如验光师和眼科医生）进行的直接、角膜压平及压陷测量程序。这种做法极大地限制了能够且需要进行眼内压升高筛查的人数。眼内压升高是全球可预防的不可逆失明的第二大主要原因，也是青光眼发生和发展的一个主要可改变风险因素。当前的筛查方法并不充分，导致许多病例未被发现，在全球范围内造成了不必要且可预防失明的高基数。研究了三个主要研究问题：能否使用Tono-Pen XL眼压计通过眼睑测量眼内压？如果可以，经睑测量值能否转换为近似角膜测量值？如果可以，转换后的值在精度、准确性和可靠性方面是否足以替代直接从角膜测量的眼内压值用于筛查目的？九十名（n = 90）健康的年轻成年人使用Tono-Pen XL眼压计对每只眼睛（n = 180只眼睛）进行了眼内压测量。直接从角膜测量眼内压，然后直接从闭合的眼睑测量。经睑测量值通过简单线性回归进行转换以估计直接角膜测量值。评估转换后的值的准确性、精度、可靠性以及与直接角膜测量值的一致性。研究结果显示直接角膜测量值与经睑测量值之间具有高准确性、精度、可靠性和一致性。当分别从右眼和左眼测量眼内压时，转换后的经睑测量值在直接角膜测量值的4毫米汞柱或以内正确分类了95%和93%的受试者。在健康的年轻成年人群中，使用Tono-Pen XL直接从闭合眼睑测量的眼内压可以通过简单线性回归进行线性转换，以高度一致、精度和可靠性估计直接从角膜测量的眼内压值。研究结果对非眼保健专家（如初级保健医生）具有启示意义，他们可以选择快速、准确且可靠地对个体进行正常眼内压筛查，而无需麻醉眼睛或使用昂贵的、需在办公室使用的设备。
