Prospective Comparative Analysis of 4 Different Intraocular Pressure Measurement Techniques and Their Effects on Pressure Readings

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To compare intraocular pressure (IOP) measurement using the Goldmann applanation tonometry (GAT) without fluorescein, with fluorescein strips, with fluorescein droplets, and IOP measurement with Tono-Pen Avia (TPA).

Patients and Methods:

This was a prospective comparative clinical analysis. It was performed in clinical practice. The study population consisted of 40 volunteer patients, 1 eye per patient. All patients who were 18 years and older having routine ophthalmological examination were eligible to participate. Active corneal abrasions and/or ulcers, previous glaucoma surgery, or prostheses interfering with GAT measurement were excluded. GAT IOP was measured first without fluorescein, then with fluorescein strip, then with fluorescein droplet, and finally with the TPA device. The main outcome measure was central corneal IOP.


Mean±SD IOP measurements for GAT without fluorescein, with fluorescein strip, with fluorescein droplet, and for TPA groups were 12.65±3.01, 14.70±2.82, 15.78±2.64, and 16.33±3.08 mm Hg, respectively. Repeated-measures analysis of variance corrected with the Greenhouse-Geisser estimate ([Latin Small Letter Open E]=0.732) showed that measuring technique had a significant effect on IOP measurements (F2.20,85.59=34.66, P<0.001). The pairwise post hoc testing showed statistically significant mean differences (P≤0.001) between all techniques except when GAT with fluorescein droplet was compared with TPA (P=0.222). The Bland-Altman analyses showed 95% limits of agreement maximum potential discrepancies in measurement ranging from 5.89 mm Hg in the GAT with fluorescein strip versus droplet compared with 11.83 mm Hg in the GAT with fluorescein strip versus TPA comparison.


IOP measurement technique significantly impacted the values obtained. The ophthalmologist should ensure consistent measurement technique to minimize variability when following patients.

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