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MEASUREMENT OF IOP IN KERATOCONIC EYES USING THE OCULAR RESPONSE ANALYZER AND GOLDMANN APPLANATION TONOMETRY

MEASUREMENT OF IOP IN KERATOCONIC EYES USING THE OCULAR RESPONSE ANALYZER AND GOLDMANN APPLANATION TONOMETRY. Yakov Goldich MD,Yaniv Barkana MD, Isaac Avni MD, David Zadok MD, Department of Ophthalmology Assaf Harofeh Medical Center Israel.

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MEASUREMENT OF IOP IN KERATOCONIC EYES USING THE OCULAR RESPONSE ANALYZER AND GOLDMANN APPLANATION TONOMETRY

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  1. MEASUREMENT OF IOP IN KERATOCONIC EYES USING THE OCULAR RESPONSE ANALYZER AND GOLDMANN APPLANATION TONOMETRY Yakov Goldich MD,Yaniv Barkana MD, Isaac Avni MD, David Zadok MD, Department of Ophthalmology Assaf Harofeh Medical Center Israel The authors have no conflicts of interest and no financial interest in the article’s subject matter or methods mentioned.

  2. Background • Keratoconus (KC) is an ectatic progressive corneal disorder characterized by irregular astigmatism, corneal thinning, and altered corneal viscoelasticity. • IOP measurements dependent on various corneal properties, including corneal thickness, viscoelasticity and curvature.1 1. Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Survey of ophthalmology 1993;38:1-30

  3. Background • Accurate IOP measurement using traditional Goldmann applanation tonometer (GAT) in keratoconic eyes is challengeable.2 • Ocular Response Analyzer (ORA; Reichert Inc, Depew, NY) is a new non-contact tonometer that provides assessment of IOPthat is less affected by corneal properties and presented by the Goldmann correlated IOP (IOPg) and corneal compensated IOP (IOPcc). 2. Mark HH, Mark TL. Corneal astigmatism in applanation tonometry. Eye 2003;17:617-618

  4. Purpose • To compare IOP measurements by GAT and ORA in keratoconic eyes, and examine their correlation with several ocular parameters.

  5. Methods • One hundred and two eyes of 59 patients with KC (39 M, 20 F, mean age 27.8 ± 6.8 years) were included. • The following parameters were assessed: • Visual acuity • Refractive error • Axial length with IOL Master • Computerized corneal topography (TMS-2N, Tomey) • Non-contact IOP with ORA • Central corneal thickness with US pachymetry • IOP with Goldmann applanation tonometer

  6. Results

  7. FIGURE 1. Box and whisker plots (smallest, median and largest values with interquartile range) showing corneal-compensated intraocular pressure (IOPcc); Goldmann-correlated intraocular pressure (IOPg); and Goldmann applanation tonometer intraocular pressure (GAT). The mean GAT IOP was 10.9 ± 2.0 mmHg, mean IOPg was 9.5 ± 2.8 (P < 0.0001) and mean IOPcc was 13.3 ± 2.5 (P < 0.0001) Results

  8. Results FIGURE 2. Bland-Altmann plot of Goldmann applanation tonometer intraocular pressure (GAT) minus corneal-compensated intraocular pressure (IOPcc) versus the mean of both (dotted line). Mean difference = -2.4 ± 2.6 mmHg, 95% limits of agreement = -7.5 to 2.8 mmHg

  9. Results FIGURE 3. Bland-Altmann plot of Goldmann applanation tonometer intraocular pressure (GAT) minus Goldmann-correlated intraocular pressure (IOPg) versus the mean of both (dotted line). Mean difference = 1.4 ± 2.7 mmHg, 95% limits of agreement = -3.9 to 6.8 mmHg .

  10. Results

  11. Conclusions • While measured GAT, IOPcc and IOPg values were all correlated, mean IOPcc was significantly higher and mean IOPg was significantly lower than GAT values. • ORA measured IOP showed more dependency on cornealproperties than GAT. • We recommend these devices should not be used interchangeably but rather complimentary in assessing intraocular pressure inkeratoconic eyes. Correspondence: Yakov Goldich MD,E-mail: doctor.goldich@gmail.com

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