Comparison Of Diaton Tonometry And Non Contact Tonometry

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Information about Comparison Of Diaton Tonometry And Non Contact Tonometry
Health & Medicine

Published on March 16, 2009

Author: DevelopAll

Source: slideshare.net

Description

The purpose of this study was to compare
Intraocular Pressure (IOP) measurements
obtained with the Diaton Tonometer (DT) and
Non Contact Pneumotonometer (PT) in
normal eyes. The effect of central corneal
thickness (CCT) on IOP measurement using
both the tonometers was also evaluated.

260 AIOC 2008 PROCEEDINGS Comparison of Diaton Tonometry and Non Contact Tonometry in Indian Subjects Dr. Shaun Maria Dacosta, Dr. Babu Rajendran, Dr. Janakiraman P. (Presenting Author: Dr. Shaun Maria Dacosta) I ntraocular pressure is an important risk informed consent, the intraocular pressure was factor for the development of any form of measured first with the Non contact glaucoma. Measurement of intraocular pneumotonometer (CT-60 Computerized pressure has come a long way, since the use of Tonometer Topcon) and after an interval of 10 digital palpation of the upper lid, the earliest mins with the Diaton tonometer (BiCOM Inc.). method employed to approximately estimate Central corneal thickness (CCT) was measured the intraocular pressure. Currently, there are using Specular Microscope (SP-2000P several noncontact and contact tonometers Topcon).The average of three readings were available for intraocular measurement. With taken for the measurements obtained with the recent introduction of the Diaton Non contact pneumotonometer and Specular tonometer, intraocular pressure measurement Microscope. Left eyes were randomly chosen has come one full circle. However, the for the analysis. All patients who met the Goldman applanation tonometer is still inclusion criteria described below were considered the gold standard, despite the enrolled in this study. sources of error which significantly influence Each study participant underwent complete its readings1. ophthalmic examination including a medical Diaton tonometer is a non-contact (no contact history review, best corrected visual acuity with cornea), pen like, hand held, portable (Snellen’s visual acuity), slit lamp examination tonometer. It has the advantages of requiring and dilated fundus examination. no anaesthesia, avoids spread of infection and INCLUSION CRITERIA can be used in children2. To be included in the study, the subjects had The purpose of this study was to compare to have a refraction within ± 5.0 dioptres of Intraocular Pressure (IOP) measurements spherical equivalent, intraocular pressure d” obtained with the Diaton Tonometer (DT) and 21mmHg, no family history of glaucoma, no Non Contact Pneumotonometer (PT) in systemic illnesses, no history of lasers or normal eyes. The effect of central corneal ocular surgery and no anterior or posterior thickness (CCT) on IOP measurement using segment pathology. both the tonometers was also evaluated. DIATON TONOMETRY Materials and Methods The patient was placed in the supine position This study included 100 eyes of 100 normal and instructed to look a little downwards. The subjects selected randomly from the patient’s upper lid was stretched (without outpatients who attended our hospital. With pulling it or pressing the eyeball) so as to

GLAUCOMA SESSION- II 261 ensure that the edge of the upperlid coincided among the CCT groups. A value of less than with the superior limbus. After initialization 0.05 was considered to be statistically of the rod, the tonometer’s tip was placed significant. Bland-Altman plot was used to vertically on the cartilaginous part of the lid evaluate the agreement between IOP margin and parallel to it. The vertical position measurements obtained with PT and DT. of the tonometer was indicated by the lack of Results the sound signal, at which instance, the This study comprised of 48 males and 52 tonometer’s body was gently moved down females with a mean age of 42.58 ± 13.83 years. until the rod fell on the eyelid, which was The summary statistics are shown in Table 1. accompanied by a short sound signal. The The CCT was stratified into various groups measurements were repeated six times with an and the IOP measurements with both interval not more than 30secs, at the end of tonometers were analysed for the different which a single long signal or two long signals groups (Table 2). The Bland-Altman plot used were heard. The operation button was then for comparison of 2 methods (DT and PT) of pressed and the mean IOP value was displayed measurement of the same variable (IOP) is in nonflickering mode which indicated a shown in Figure 2. reliable result. STATISTICAL ANALYSIS Table-1: Summary statistics (N=100) Descriptive analysis including mean values Parameter Mean±Standard and standard deviation (SD) of the various Deviation Range parameters were performed. Paired t-test was Age 42.58±13.83 20-74 done to compare IOP measurements between PT IOP 17.72 ± 2.65 10-23 the two tonometers. One-way ANOVA was DT IOP 16.39 ± 4.84 6-25 performed for the comparison of means PT-DT IOP 1.35 ± 5.40 -10-15 CCT 518 ± 35 425-604 PT IOP = Pneumotonometry intraocular pressure; DT IOP =Diaton tonometry intraocular pressure; PT-DT IOP =difference between PT and DT Fig-1: Diaton Tonometer tonometry IOP; CCT = central corneal thickness. Discussion Currently, there are several instruments available for the measurement of intraocular pressure. Studies have shown that the intraocular pressure measurement obtained with most of these instruments is influenced by central corneal thickness by varying degrees 3. Diaton tonometer is a newly developed transpalpebral tonometer in which the ballistic principle of tonometry based on measuring the elastic reaction of the eye during the momentary influence of a free falling object with a definite weight is used. Fig-2: Bland—Altman plot of the agreement This study was conducted to compare the between Non Contact Pneumatonometry (PT) intraocular pressure measurements by the intraocular pressure measurements and Diaton Diaton tonometer and the Non contact Tonometry (DT) intraocular pressure pneumotonometer and to evaluate the measurements. The difference between the influence of central corneal thickness on measurements is plotted against the average of intraocular pressure measurements with these the measurements. Dashed lines represent 95% limits of agreement. instruments.

262 AIOC 2008 PROCEEDINGS Table-2: Comparison of Non Contact Pneumotonometry (PT), Diaton Tonometry (DT) and difference between PT and DT intraocular pressure measurements among Central Corneal Thickness Groups Pa value CCT Groups < 500 501-550 551-600 >600 PT (mm Hg) Mean (SD) 16.97 (2.82) 17.64 (2.33) 19.33 (2.35) 22.50 (0.71) 0.002 Median (range) 17 (10-23) 17 (12-22) 20 914-220 22.50 (22-23) DT (mm Hg) Mean (SD) 16.12 (4.85) 16.64 (4.84) 15.83 (5.41) 17.50 (3.54) 0.919 Median (range) 15 (8-25) 17 (6-25) 17.50 (6-22) 17.50 (15-20) PT-DT Mean (SD) 0.85 (5.64) 1.04 (5.29) 3.50 (5.33) 5.00 (2.83) 0.355 Median (range) 1 (-9 to 11) 0.00 (-10 to 15) 3 (-5 to 15) 1 (-10 to 15) PT IOP = Pneumotonometry intraocular pressure; DT IOP = Diaton tonometry IOP; PT-DT IOP = difference between PT and DT tonometry IOP; CCT = central corneal thickness. a One wa y ANOVA for comparison of means within the groups was done. Table 3: Results of multiple regression analysis of the association between intraocular pressure measurements with age and CCT Parameter PT IOP DT IOP Coefficient (Standard Error) P value Coefficient (Standard Error) P value Age 0.045 (0.018) 0.012 -0.008 (0.036) 0.823 CCT 0.028 (0.007) 0.000 0.007 (0.014) 0.638 PT IOP = Pneumotonometry IOP; DT IOP = Diaton tonometry IOP difference in the DT IOP’s (p = 0.919).In the We found the mean IOP by the Diaton present study, PT IOP measurements were tonometer (16.39±4.84 mm Hg) to be influenced significantly by CCT and age as statistically lower compared with the Non predicted by other studies6. However DT IOP contact pneumotonometer (17.72 ± 2.65mm measurements were not influenced Hg) (p = 0.01). However, studies have shown significantly by CCT and age. that the transpalpebral method of measuring IOP with the Diaton tonometer correlates well The Bland-Altman plot showed excellent with Goldmann Applanation and Tonopen 4,5. agreement between the DT and PT tonometers as indicated by the mean difference being near The mean CCT in our study was 518 ± 35. The zero and location of very few points outside the DT and PT IOP’s were highest for thicker upper and lower boundary limits (Figure 2). corneas (> 600µ). The difference between the 2 measurements was greatest in subjects with In conclusion, Diaton tonometer may be a thick corneas, gradually lessening as CCT clinically useful device for measuring IOP in decreased. Although there was a significant routine eye exams especially in patients after difference in the PT IOP’s among the various refractive surgery or with corneal pathology CCT groups (p = 0.002) there was no significant since Diaton does not applanate the cornea. References 1. Whitacre MM, Stein R. Sources of error with use 3. Brian A.Francis, Amy Hsieh, Mei-Ying Lai, of Goldmann-type tonometers. Surv Ophthalmol Vikas Chopra, Fernando Pena, Stanley Azen et 1993;38:1-30. al. Effects of Corneal Thickness, Corneal Curvature and Intraocular Pressure Level on 2. Diaton: digital portable tonometer of intraocular Goldmann Applanation Tonometry and pressure through the eyelid. Operation Manual. Dynamic Contour Tonometry. Ophthalmology Ryazan State Instrument Making Enterprise. 2007;114:20-6. Ryazan, Russia.

GLAUCOMA SESSION- II 263 4. R. S. Davidson; N. Faberowski; R. J. Noecker; M. www.tonometer.diaton.com Y. Kahook. Comparison of the Diaton 6. Tonnu PA, Ho T, Newson T, El Sheikh A, Transpalpebral Tonometer Versus Goldmann Sharma K, White E et al. The influence of central Applanation.www.tonometer.diaton.com corneal thickness and age on intraocular pressure 5. Theodore H. Curtis, Douglas L Mackenzie, measured with pneumotonometry, non contact Robert J. Noecker and Malik Y. Kahook tonometry, the Tonopen XL and Goldmann Comparison of the Diaton Transpalpebral Applanation Tonometry. Br J Ophthalmol. Tonometer Versus TonoPen-Applination. 2005;89:851-4.

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