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Title: Systematic review of the agreement of tonometers with Goldmann applanation tonometry
Authors: Cook, J. A.
Botello, A. P.
Elders, A.
Ali, A. Fathi
Azuara-Blanco, A.
Fraser, C.
McCormack, K.
Burr, Jennifer Margaret
Group(), Surveillance of Ocular Hypertension Study
Keywords: RE Ophthalmology
Issue Date: Aug-2012
Citation: Cook , J A , Botello , A P , Elders , A , Ali , A F , Azuara-Blanco , A , Fraser , C , McCormack , K , Burr , J M & Group() , S O O H S 2012 , ' Systematic review of the agreement of tonometers with Goldmann applanation tonometry ' Ophthalmology , vol 119 , no. 8 , pp. 1552-1557 . , 10.1016/j.ophtha.2012.02.030
Abstract: OBJECTIVE: To assess the agreement of tonometers available for clinical practice with the Goldmann applanation tonometer (GAT), the most commonly accepted reference device. DESIGN: A systematic review and meta-analysis of directly comparative studies assessing the agreement of 1 or more tonometers with the reference tonometer (GAT). PARTICIPANTS: A total of 11 582 participants (15 525 eyes) were included. METHODS: Summary 95% limits of agreement (LoA) were produced for each comparison. MAIN OUTCOME MEASURES: Agreement, recordability, and reliability. RESULTS: A total of 102 studies, including 130 paired comparisons, were included, representing 8 tonometers: dynamic contour tonometer, noncontact tonometer (NCT), ocular response analyzer, Ocuton S, handheld applanation tonometer (HAT), rebound tonometer, transpalpebral tonometer, and Tono-Pen. The agreement (95% limits) seemed to vary across tonometers: 0.2 mmHg (-3.8 to 4.3 mmHg) for the NCT to 2.7 mmHg (-4.1 to 9.6 mmHg) for the Ocuton S. The estimated proportion within 2 mmHg of the GAT ranged from 33% (Ocuton S) to 66% and 59% (NCT and HAT, respectively). Substantial inter- and intraobserver variability were observed for all tonometers. CONCLUSIONS: The NCT and HAT seem to achieve a measurement closest to the GAT. However, there was substantial variability in measurements both within and between studies. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Version: Postprint
Description: This review was part of the Surveillance for Ocular Hypertension study funded by the UK National Institute for Health Research Health Technology Assessment Programme (Project No. 07/46/02).
Status: Peer reviewed
ISSN: 0161-6420
Type: Journal article
Rights: This is the accepted version of an article published in Ophthalmology, © 2012 American Academy of Ophthalmology, available from
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