Comparison of Three Intraocular Pressure Measurement Methods Including Biomechanical Properties of the Cornea

Clinical Staging of Prostaglandin-Associated Periorbitopathy Syndrome in Glaucoma: A Review from Asia

PURPOSE

Topical prostaglandin analogues are commonly used to treat patients with glaucoma, but may cause periocular and periorbital complications known as prostaglandin-associated periorbitopathy syndrome (PAPS).

METHODS

A literature review was conducted on PAPS. Given the lack of consensus on grading PAPS, glaucoma specialists from Asia convened to evaluate current PAPS grading systems and propose additional considerations in grading PAPS.

RESULTS

Existing grading systems are limited by the lack of specificity in defining grades and consideration for patients' subjective perception of symptoms. Patient-reported symptoms (e.g., via a self-assessment tool) and additional clinical assessments (e.g., exophthalmometry, lid laxity, differences between tonometry results, baseline measurements, and external ocular photographs) would be beneficial for grading PAPS systematically.

CONCLUSIONS

Effective management of PAPS could be facilitated by a common clinical grading system to consistently and accurately diagnose and characterise symptoms. Further research is required to validate specific recommendations and approaches to stage and monitor PAPS.

The alterations of corneal biomechanics in adult patients with corneal dystrophy

PURPOSE

To evaluate the changes of corneal biomechanics in granular, lattice and macular corneal dystrophy (GCD, LCD and MCD), and to assess the agreement of intraocular pressure (IOP) between Corvis ST tonometer (CST) and Goldmann applanation tonometer (GAT) and the agreement of central corneal thickness (CCT) between CST and ultrasound pachymeter (USP) in patients with corneal dystrophy.

METHODS

Fifty-nine eyes with corneal dystrophy (26 eyes with GCD, 18 eyes with LCD and 15 eyes with MCD) and 48 eyes from healthy subjects were included in this study. All subjects received ocular examination and anterior segment photography under slit-lamp microscope. Corneal biomechanical parameters were obtained using CST. IOP and CCT were obtained using GAT and USP, respectively. Mixed-effects models were fitted for group comparisons and Bland-Altman analyses were applied for assessing the agreement of IOP or CCT between devices.

RESULTS

GCD, LCD and MCD showed higher First Applanation Deformation Amplitude (A1DA) and Corvis Biomechanical Index (CBI), and a lower Stiffness Parameter at First Applanation (SPA1), compared to controls. After CCT adjustment, MCD group showed a higher A1DA compared to GCD or LCD. The IOP measured by CST demonstrated an overestimated bias to the one obtained by GAT in all groups. The CCT measured by CST and USP showed good agreement in healthy eyes but not in those with corneal dystrophy.

CONCLUSION

Corneal biomechanical alterations were observed in GCD, LCD and MCD. IOP and CCT measured by CST should be interpreted carefully in eyes with corneal dystrophy.

Corneal Tonometric and Morphological Changes in Patients with Acromegaly

(1) Purpose: This study aimed to investigate the changes in Reichert Ocular Response Analyzer (ORA) parameters, corneal endothelium parameters, central corneal thickness (CCT), and intraocular pressure (IOP) before and after the transsphenoidal resection of pituitary adenoma in patients with acromegaly. (2) Methods: This was a single-center, prospective, interventional study. Twenty patients with newly diagnosed acromegaly were examined before and 19 ± 9 months after transsphenoidal resection. The participants underwent a comprehensive ophthalmological examination including pneumatic IOP (IOP air puff), Goldmann applanation tonometry (IOP GAT), CCT measured using the iPac pachymeter (CCT_UP), IOP value corrected for CCT_UP using the Ehlers formula (IOPc) ORA measurements included corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). CCT from non-contact specular microscopy (CCT_NSM), the number of endothelial cells (CD) per mm2, and average cell size (AVG) were determined with non-contact specular microscopy. (3) Results: A statistically significant decrease was observed in CCT_UP (p = 0.007), and IOP air puff (p = 0.012) after surgery. Moreover, we noted a statistically significant increase in CD (p = 0.001), and a statistically significant decrease in AVG (p = 0.009) and CCT_NSM (p = 0.004) after surgery. A statistically significant decrease was also observed in IOPg (p = 0.011), CH (p = 0.016), and CRF (p = 0.001) after surgery. The mean value of IOP GAT and IOPc was lower after the surgery. However, the difference was not statistically significant. (4) Conclusions: Our study revealed significant changes in biomechanics, corneal endothelium, CCT and IOP after pituitary adenoma resection in patients with acromegaly. It proves that the eye might be sensitive to long-term overexposure to growth hormone (GH) and insulin-like growth factor-1 (IGF-1). We suggest that disease activity be taken into consideration on ophthalmological examination.

A Review of Intraocular Pressure (IOP) and Axial Myopia

The pathogenesis of myopia is driven by genetic and environmental risk factors. Accommodation not only alters the curvature and shape of the lens but also involves contraction of the ciliary and extraocular muscles, which influences intraocular pressure (IOP). Scleral matrix remodeling has been shown to contribute to the biomechanical susceptibility of the sclera to accommodation-induced IOP fluctuations, resulting in reduced scleral thickness, axial length (AL) elongation, and axial myopia. The rise in IOP can increase the burden of scleral stretching and cause axial lengthening. Although the accommodation and IOP hypotheses were proposed long ago, they have not been validated. This review provides a brief and updated overview on studies investigating the potential role of accommodation and IOP in myopia progression.

A stochastic approach to estimate intraocular pressure and dynamic corneal responses of the cornea

IntraOcular Pressure (IOP) is one of the most informative factors for monitoring the eye-health. This is usually measured by tonometers. However, the outputs of the tonometers depend on the physical and geometrical properties of the cornea. Therefore, the common practice is to develop a numerical model to generate some correction factors. The main challenge here is the accuracy and efficiency of a numerical model in predicting the IOP and Dynamic Corneal Response (DCR) of each patient. This study addresses this issue by developing a two-step surrogate model based on adaptive sparse Polynomial Chaos Expansion (PCE) for fast and accurate prediction of the IOP. In this regard, first, an FE model of the cornea has been developed to predict the DCR parameters. This FE model has been replaced with a PCE-based surrogate model to speed up the simulation step. The uncertainties in the geometry and material model of the cornea have been propagated through the surrogate model to estimate the distributions of the DCR parameters. In the second step, the combination of DCR parameters and the input parameters provide a proper parameter space for developing an efficient data-driven PCE model to predict the IOP. Moreover, sensitivity analysis by using PCE-based Sobol indices has been performed. The results demonstrate the accuracy and efficiency of the proposed method in predicting the IOP. Sensitivity analysis revealed that IOP measurement was influenced mostly by deflection amplitude and applanation time. The analysis indicates the importance of the interactions between the parameters.

Long-Term Clinical Outcomes of Small-Incision Femtosecond Laser-Assisted Intracorneal Concave Lenticule Implantation in Patients with Keratoconus

Purpose

The purpose of this study was to evaluate the long-term prognosis of small-incision femtosecond laser-assisted intracorneal concave lenticule implantation (SFII) in correction of human keratoconus.

Methods

This was a prospective study for 11 patients who received SFII after being diagnosed as progressive keratoconus based on the Amsler–Krumeich classification system. Clinical assessment was performed for all the patients prior to and postsurgically at different time points for 5 years. These included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), biomechanically corrected intraocular pressure (bIOP), corneal topography, anterior segment optical coherence tomography (AS-OCT), confocal microscopy, and biomechanical assessment with Corvis ST.

Results

Comparison of preoperative and 60-month postoperative UDVA and CDVA (P_60months=0.081 and 0.001, respectively), all eyes showed an improvement in CDVA. Corneal topography showed no significant changes in corneal anterior K1, K2, posterior K1, K2, posterior elevation, or corneal densitometry compared with preoperative levels (P > 0.05). Corvis ST showed that central corneal thickness (CCT) and stiffness at applanation 1 (SP-A1) were significantly greater 1 week postsurgically when compared to the baseline (P < 0.05) and remained stable thereafter. The lenticule under the AS-OCT remained transparent throughout the entire postsurgical period. Under confocal microscopy, corneal edema and an increase in cell activation and reflectivity were observed at the lenticule-stromal interface within 1 week postoperatively. These reactions gradually subsided with time within 6 months.

Conclusion

SFII is an effective procedure to prevent the progression of keratoconus due to its minimal invasiveness and capability of maintaining a steady biometry of the cornea.

Comparison of intraocular pressure obtained by Goldmann applanation tonometer, Corvis ST and an airpuff tonometer in healthy adults

PURPOSE

To assess the agreement among four types of intraocular pressure (IOP) measurements: IOP obtained by Goldmann applanation tonometer (IOP-GAT),IOP obtained by an air-puff tonometer (Nidek NT-510)(IOP-NCT), the non-corrected IOP obtained by the Corneal Visualization Scheimpflug Technology (IOP-Corvis) and the biomechanically corrected IOP obtained by the Corvis ST (bIOP-Corvis) in healthy patients with a broad spectrum of IOP values. Methods: This prospective, observational study recruited 113 healthy individuals. Each patient underwent IOP evaluation via GAT, Nidek NT-510 and Corvis ST. Difference in mean in IOP readings was assessed by one-way repeated-measures analysis of variance (ANOVA).Tonometer intermethod agreement was assessed by the Bland-Altman method. The difference between the four IOP measurements was correlated against corneal (CCT) and age with Pearson's correlation test. Results: IOP-Corvis showed the highest values (16.59  ±  3.08 mmHg),followed by IOP-NCT (16.05  ±  3.43 mmHg), IOP-GAT (15.62 ± 3.08 mmHg) and bIOP-Corvis (15.10 ± 2.67 mmHg).There were statistically significant differences in IOP measurements among all the ANOVA pairwise comparisons except between IOP-GAT and bIOP-Corvis (p = 0.07),as well as between IOP-GAT and IOP-NCT (p = 0.25). Bland Altman analysis revealed a notable bias (all p < 0.05) among IOP-GAT and bIOP-Corvis, IOP-GAT and IOP-Corvis, IOP-GAT and IOP-NCT, bIOP-Corvis and IOP-Corvis, bIOP-Corvis and IOP-NCT,IOP-Corvis and IOP-NCT of 0.51, -0.97, -0.43, -1.49, -0.95, 0.53 mmHg respectively. We observed a strong correlation of the difference between bIOP-Corvis and IOP-Corvis with CCT and patient age. Conclusion: Compared with GAT and Nidek NT-510, the Corvis-derived IOPs were recorded either the highest as IOP-Corvis or the lowest as bIOP-Corvis. Even if the differences among the tonometers were relatively small, the IOP values obtained with the Corvis ST, NCT and GAT were not interchangeable.

Different Effects of Aging on Intraocular Pressures Measured by Three Different Tonometers

This study aimed to compare intraocular pressures (IOP) using different tonometers, Goldmann applanation (IOP_GAT), non-contact (IOP_NCT), and rebound (IOP_RBT), and to assess the effects of aging and central corneal thickness (CCT) on the measurements. The IOP_GAT, IOP_NCT, IOP_RBT, mean patient age (65.1 ± 16.2 years), and CCT (521.7 ± 39.2 µm) were collected retrospectively from 1054 eyes. The differences among IOPs were compared by the paired t-test. Possible correlations between devices, age, and CCT were assessed by linear regression analyses. The effects of age and CCT on the IOP reading were assessed by mixed-effects regression models. The IOP_GAT values were 2.4 and 1.4 mmHg higher than IOP_NCT and IOP_RBT, respectively; the IOP_NCT was 1.0 mmHg lower than IOP_RBT (p < 0.0001 for all comparisons). The IOPs measured by each tonometer were highly correlated with each other (r = 0.81–0.90, t = 45.2–65.5). The linear regression analyses showed that age was negatively correlated with IOP_NCT (r = −0.12, t = −4.0) and IOP_RBT (r = −0.14, t = −4.5) but not IOP_GAT (r = 0.00, t = −0.2); the CCT was positively correlated with IOP_GAT (r = 0.13, t = 4.3), IOP_NCT (r = 0.29, t = 9.8), and IOP_RBT (r = 0.22, t = 7.2). The mixed-effect regression models showed significant negative correlations between age and IOP_NCT (t = −2.6) and IOP_RBT (t = −3.4), no correlation between age and IOP_GAT (t = 0.2), and a significant positive correlation between CCT and the tonometers (t = 3.4–7.3). No differences between IOP_GAT and IOP_RBT were seen at the age of 38.8 years. CCT affects IOPs from all tonometers; age affects IOP_NCT and IOP_RBT in different degrees. IOP_RBT tended to be higher than IOP_GAT in young subjects, but this stabilized in middle age and became higher in older subjects.

Correlation of iCare ic100 tonometry with iCare TA01i in screening of unselected population in Northern Finland Birth Cohort Eye study

PURPOSE

iCare tonometers are easy-to-use and portable devices for measuring the intraocular pressure (IOP). Purpose was to evaluate the IOP values measured by both novel iCare ic100 and conventional model TA01i devices in unselected population.

METHODS

IOP was measured with iCare ic100 and TA01i tonometers in 149 participants aged 32-33 years (born in 1985 or 1986) of the Northern Finland Birth Cohort Eye 2 study. The right eye of each participant was selected for analysis. We also collected data on axial length, corneal curvature and central corneal thickness (CCT). Bland-Altman plot was used for comparing the values obtained by these devices.

RESULTS

Mean IOP measured with the ic100 device was 13.8 (3.4) mmHg, with TA01i it was 12.5 (3.0) mmHg. The mean difference between these devices was 1.30 mmHg (p < 0.001) and R2 was 0.694. In Bland-Altman analysis, the agreement between the two tonometers ic100 and TA01i was constantly good (mean difference -1.30, ic100 device showing higher measures). There was a correlation between IOP and CCT (r = 0.269, p < 0.001 for ic100 and r = 0.255, p = 0.002 for TA01i), but not with IOP and corneal curvature or IOP and axial length.

CONCLUSION

In summary, we found ic100 rebound tonometry to be both reliable and effective, although CCT may influence IOP measurements with ic100 and TA01i. Therefore, iCare ic100 is suitable for IOP measurement in large cohort studies.

Goldmann Tonometry and Corneal Biomechanics

Glaucoma is the second cause of irreversible blindness in the world. Intraocular pressure (IOP) is a recognized major risk factor for the development and progression of glaucomatous damage. Goldmann applanation tonometry (GAT) is internationally accepted as the gold standard for the measurement of IOP. The purpose of this study was to search for correlations between Goldmann tonometry and corneal mechanical properties and thickness by means of in vitro tests. IOP was measured by the Goldmann applanation tonometer (GIOP), and by a pressure transducer inserted in the anterior chamber of the eye (TIOP), at increasing pressure levels by addition of saline solution in the anterior chamber of enucleated pig eyes (n = 49). Mechanical properties were also determined by inflation tests. The GAT underestimated the real measurements made by the pressure transducer, with most common differences in the range 15–28 mmHg. The difference between the two instruments, highlighted by the Bland–Altman test, was confirmed by ANOVA, normality tests, and Mann–Whitney’s tests, both on the data arranged for infusions and for the data organized by pressure ranges. Pearson correlation tests revealed a negative correlation between (TIOP-GIOP) and both corneal stiffness and corneal thickness. In conclusion, data obtained showed a discrepancy between GIOP and TIOP more evident for softer and thinner corneas, that is very important for glaucoma detection.

A pilot study for intraocular pressure measurements based on vibroacoustic parameters

The present study aimed to identify vibroacoustic properties associated with intraocular pressure (IOP) changes and to suggest a new way to measure the IOP based on these properties. Ten ex vivo porcine eyeballs were used in this study. Each eyeball was fixated in a central hole of a Styrofoam block, and vibration applied to the Styrofoam block was transmitted to the eyeball. An accelerometer directly attached to the eyeball measured the vibration response. Excitations and measurements were performed for 1 s, and the excitation magnitude was varied for the same signal in repeat measurements. A 30-gauge needle was inserted into the anterior chamber of the eyeball to inject a balanced salt solution, and the height of the bottle was adjusted to adjust the IOP. A tonometer was used under identical conditions to measure the IOP five times, and the mean value was determined for further analyses. The measurements showed that the parameters resonance frequency and change in the magnitude of the vibration response (CMVR) increased with rising IOP values. The CMVR was highly correlated with the IOP (p-value < 0.0001). A linear mixed effects model (LMM) was used as a statistical analysis method. We confirmed that vibroacoustic properties of the eyeball are correlated with IOP changes. It is expected that the CMVR will serve as a new parameter for IOP measurements. Thus, in the future, continuous IOP measurements would be easily performed using the CMVR.

Acute Intraocular Pressure Responses to Reading: The Influence of Body Position

PRéCIS:: Greater intraocular pressure (IOP) values are observed when reading in the supine position in comparison with the sitting position, and thus, it should be considered by eye care specialists for the management of glaucoma patients or those at risk.

PURPOSE

IOP is sensitive to near work and body position, however, the influence of the body position adopted while performing near tasks remains unknown. This study aimed to assess the IOP changes induced by reading on a smartphone in sitting and supine position, and to explore whether these IOP changes differ between men and women.

METHODS

Twenty-four healthy young adults (12 men and 12 women) read a text on a smartphone placed at 30 cm for 25 minutes while lying down and sitting in 2 different days. A rebound tonometer, which allows assessing IOP in the supine position, was used to measure IOP before reading, during reading (5, 15, and 25 min), and after 5 minutes of recovery. Complementarily, the authors checked the level of sleepiness/alertness before reading, and the perceived levels of fatigue and discomfort after reading.

RESULTS

The data showed that reading induces an IOP rise [P<0.001, partial eta squared (ηp)=0.44]. These effects were more accentuated when reading in the supine position in comparison with the sitting position (P=0.019, ηp=0.23) with an increment of 2.4 mm Hg (14%) and 1.3 mm Hg (8%) after 25 minutes of reading, respectively. The IOP rises associated with reading did not differ between men and women (P=0.127). Participants reported greater levels of discomfort in the neck and back when reading in the sitting position (P=0.012, ηp=0.25).

CONCLUSIONS

The IOP rises associated with reading are greater when it is performed in the supine position in comparison with the sitting position. The present findings indicate that reading in the supine position should be discouraged in individuals who should avoid IOP increments or fluctuations.

Evaluation of biomechanically corrected intraocular pressure using Corvis ST and comparison of the Corvis ST, noncontact tonometer, and Goldmann applanation tonometer in patients with glaucoma

Purpose

The aim of the study was to investigate the effects of various anatomical structures on intraocular pressure (IOP) measurements obtained by the Corneal Visualization Scheimpflug Technology (Corvis ST), Goldmann applanation tonometer (GAT), and noncontact tonometer (NCT), as well as to assess the interchangeability among the four types of IOP measurement: IOP-GAT, IOP-NCT, IOP-Corvis, and biomechanically corrected IOP (bIOP-Corvis), with a particular focus on bIOP-Corvis.

Materials and methods

We included 71 patients with primary open-angle glaucoma and assessed their IOP measurements obtained with the GAT, NCT, and Corvis ST using a repeated measures ANOVA, a paired t-test with Bonferroni correction, stepwise multiple regression analyses and Bland–Altman plots.

Results

IOP-GAT showed the highest values (13.5 ± 2.1 mmHg [mean ± standard deviation]), followed by IOP-NCT (13.2 ± 2.7 mmHg), IOP-Corvis (10.6 ± 2.8 mmHg), and bIOP-Corvis (10.0 ± 2.3 mmHg). With exceptions of bIOP-Corvis and IOP-GAT, all IOP variations were explained by regression coefficients involving the central corneal thickness. Bland–Altman plots showed a mean difference between IOP-GAT and the other IOP measurements (IOP-Corvis, bIOP-Corvis, and IOP-NCT), which were -2.90, -3.48, and -0.29 mmHg, respectively. The widths of the 95% limits of agreement between all pairs of IOP measurements were greater than 3 mmHg.

Conclusion

IOP values obtained with the Corvis ST, NCT, and GAT were not interchangeable. The bIOP-Corvis measurement corrected for the ocular structure.

Non-contact determination of intra-ocular pressure in an ex vivo porcine model

People suffering from glaucoma often endure high intra-ocular pressure (IOP). Methods for determining IOP either contact the eye or are unpleasant to some patients. There is therefore a need for a rapid and patient friendly non-contacting method to determine IOP. To address this need, we developed a tonometer prototype that employs spark-gap induced shock waves and a laser Doppler vibrometer (LDV) that reads the amplitude of membrane waves. The IOP was first identified from the membrane wave propagation velocity first in a custom-made ocular phantom and was then verified in ex vivo porcine eyes. The time-of-flight (TOF) of the membrane wave travelling on a hemispherical membrane was compared to reference IOP values in the sample obtained with an iCare TA01 tonometer. The shock front was characterized by high speed photography. Within one eye, the method achieved an agreement of 5 mmHg (1.96 standard deviation between the shock wave tonometer and the commercial manometer) and high method-to-method association (Pearson correlation, R² = 0.98). The results indicate that the presented method could potentially be developed into a non-contacting technique for measuring IOP in vivo.

ICare Pro: Age Dependent Effect of Central Corneal Thickness on Intraocular Pressure in Glaucoma and Ocular Hypertension Patients

Purpose: Measurement of the exact intraocular pressure (IOP) is essential in glaucoma diagnosis and follow-up, thus all therapeutic options affect IOP in order to win sighted lifetime. As it is known that corneal properties of glaucoma patients differ from normal subjects, the present study aimed to investigate the influence of CCT on rebound tonometry (ICT, ICare Pro) in glaucoma and ocular hypertension patients in dependency of age additionally considering different times of day.Methods: Three hundred sixty-two eyes of 190 subjects were included: 339 open-angle glaucoma and 23 ocular hypertension. IOP was measured at 5 different times of day (6 a.m., 12 a.m., 4 p.m., 9 p.m., and 0 p.m.) by Goldmann applanation tonometry (GAT) and Icare Pro rebound tonometry in a sitting position. Central corneal thickness was measured by central ultrasonic pachymetry (Pachymeter SP-100). Δ ICT was calculated as the difference of GAT, corrected according to age and CCT, and ICT, respectively at each time point.Results: All different GAT time points data correlated significantly (p < .05) with ICT time points. An age effect was observed on overall ICT (p = .02). A decrease of ICT was observed with increasing age. The within differences among ICT repeated measurements were significant as well. Additionally, repeated means of Δ ICT correlated significantly with age and CCT. Intercepts and coefficients were offered for each time point, respectively. GLM model yielded a relation between MD (dependent variable) and age together with CCT (age: p < .0001) and (CCT: p = .043).Conclusions: IOP measurements with ICare Pro were shown to be dependent on age, CCT and time of day in glaucoma and ocular hypertension patients. Thus, aging, corneal biomechanical properties and circadian rhythms should be taken into consideration when adjusting IOP.

A new method for detecting the outer corneal contour in images from an ultra-fast Scheimpflug camera

Background

The Corvis^® ST tonometer is an innovative device which, by combining a classic non-contact tonometer with an ultra-fast Scheimpflug camera, provides a number of parameters allowing for the assessment of corneal biomechanics. The acquired biomechanical parameters improve medical diagnosis of selected eye diseases. One of the key elements in biomechanical measurements is the correct corneal contour detection, which is the basis for further calculations. The presented study deals with the problem of outer corneal edge detection based on a series of images from the afore-mentioned device. Corneal contour detection is the first and extremely important stage in the acquisition and analysis of corneal dynamic parameters.

Result

A total of 15,400 images from the Corvis^® ST tonometer acquired from 110 patients undergoing routine ophthalmologic examinations were analysed. A method of outer corneal edge detection on the basis of a series of images from the Corvis^® ST was proposed. The method was compared with known and commonly used edge detectors: Sobel, Roberts, and Canny operators, as well as others, known from the literature. The analysis was carried out in MATLAB^® version 9.0.0.341360 (R2016a) with the Image Processing Toolbox (version 9.4) and the Neural Network Toolbox (version 9.0). The method presented in this paper provided the smallest values of the mean error (0.16%), stability (standard deviation 0.19%) and resistance to noise, characteristic for Corvis^® ST tonometry tests, compared to the methods known from the literature. The errors were 5.78 ± 9.19%, 3.43 ± 6.21%, and 1.26 ± 3.11% for the Roberts, Sobel, and Canny methods, respectively.

Conclusions

The proposed new method for detecting the outer corneal contour increases the accuracy of intraocular pressure measurements. It can be used to analyse dynamic parameters of the cornea.

The influence of corneal geometrical and biomechanical properties on tonometry readings in keratoconic eyes

PURPOSE

To identify the effect of corneal geometrical and biomechanical parameters on the intraocular pressure (IOP) measurements obtained by Goldmann Applanation Tonometer (GAT), non-contact tonometer, iCare Pro Rebound Tonometer (IRT), Tonopen and Ocular Response Analyzer (ORA, Goldmann-correlated IOP: IOPg, corneal compensated IOP: IOPcc).

METHODS

We prospectively recruited patients with a tomographically confirmed diagnosis of keratoconus. IOP measurements were performed in the following order: non-contact tonometry, ORA, IRT, GAT and Tonopen. The means of the three IOP measurements were used for the analysis. Correlation analyses were performed to assess the association between tonometer readings and the corneal geometrical and biomechanical parameters including ORA waveform parameters. Tonometer variability was assessed using a stepwise linear regression analysis.

RESULTS

Fifty-one patients with keratoconus (27 females, mean age 30.8 ± 8.7 years) were evaluated. The highest mean IOP was measured by IOPcc (14.6 ± 2.3 mmHg) followed by IRT IOP (13.0 ± 3.2 mmHg), Tonopen IOP 12.0 ± 2.6 mmHg), GAT IOP (11.7 ± 3.1 mmHg), NCT IOP (10.2 ± 3.2 mmHg) and IOPg (10.2 ± 3.6 mmHg). NCT and IOPg were affected from all corneal parameters including thickness, curvature and biomechanical parameters. While GAT and IRT had significant correlations with corneal resistance factor (CRF) and corneal hysteresis, IOPcc only had a significant correlation with CRF. None of the corneal factors had any statistically significant correlation with Tonopen. CRF predicted tonometer measurement variability in 7 of the 15 inter-device variability assessments.

CONCLUSION

Tonopen was the least affected from the corneal parameters followed by IOPcc and GAT. CRF was a strong determinant of tonometer variability.

Comparability of three intraocular pressure measurement: iCare pro rebound, non-contact and Goldmann applanation tonometry in different IOP group

Background

Measurement of intraocular pressure (IOP) is essential for glaucoma patients. Many factors such as central corneal thickness (CCT) can affect the accuracy of IOP measurement. The purpose of this study was to evaluate the agreement of IOP measured by non-contact tonometer (NCT), iCare pro rebound tonometer (iCare), and Goldmann applanation tonometer (GAT) in different IOP group.

Methods

This was a Hospital-based cross-sectional study. Two hundred subjects were enrolled in this study. All subjects underwent IOP measurement using an NCT–iCare–GAT sequence. Bland-Altman, Pearson correlation and intraclass correlation analysis were performed using SPSS 17.0 software. The influence of CCT on each IOP measurement methods was evaluated by linear regression analysis.

Results

The mean difference (Δ) of NCT–GAT did not differ from (Δ) iCare–GAT in IOP < 10 and 10–21 mmHg group. However, (Δ) NCT–GAT was significantly higher than (Δ) iCare–GAT in IOP 22–30 and > 30 mmHg group (P < 0.05). Bland–Altman analysis showed significant agreement between the three devices (P < 0.01). IOP measurements of the three methods were significantly correlated with CCT (P < 0.01).

Conclusions

ICare pro shows a higher agreement with GAT over a wide range of IOP compared with NCT. The consistency between the three tonometers was similar in a low and normal IOP range. However, NCT shows a greater overestimate of IOP in moderate and higher IOP group. The variability of IOP measurement affected by CCT is NCT > iCare pro > GAT.

Wearing Swimming Goggles Reduces Central Corneal Thickness and Anterior Chamber Angle, and Increases Intraocular Pressure

Purpose/Aim: To assess the changes in anterior eye segment biometrics and intraocular pressure during and after wearing swimming goggles.Materials and methods: Anterior segment biometry and intraocular pressure were assessed in 20 healthy young adults (22.2 ± 4.7 years) during the wearing of a drilled swimming goggle. The central corneal thickness, anterior chamber depth, anterior chamber volume, and anterior chamber angle, using the Pentacam rotating Scheimpflug camera (Oculus Optikgerate GmbH, Wetzlar, Germany), and intraocular pressure, using a rebound tonometer, were obtained before, at 2, 3.5, and 5 min of wearing swimming goggle, just after removal, as well as after 5 min of recovery.Results: During swimming goggles wear, there was a significant corneal thinning (54.8 ± 41.1 µm, p < .001, ƞ_p² = 0.532), iridocorneal angle reduction (2.6 ± 2.6 degrees, p < .001, ƞ_p² = 0.241) and intraocular pressure elevation (4.0 ± 1.9 mmHg, p < .001, ƞ_p² = 0.530). These changes returned to baseline values immediately after swimming goggle removal (corrected p-value <0.05 in all cases). No significant effects of swimming goggles use were observed for anterior chamber depth and anterior chamber volume.Conclusions: Wearing swimming goggles leads to acute corneal thinning, iridocorneal angle reduction, and intraocular pressure elevation. These findings may be of special relevance for individuals with corneal ectasias, as well as for individuals at high risk of glaucoma onset or progression.

Novel dynamic corneal response parameters in a practice use: a critical review

Background

Non-contact tonometers based on the method using air puff and Scheimpflug’s fast camera are one of the latest devices allowing the measurement of intraocular pressure and additional biomechanical parameters of the cornea. Biomechanical features significantly affect changes in intraocular pressure values, as well as their changes, may indicate the possibility of corneal ectasia. This work presents the latest and already known biomechanical parameters available in the new offered software. The authors focused on their practical application and the diagnostic credibility indicated in the literature.

Discussion

An overview of available literature indicates the importance of new dynamic corneal parameters. The latest parameters developed on the basis of biomechanics analysis of corneal deformation process, available in non-contact tonometers using Scheimpflug’s fast camera, are used in the evaluation of laser refractive surgery procedures, e.g. LASIK procedure. In addition, the assessment of changes in biomechanically corrected intraocular pressure confirms its independence from changes in the corneal biomechanics which may allow an intraocular pressure real assessment. The newly developed Corvis Biomechanical Index combined with the corneal tomography and topography assessment is an important aid in the classification of patients with keratoconus.

Conclusion

New parameters characterising corneal deformation, including Corvis Biomechanical Index and biomechanical compensated intraocular pressure, significantly extend the diagnostic capabilities of this device and may be helpful in assessing corneal diseases of the eye. Nevertheless, further research is needed to confirm their diagnostic pertinence.

Biomechanical assessment of healthy and keratoconic corneas (with/without crosslinking) using dynamic ultrahigh-speed Scheimpflug technology and the relevance of the parameter (A1L-A2L)

AIMS

To examine corneal biomechanics in healthy and keratoconic eyes, with or without crosslinking obtained by ultrahigh-speed Scheimpflug measurements (Corvis ST).

METHODS

One hundred and seventeen eyes were studied in three groups: group 1 (n=39) contained keratoconic eyes without crosslinking. Group 2 (CXL; n=28) comprised keratoconic eyes after crosslinking. These were compared with a control group (n=50 matched healthy eyes). In addition, 10 keratoconus patients, before and after CXL treatment, respectively, were examined.

RESULTS

The novel parameter A1L-A2L demonstrated highly significant differences between crosslinked corneas and untreated keratoconic or healthy corneas. Velocity during second applanation (A2V) and deformation amplitude (DA) were significantly increased in crosslinked keratoconic eyes both compared with untreated keratoconic eyes and with healthy controls. Radius at highest curvature also was significant among all groups. Inward applanation length (A1L) was significantly increased in controls, whereas outward applanation length (A2L) was significantly reduced in crosslinked keratoconic eyes compared with both other groups. The follow-up analysis revealed statistically significant changes in pachymetry and intraocular pressure and showed tendencies towards significance in applanation times 1 and 2 and in DA.

CONCLUSIONS

Both A2V and A2L are viable parameters to discriminate healthy from keratoconic but also crosslinked from non-crosslinked keratoconic corneas. The difference of A1L-A2L could reliably discriminate crosslinked from non-crosslinked and healthy corneas. Follow-up examination in a small cohort allows distinction between crosslinked and untreated keratoconus in follow-up examinations. The difference of A1L-A2L could reliably discriminate crosslinked from non-crosslinked and healthy corneas. Measurements of corneal deformation using dynamic ultrahigh-speed Scheimpflug technology are reproducible and provide useful information about keratoconus assessment and biomechanics. Therefore, the Corvis ST seems to provide useful technology to monitor therapeutic success of crosslinking treatment.

Longitudinal changes in intraocular pressure and association with systemic factors and refractive error: Lingtou Eye Cohort Study

OBJECTIVES

To investigate the longitudinal changes in intraocular pressure (IOP) and its associations with refractive error and systemic determinants in a Chinese geriatric population.

DESIGN

Prospective cohort study.

SETTING

Guangzhou Government Servant Physical Check-up Center, Guangzhou, China.

PARTICIPANTS

4413 government employees aged no less than 40 years (41.9% female) attending annual physical and eye examinations were included in this study. The inclusion criterion was having attended the 2010 follow-up examination. The exclusion criteria include glaucoma or intraocular surgery history, IOP >21 mm Hg at any visit or without available IOP data at all visits from 2010 to 2014.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measure was IOP at each follow-up visit from 2010 to 2014. Mixed-effect model was used to assess the relationship between longitudinal changes in IOP and potential risk factors.

RESULTS

For the 2653 participants who had available IOP data at both the 2010 and 2014 follow-up visits, the average change in IOP was an increase of 0.43 (95% CI 0.36 to 0.50) mm Hg. For the whole study population and in the optimised mixed model, there was a non-linear increase of IOP with age (P<0.001), with greater changes in younger subjects and in women (P<0.001 and P=0.002, respectively). Elevations in systolic blood pressure, diastolic blood pressure, body mass index (BMI) and fasting plasma glucose (FPG), as well as a myopic shift (all with P<0.001), during the follow-up were associated with an increasing trend of IOP, while serum lipids were found to be not significantly associated.

CONCLUSIONS

In this cohort of elderly Chinese adults, IOP increases non-linearly with ageing. People with increasing blood pressure, BMI, FPG and myopic progression are more likely to have IOP elevation over time.

Clinical Evaluation of Methods to Correct Intraocular Pressure Measurements by the Goldmann Applanation Tonometer, Ocular Response Analyzer, and Corvis ST Tonometer for the Effects of Corneal Stiffness Parameters

PURPOSE

To evaluate the effectiveness of methods to correct intraocular pressure (IOP) measurements obtained using the Goldmann applanation tonometer (GAT), the ocular response analyzer (ORA), and the Corvis ST tonometer (CVS) for the effects of corneal stiffness parameters: central corneal thickness (CCT), corneal curvature (R), and age in a Chinese population.

PATIENTS AND METHODS

Data were collected for 99 eyes of 99 participants. Whereas cornea-corrected IOP was obtained directly from ORA (ORA-IOPcc), cornea correction in GAT and CVS was implemented using multiparameter equations developed earlier. The study also included IOP measurements by the dynamic contour tonometer, which is thought to be less affected by corneal stiffness parameters than other tonometers. Statistical analyses were performed to determine the association of both uncorrected and corrected IOP with the main stiffness parameters: CCT, R, and age.

RESULTS

After correction, a significantly decreased association between the GAT (from r=0.15 to r=-0.02), ORA (from r=0.24 to r=-0.19), and CVS (from r=0.47 to r=0.004) IOP measurements and the CCT was found, to levels below that with the dynamic contour tonometer-IOP (r=0.11). The IOP measurements made by the 4 tonometers, both uncorrected and corrected, did not correlate with age. The same was true for R except with ORA-IOPcc (r=0.23).

CONCLUSIONS

CCT accounted for the majority of variance in IOP, whereas age and R had a much smaller effect. The IOP correction processes studied were successful in reducing reliance of IOP measurements, especially those by GAT and CVS, on CCT in a healthy Chinese population.

Corneal Biomechanics in Ectatic Diseases: Refractive Surgery Implications

BACKGROUND

Ectasia development occurs due to a chronic corneal biomechanical decompensation or weakness, resulting in stromal thinning and corneal protrusion. This leads to corneal steepening, increase in astigmatism, and irregularity. In corneal refractive surgery, the detection of mild forms of ectasia pre-operatively is essential to avoid post-operative progressive ectasia, which also depends on the impact of the procedure on the cornea.

METHOD

The advent of 3D tomography is proven as a significant advancement to further characterize corneal shape beyond front surface topography, which is still relevant. While screening tests for ectasia had been limited to corneal shape (geometry) assessment, clinical biomechanical assessment has been possible since the introduction of the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, USA) in 2005 and the Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) in 2010. Direct clinical biomechanical evaluation is recognized as paramount, especially in detection of mild ectatic cases and characterization of the susceptibility for ectasia progression for any cornea.

CONCLUSIONS

The purpose of this review is to describe the current state of clinical evaluation of corneal biomechanics, focusing on the most recent advances of commercially available instruments and also on future developments, such as Brillouin microscopy.

IOP measurement in silicone oil tamponade eyes by Corvis ST tonometer, Goldmann applanation tonometry and non-contact tonometry

PURPOSE

To compare the postoperative intraocular pressure (IOP) of eyes following pars plana vitrectomy (PPV) combined with intravitreal silicone oil (SO) tamponade by Corneal Visualization Scheimpflug Technology (CST), Goldmann applanation tonometry (GAT) and non-contact tonometry (NCT).

METHODS

Thirty-eight participants who had undergone PPV combined with SO tamponade to treat vitreoretinal diseases were enrolled. Postoperative IOP measurements were obtained using CST, NCT and GAT. Inter-device agreement was assessed by Bland-Altman analysis. The correlation coefficient was used to describe the potential postoperative factors affecting the postoperative IOP differences between each device.

RESULTS

Bland-Altman analysis revealed the bias between CST and GAT, between CST and NCT, and between GAT and NCT to be -0.2, 2.1 and 2.4 mmHg, respectively. CST and GAT correlated well with each other. NCT values were lower than those of GAT and CST (all p < 0.05), whereas CST values did not differ from the GAT readings. Central corneal thickness, corneal biomechanical properties and age showed significant correlation with the differences of CST-NCT and GAT-NCT.

CONCLUSIONS

In SO tamponade eyes, NCT obtains lower IOP than other tonometry techniques, and CST is highly consistent with GAT. CST offers an optional non-contact method for measuring postoperative IOP in SO tamponade eyes.

Applanation optical coherence elastography: noncontact measurement of intraocular pressure, corneal biomechanical properties, and corneal geometry with a single instrument

Current clinical tools provide critical information about ocular health such as intraocular pressure (IOP). However, they lack the ability to quantify tissue material properties, which are potent markers for ocular tissue health and integrity. We describe a single instrument to measure the eye-globe IOP, quantify corneal biomechanical properties, and measure corneal geometry with a technique termed applanation optical coherence elastography (Appl-OCE). An ultrafast OCT system enabled visualization of corneal dynamics during noncontact applanation tonometry and direct measurement of micro air-pulse induced elastic wave propagation. Our preliminary results show that the proposed Appl-OCE system can be used to quantify IOP, corneal biomechanical properties, and corneal geometry, which builds a solid foundation for a unique device that can provide a more complete picture of ocular health.

A Comparison of the Corrected Intraocular Pressure Obtained by the Corvis ST and Reichert 7CR Tonometers in Glaucoma Patients

The purpose of the study was to investigate the accuracy of two corrected intraocular pressure (IOP) measurements by Corvis Scheimpflug Technology (CST)-IOPpachy and by corneal-compensated IOP (IOPcc) using the Reichert 7CR (7CR) tonometers. We also investigated the effects of corneal anatomical and structural parameters on the IOP measurements. The participants included 90 primary open-angle glaucoma patients. We assessed the IOP measurements, obtained by the CST, 7CR, and Goldmann applanation tonometer (GAT), using a paired t-test with Bonferroni correction, Bland-Altman plots, and multiple regression analyses. The 7CR-IOPcc gave the highest value (15.5 ± 2.7 mmHg), followed by the 7CR-IOPg (13.7 ± 3.1 mmHg), GAT-IOP (13.6 ± 2.2 mmHg), CST-IOP (10.3 ± 2.6 mmHg), and CST-IOPpachy (9.7 ± 2.5 mmHg). The values of CST-IOPpachy were significantly lower than those obtained by the other IOP measurement methods (all, p < 0.01). The values of 7CR-IOPcc were significantly higher than those obtained by the other IOP measurement methods (all, p < 0.01). Bland-Altman plots showed a mean difference between the GAT-IOP and the other IOP measurements (CST-IOP, CST-IOPpachy, 7CR-IOPg, and 7CR-IOPcc), which were -3.20, -3.82, 0.14, and 2.00 mmHg, respectively. The widths of the 95% limits of agreement between all pairs of IOP measurements were greater than 3 mmHg. With the exception of the 7CR-IOPcc, all of the IOP variations were explained by regression coefficients involving gender, average corneal curvature, and central corneal thickness. The IOP values obtained by the GAT, CST, and 7CR were not interchangeable. Each new IOP measurement device that was corrected for ocular structure had its own limitations.

Applications of Scheimpflug Imaging in Glaucoma Management: Current and Potential Applications

Scheimpflug photography is the basis for a variety of imaging devices that are highly versatile. The applications of Scheimpflug imaging are wide in scope, spanning from evaluation of corneal ectasia to quantifying density in nuclear sclerotic cataracts. The potential uses for Scheimpflug-based devices are expanding and a number of them are relevant in glaucoma. In particular, they can provide three-dimensional image reconstruction of the anterior segment which includes assessment of the iridocorneal angle. Photographic analyses allow also for a noncontact method of estimating central corneal thickness (CCT) and intraocular pressure (IOP), as well as the study of various corneal biomechanical properties, which may be useful for stratifying glaucoma risk.

Visual light effects on mitochondria: The potential implications in relation to glaucoma

Light of different wave-lengths have the potential to interact with four major mitochondrial protein complexes that are involved in the generation of ATP. Neurones of the central nervous system have an absolute dependence on mitochondrial generated ATP. Laboratory studies show that short-wave or blue light (400-480nm) that impinges on the retina affect flavin and cytochrome constituents associated with mitochondria to decrease the rate of ATP formation, stimulate ROS and results in cell death. This suggests that blue light could potentially have a negative influence on retinal ganglion cell (RGC) mitochondria that are abundant and not shielded by macular pigments as occurs for photoreceptor mitochondria. This might be of significance in glaucoma where it is likely that RGC mitochondria are already affected and therefore be more susceptible to blue light. Thus simply filtering out some natural blue light from entering the eye might be beneficial for the treatment of glaucoma. Long-wave or red light (650-800nm) affects mitochondrial complex IV or cytochrome oxidase to increase the rate of formation of ATP and ROS causing the generation of a number of beneficial factors. Significantly, laboratory studies show that increasing the normal amount of natural red light reaching rat RGC mitochondria in situ, subjected to ischemia, proved to be beneficial. A challenge now is to test whether extra red light delivered to the human retina can slow-down RGC loss in glaucoma. Such a methodology has also the advantage of being non-invasive. One very exciting possibility might be in the production of a lens where solar UV light is convertes to add to the amount of natural red light entering the eye.

The Icare HOME (TA022) Study: Performance of an Intraocular Pressure Measuring Device for Self-Tonometry by Glaucoma Patients

PURPOSE

To evaluate the Icare HOME (TA022) device (Icare Oy, Vanda, Finland) for use by glaucoma patients for self-tonometry.

DESIGN

Prospective performance evaluation of a medical device.

PARTICIPANTS

One hundred eighty-nine participants with glaucoma or suspected glaucoma were recruited from the Wilmer Eye Institute, Baltimore, Maryland, between July 2014 and April 2015.

METHODS

Participants had standardized training and had to be able use the Icare HOME device independently. Subjects also had to be able to obtain the first intraocular pressure (IOP) measurement within 5 mmHg of Goldmann applanation tonometry (GAT). Those certified obtained 3 IOP measures using the HOME device, and these were compared with Icare TA01i and GAT IOP measurements.

MAIN OUTCOME MEASURES

The agreement between Icare HOME and reference tonometers was used to assess precision. The intraclass correlation coefficient was used to assess within-patient reliability for the HOME device.

RESULTS

Eighteen of 189 recruited patients were ineligible to take part in the study. Forty-four of 171 patients (25.7%) started but failed to complete the study: 7 stopped because of time concerns, 10 of 171 patients (6%) stopped because of difficulty using the device during certification, and 27 of 171 patients (16%) failed to be certified based on IOP. The HOME and GAT measurements agreed within 5 mmHg in 116 of 127 participants (91.3%); 2 participants (1.6%) had a difference of more than 7 mmHg. The mean difference between the Icare HOME and GAT measurements was -0.33 mmHg (standard deviation, 3.11 mmHg). The overall intraclass correlation coefficient for the HOME device was 0.92 (95% confidence interval, 0.89-0.95).

CONCLUSIONS

Not all participants could learn how to use the Icare HOME device, but for those who could, most were able to obtain measurements similar to those obtained by GAT. The Icare HOME device is safe and reliable for self-tonometry, but nearly 1 in 6 individuals may fail to certify in use of the device based on large differences in IOP when comparing GAT with the Icare HOME measurements. The device has the potential to address an unmet need by providing more frequent IOP measurements in a patient's day to day life.

Changes in Corneal Biomechanical Properties after Long-Term Topical Prostaglandin Therapy

OBJECTIVE

To compare corneal biomechanical properties, measured by a newly developed tonometer (Corneal Visualization Scheimpflug Technology, Corvis ST), in untreated primary open angle glaucoma (POAG) patients, POAG patients with long-term topical prostaglandin analog (PGA) therapy and in normal controls. Further is to investigate the potential effects of PGA on corneal biomechanics.

METHODS

In this case-control study, 35 consecutive medication naïve eyes with POAG, 34 POAG eyes with at least 2 years treatment by PGA and 19 normal eyes were included. Intraocular pressure (IOP), central corneal thickness (CCT) and corneal biomechanical parameters, including deformation amplitude (DA), applanation time (AT1 and AT2), applanation length (AL1 and AL2), applanation velocity (AV1 and AV2), and peak distance and radius were measured using Corvis ST. Axial length and corneal curvature were measured with partial coherence interferometry (IOLMaster, Zeiss, Germany). General linear model analysis was performed to investigate the corneal biomechanical property changes among the normal controls, newly diagnosed POAG patients and POAG patients with long-term PGA treatment, and among the subgroups of different types of PGA treatment, including bimatoprost, latanoprost and travoprost. Furthermore, pairwise comparisons using Bonferroni correction for least squares means were employed.

RESULTS

AT1 (p<0.0001), AV1 (p<0.0001), AT2 (p = 0.0001), AV2 (p<0.0001) and DA (p = 0.0004) in newly diagnosed glaucoma patients were significantly different from those in normal subjects and in patients underwent at least 2 years topical PGA therapy after adjusting for age and gender. After adjusting for age, gender, IOP, CCT, axial length and corneal curvature, a significant difference was detected for DA between glaucoma patients without PGA treatment and patients with long-term PGA therapy (p = 0.0387). Furthermore, there were no statistical significant differences in all of the corneal biomechanical parameters among the 3 types of PGA therapy subgroups, namely bimatoprost, latanoprost and travoprost.

CONCLUSIONS

Significant changes in corneal deformation parameters were found among untreated POAG patients, POAG patients with long-term topical PGA therapy and normal controls. Long-term topical PGA treatment might have a direct effect on corneal biomechanical properties in addition to the indirect effect owing to the PGA-induced IOP reduction and CCT decrease on corneal dynamic properties.

In vivo human corneal deformation analysis with a Scheimpflug camera, a critical review

Corneal morphological analysis has greatly improved in recent years, providing physicians with new and reliable parameters to study. Moreover, today corneal functional too is a routine analysis, thanks to biomechanical evaluation allowed by an ocular response analyzer (Reichert Ophthalmic Instrument, Depew, NY, USA). Corvis ST (OCULUS Optikgeräte GmbH, Wetzlar, Germany), that relies on the ultrahigh speed Scheimpflug camera, is a new device providing corneal deformation parameters measured ny scanning the cornea response to an air puff; it is an instrument able to measure intraocular pressure too. This device could open up a whole new prospective in screening, detecting and managing corneal diseases, intraocular pressure measurement and in evaluating surgical procedures involving the cornea. This paper provides a comprehensive explanation of Corvis ST measurement principles and parameters and a literature review of scientific studies.

Comparison of Diaton transpalpebral tonometer with applanation tonometry in keratoconus

AIM

To investigate the added value of using a Diaton transpalpebral tonometer (DT) to measure IOP in keratoconus. Most type of tonometers use corneal applanation or biomechanical resistance to measure intraocular pressure (IOP); however, these factors can be altered by keratoconus. Specifically, we examined whether DT can detect false-negative low Goldmann applanation tonometry (AT) measurements.

METHODS

Patients with keratoconus were recruited from our tertiary academic treatment center. Measurements included AT and DT (in random order) and Scheimpflug imaging. An age- and gender-matched group of control subjects with no history of corneal disease or glaucoma was also recruited.

RESULTS

In total, 130 eyes from 66 participants were assessed. In the keratoconus group, mean AT was 11.0 ± 2.6, mean DT 11.2±5.5 (P=0.729), and the two measures were correlated significantly (P=0.006, R=0.323). However, a Bland-Altman plot revealed a wide distribution and poor agreement between both measurements. Previous corneal crosslinking, corneal pachymetry, and Krumeich classification had no effect on measured IOP.

CONCLUSION

Measurements obtained using a Diaton tonometer are not affected by corneal biomechanics; however, its poor agreement with Goldmann AT values calls into question the added value of using a Diaton tonometer to measure IOP in keratoconus.

Age-Related Changes of Intraocular Pressure in Elderly People in Southern China: Lingtou Eye Cohort Study

PURPOSE

To study age-related changes of intraocular pressure (IOP) and assess the cohort effect in both cross-sectional and longitudinal settings among elderly Chinese adults.

METHODS

Participants were enrolled from the Lingtou Eye Cohort Study with Chinese government officials aged 40 years and older at baseline and received physical check-up and ocular examinations from 2010 to 2012. IOP was measured using a non-contact tonometer according to standardized protocols, as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI). Participants who had attended IOP measurements in both 2010 and 2012 were included in this study. Cross-sectional association of IOP with age was assessed using multivariate liner regression analyses and based on the data of 2010. Longitudinal changes in IOP were assessed by paired t-test.

RESULTS

A total of 3372 subjects were enrolled in the current analysis (2010 mean [SD] age, 61.9 [7.1] years; 60.2% men). The mean IOP in 2010 was 15.4 ± 2.3 mmHg for women and 15.2 ± 2.3 mmHg for men with an intersex difference (P = 0.029). Cross-sectional analysis showed that IOP was negatively associated with age (P = 0.003, β = -0.033 for women and P<0.001, β = -0.061 for men) adjusted for baseline SBP, DBP and BMI. Paired t-test suggested that IOP was higher in the year 2012 than 2010 in women (P = 0.006) but did not change significantly in men within 2 years (P = 0.345). In addition, the 2-year changes of IOP were not associated with age adjusted for baseline IOP in 2010 (P = 0.249).

CONCLUSION

Cross-sectional data suggests that IOP is lower in people with older age. Longitudinal data does not support such findings and thus the identified decreasing pattern with age in cross-sectional analysis is likely caused by cohort effects.

Comparison of intraocular pressure measurements with different contact tonometers in young healthy persons

AIM

To analyze the correlation of Goldmann applanation tonometer (GAT), I-Care tonometer and Tono-Pen tonometer results in young healthy persons, and to investigate the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements recorded with these tonometers.

METHODS

We conducted a pilot clinical study in 78 eyes of 78 subjects aged 22-28 years old (44 women and 34 men; mean age 23.8±1.19y). IOP was measured using GAT, I-Care and Tono-Pen tonometers, followed by measurements of CCT. Statistical analysis was performed using SPSS 20.0.

RESULTS

The mean IOPs and standard deviation (±SD) for GAT, I-Care and Tono-Pen were 15.62±2.281 mm Hg, 16.29±2.726 mm Hg and 16.32±2.393 mm Hg, respectively. The mean CCT was 555.15±29.648 µm. Clear positive correlations between GAT and I-Care, GAT and Tono-Pen, and I-Care and Tono-Pen tonometers were found (r=0.867, P<0.001; r=0.861, P<0.001; r=0.915, P<0.001, respectively). In comparison between devices, Bland-Altman analysis showed a significant mean difference (MD) in the measurements by GAT and I-Care of -0.679 mm Hg and by GAT and Tono-Pen of -0.705 mm Hg ( P<0.001), but there was no significant difference between I-Care and Tono-Pen ( P>0.05). Both non-gold standard tonometers were affected by CCT; that is, both I-Care and Tono-Pen tonometer values were significantly higher with higher CCT means (>555 µm; MD=-1.282, P<0.001; MD=-0.949, P<0.001, respectively) compared with GAT.

CONCLUSION

Both I-Care and Tono-Pen tonometers overestimated IOP compared with the GAT values. Either the I-Care or Tono-Pen tonometer could be used instead of GAT because there was no significant difference between their results. Higher CCT values (>555 µm) were associated with overestimated IOP values.

A Comparative Study of Rebound Tonometry With Tonopen and Goldmann Applanation Tonometry Following Vitreoretinal Surgery

PURPOSE

To investigate agreement in intraocular pressure (IOP) measurements among Icare rebound tonometry, Tonopen tonometry, and Goldmann applanation tonometry following vitreoretinal surgery.

DESIGN

Reliability analysis of tonometers.

METHODS

Fifty-eyes of 50 adults undergoing vitreoretinal surgery were enrolled. IOP was measured on first postoperative day using Icare (Tiolat, Helsinki, Finland), followed by Tonopen (Reichert, Depew, New York, USA) and Goldmann (Haag-Streit USA, Mason, Ohio, USA) in randomized order. Intraclass correlation coefficients (ICC) and Bland-Altman plots were calculated for all subcategories.

RESULTS

Icare successfully measured IOP in all eyes, while Goldmann was unmeasurable in 6 eyes (12%) and Tonopen in 1 eye (2%). Mean IOP by Icare, Tonopen, and Goldmann was 15.9 ± 8.9, 16.9 ± 6.2, and 16.0 ± 7.3 mm Hg, respectively (P = .76). Type of intraocular tamponade, status of lens, status of cornea, gauge of instrumentation, and history of prior vitrectomy did not result in significant differences among the 3 tonometers. ICC was excellent (>0.75) in all subgroups, except at IOP <10 and ≥ 23 mm Hg (based on Icare). In eyes with IOP <10 mm Hg, Icare underestimated IOP (mm Hg; P = .01) compared to Goldmann (2.0 ± 2.1) and Tonopen (3.5 ± 2.4), whereas at IOP ≥ 23 mm Hg Icare was overestimated (P = .01) compared to Goldmann (3.77 ± 3.49) and Tonopen (4.97 ± 3.33). Overall, differences in IOP were ≤ 3 mm Hg in 58% of eyes for Icare-Tonopen, 72% for Tonopen-Goldmann, and 62% for Icare-Goldmann.

CONCLUSION

IOP measurements using Icare rebound tonometry, Tonopen, and Goldmann tonometry are in excellent agreement following vitreoretinal surgery. However, Icare overestimates at IOP ≥ 23 and underestimates at IOP <10 mm Hg.

Evaluation of Central Corneal Thickness Using Corneal Dynamic Scheimpflug Analyzer Corvis ST and Comparison with Pentacam Rotating Scheimpflug System and Ultrasound Pachymetry in Normal Eyes

Purpose. To assess the repeatability and reproducibility of central corneal thickness (CCT) measurements by corneal dynamic Scheimpflug analyzer Corvis ST in normal eyes and compare the agreement with Pentacam rotating Scheimpflug System and ultrasound pachymetry. Methods. 84 right eyes underwent Corvis ST measurements performed by two operators. The test-retest repeatability (TRT), within-subject coefficient of variation (CoV), and intraclass correlation coefficient (ICC) were used to evaluate the intraoperator repeatability and interoperator reproducibility. CCT measurements also were obtained from Pentacam and ultrasound pachymetry by the first operator. The agreement between the three devices was evaluated with 95% limits of agreement (LoA) and Bland-Altman plots. Results. Corvis ST showed high repeatability as indicated by TRT ≤ 13.0 μm, CoV < 0.9%, and ICC > 0.97. The interoperator reproducibility was also excellent. The CoV was <0.9%, and ICC was >0.97. Corvis ST showed significantly lower values than Pentacam and ultrasound pachymetry (P < 0.001). The 95% LoA between Corvis ST and Pentacam or ultrasound pachymetry were −15.8 to 9.5 μm and −27.9 to 12.3 μm, respectively. Conclusions. Corvis ST showed excellent repeatability and interoperator reproducibility of CCT measurements in normal eyes. Corvis ST is interchangeable with Pentacam but not with ultrasound pachymetry.

Scheimpflug camera in the quantitative assessment of reproducibility of high-speed corneal deformation during intraocular pressure measurement

The paper presents an original analysis method of corneal deformation images from the ultra-high-speed Scheimpflug camera (Corvis ST tonometer). Particular attention was paid to deformation frequencies exceeding 100 Hz and their reproducibility in healthy subjects examined repeatedly. A total of 4200 images with a resolution of 200 × 576 pixels were recorded. The data derived from 3 consecutive measurements from 10 volunteers with normal corneas. A new image analysis algorithm, written in Matlab with the use of the Image Processing package, adaptive image filtering, morphological analysis methods and fast Fourier transform, was proposed. The following results were obtained: (1) reproducibility of the eyeball reaction in healthy subjects with precision of 10%, (2) corneal vibrations with a frequency of 369 ± 65 Hz (3) and amplitude of 7.86 ± 1.28 µm, (4) the phase shift within two parts of the cornea of the same subject of about 150°. The result of image sequence analysis for one subject and deformations with a corneal frequency response above 100 Hz.

Development and validation of a correction equation for Corvis tonometry

PRIMARY OBJECTIVE

This study uses numerical analysis and validation against clinical data to develop a method to correct intraocular pressure (IOP) measurements obtained using the Corvis Tonometer for the effects of central corneal thickness (CCT), and age.

MATERIALS AND METHODS

Finite element analysis was conducted to simulate the effect of tonometric air pressure on the intact eye globe. The analyses considered eyes with wide variations in IOP (10-30 mm Hg), CCT (445-645 microns), R (7.2-8.4 mm), shape factor, P (0.6-1) and age (30-90 years). In each case, corneal deformation was predicted and used to estimate the IOP measurement by Corvis (CVS-IOP). Analysis of the results led to an algorithm relating estimates of true IOP as a function of CVS-IOP, CCT and age. All other parameters had negligible effect on CVS-IOP and have therefore been omitted from the algorithm. Predictions of corrected CVS-IOP, as obtained by applying the algorithm to a clinical data-set involving 634 eyes, were assessed for their association with the cornea stiffness parameters; CCT and age.

RESULTS

Analysis of CVS-IOP measurements within the 634-large clinical data-set showed strong correlation with CCT (3.06 mm Hg/100 microns, r(2) = 0.204) and weaker correlation with age (0.24 mm Hg/decade, r(2) = 0.009). Applying the algorithm to IOP measurements resulted in IOP estimations that became less correlated with both CCT (0.04 mm Hg/100 microns, r(2) = 0.005) and age (0.09 mm Hg/decade, r(2) = 0.002).

CONCLUSIONS

The IOP correction process developed in this study was successful in reducing reliance of IOP measurements on both corneal thickness and age in a healthy European population.

Repeatability, reproducibility, and age dependency of dynamic Scheimpflug-based pneumotonometer and its correlation with a dynamic bidirectional pneumotonometry device

PURPOSE

To assess the repeatability, reproducibility, and age dependency of dynamic Scheimpflug-based pneumotonometry (Corvis)-generated parameters and their correlation with dynamic bidirectional pneumotonometry device [Ocular Response Analyzer (ORA)] measurements [corneal hysteresis (CH) and corneal resistance factor (CRF)].

METHODS

Eyes of 29 healthy participants between 20 and 30 years old were measured using Corvis and ORA. Measurements were performed twice in a row and repeated after 1 week. Repeatability and reproducibility were examined by calculating intraday and interday coefficients of variation (CVs). Corvis measurements were compared with measurements from 19 participants older than 65 years.

RESULTS

The most repeatable and reproducible Corvis-generated parameters, with intraday and interday CVs < 10% were as follows: intraocular pressure (IOP), pachymetry, time to first and second applanation (A1 time, A2 time), radius and amplitude at highest concavity (HC radius and HC deformation amplitude, respectively), time to highest concavity (HC time), deflection length and amplitude at highest concavity [HC deflection length and HC deflection amplitude (millimeter), respectively], and time to highest deflection amplitude [HC deflection amplitude (millisecond)]. However, 7 of 19 analyzed parameters showed CVs > 10%. HC-related parameters showed significant age dependency. The correlation between Corvis and ORA was weak (A2 time and CH, r = 0.36, A1 time and CRF, r = 0.41). Corvis-derived IOP was on average 2.2 ± 2.3 mm Hg higher than cornea-compensated IOP, with large differences in patients with high-average IOP.

CONCLUSIONS

The considerable variation in repeatability and reproducibility should be taken into account when using the Corvis. Corvis parameters showed poor correlation with CH and CRF obtained by ORA measurements.

Open source software for the analysis of corneal deformation parameters on the images from the Corvis tonometer

Background

The software supplied with the Corvis tonometer (which is designed to measure intraocular pressure with the use of the air-puff method) is limited to providing basic numerical data. These data relate to the values of the measured intraocular pressure and, for example, applanation amplitudes. However, on the basis of a sequence of images obtained from the Corvis tonometer, it is possible to obtain much more information which is not available in its original software. This will be presented in this paper.

Material and method

The proposed software has been tested on 1400 images from the Corvis tonometer. The number of analysed 2D images (with a resolution of 200 × 576 pixels) in a sequence is arbitrary. However, in typical cases there are 140 images. The proposed software has been written in Matlab (Version 7.11.0.584, R2010b). The methods of image analysis and processing and in particular edge detection and the fast Fourier transform have been applied.

Results and discussion

The software allows for fully automatic (1) acquisition of 12 new parameters previously unavailable in the original software of the Corvis tonometer. It also enables off-line (2) manual and (3) automatic browsing of images in a sequence; 3D graph visualization of: (4) the corneal deformation and (5) eyeball response; 6) change of the colour palette; (7) filtration and (8) visualization of selected measured values on individual 2D images. In addition, the proposed software enables (9) to save the obtained results for further analysis and processing.

Conclusions

The dedicated software described in this paper enables to obtain additional new features of corneal deformations during intraocular pressure measurement. The software can be applied in the diagnosis of corneal deformation vibrations, glaucoma diagnosis, evaluation of measurement repeatability and others. The software has no licensing restrictions and can be used both commercially and non-commercially without any limitations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12938-015-0027-3) contains supplementary material, which is available to authorized users.

Quantitative assessment of responses of the eyeball based on data from the Corvis tonometer

BACKGROUND

The "air-puff" tonometers, include the Corvis, are a type of device for measuring intraocular pressure and biomechanics parameters. The paper attempts to analyse this response and its relationship with other parameters measured in the Corvis tonometer.

METHODS

A number of 13,400 2D images were acquired from the Corvis device and analysed (32 healthy and 16 ill people). A new method has been proposed for the analysis of responses of the eyeball based on morphological transformations and contextual operations.

RESULTS

The proposed algorithm enables to determine responses of the eyeball to an air puff coming from the Corvis tonometer. Additionally, responses of the eyeball have been linked to some selected features of corneal deformation. The results include, among others: (1) distinguishability between the left and right eye with an error of 7%; (2) the correlation between the area under the curve in corneal deformation and the response of the eyeball -0.26; (3) the correlation between the highest concavity time and the maximum deformation amplitude of 0.4. All these features are obtained fully automatically and repetitively at a time of 3.8s per patient (Core i7 10GB RAM).

DISCUSSION

It is possible to measure additional parameters of the eye deformation which are not available in the original software of the Corvis tonometer. The use of the proposed methods of image analysis and processing provides results directly from the eye response measurement when measuring intraocular pressure.