Evaluation of correction formulas for tonometry

BACKGROUND Accurate determination of intraocular pressure (IOP) is essential for correct management of glaucoma. Goldmann applanation tonometry (GAT) is the gold standard for measuring IOP despite its limitations due to its dependence on corneal properties. With the aim of improving the accuracy of GAT readings, several correction formulas have been developed. OBJECTIVE The aim of this study was to investigate the accuracy and clinical relevance of five correction equations for GAT. MATERIAL AND METHODS Prospective study of 112 glaucoma patients at the University Hospital and Talacker Eye Center, Zurich, Switzerland. The IOP was measured with GAT and dynamic contour tonometry (DCT) in randomized order. The GAT readings were adjusted with five correction equations. The primary study endpoint was the degree of concordance between corrected GAT and DCT readings. A discordance of ≥2 mm Hg was defined as significant. The association between discordant IOP measurements and central corneal thickness (CCT) was the secondary study endpoint. RESULTS The mean patient age was 66 ± 13 years (60% females and 56% left eyes). The mean IOP was 17.0 mm Hg for GAT and 20.3 mm Hg for DCT, with a discordance of 3.3 mm Hg between GAT und DCT. The discordances between DCT and the corrected values ranged from 2.7 to 5.4 mm Hg. Spearman's rank testing showed a positive correlation between CCT and the discordances of all correction equations and a negative correlation between CCT and the discordance of DCT and GAT. CONCLUSION The use of GAT correction formulas involves the risk of creating significant error. The correction equations examined showed extensive scatter and resulted in mean IOP values that were lower than the IOP initially measured by GAT. Thus the use of any correction equation may delay diagnosis of glaucoma and should be avoided

Age-Related Variation in the Biomechanical and Structural Properties of the Corneo-Scleral Tunic

With increasing age, the mechanical performance of the cornea and sclera is impaired due to structural changes in the major structural proteins, namely collagens , proteoglycans and elastin. In addition, the level of hydration in the ocular tunic decreases over time. These structural changes profoundly impact on the biomechanical properties of the corneo-scleral tunic. This chapter focuses on the structural and biomechanical changes that occur in the corneo-scleral tunic with age. The techniques that are utilized in order to determine the mechanical properties of both the cornea and sclera are discussed, and a comprehensive review of studies which have characterized age-related changes in ocular biomechanics are presented. The cornea is found to increase in stiffness with age and all the characteristics of viscoelastic behavior (creep , stress-relaxation and hysteresis) decrease with age. Similarly, the stiffness of the sclera increases markedly with age although the reported magnitude of stiffening varies significantly from one study to another. This may be related to variations amongst the different techniques that have been utilized. Increased stiffening in the cornea and the sclera with age is strongly associated with the increase in collagen crosslinking that occurs as part of the natural aging process