Intraocular pressure in a cohort of healthy Eastern European schoolchildren: variations in method and corneal thickness

BACKGROUND: Intraocular pressure (IOP) in the developing eye of a child is not always easy to measure and there is no technique that is known to be the most accurate for the young eye. Measurements are needed on many cohorts of children with different tonometers to determine how the values correlate between instruments, whether corneal parameters affect readings and whether correlations between age and IOP values can be discerned. The aim of this study was to undertake a comparative analysis of three different tonometers on a group of healthy children to see whether differences exist and whether these may be related to central corneal thickness and/or radius of curvature. In addition, the study adds to the relatively small body of literature on IOP in the growing eye which will collectively allow trends to be identified and ultimately norms to be established. METHODS: IOP was measured on 115 eyes in a group of Polish children, aged between 5-17 years (mean±standard deviation [SD] 11.3±3.0 years) using three different tonometers: non-contact (NCT), the ICare and Goldmann applanation (GAT). Readings obtained were compared between instruments and with central corneal thickness and radius of curvature. RESULTS: The ICare tonometer provided statistically higher IOP values (16.9±3.4 mmHg) than the GAT (14.7±2.9 mmHg) regardless of corneal thickness and whether or not a correction factor was applied. A correlation was found between central corneal thickness (CCT) and IOP values obtained with all three tonometers but only the IOP values detected with the ICare tonometer showed a statistically significant correlation with radius of curvature (p<0.004). No correlations with age or gender were found for IOP values measured with any of the instruments. CONCLUSIONS: IOP measurements on children vary significantly between instruments and correlations are affected by the corneal thickness. Further studies on children are needed to determine which instrument is most appropriate and to derive a normative IOP scale for the growing eye

How a dynamic optical system maintains image quality: Self-adjustment of the human eye

The eyeball is continually subjected to forces that cause alterations to its shape and dimensions, as well as to its optical components. Forces that induce accommodation result in an intentional change in focus; others, such as the effect of intraocular pressure fluctuations, are more subtle. Although the mechanical properties of the eyeball and its components permit mediation of such subtle forces, the concomitant optical changes are not detected by the visual system. Optical self-adjustment is postulated as the mechanism that maintains image quality. The purpose of this study was to investigate how self-adjustment occurs by using an optical model of the eyeball and to test the requisite optical and biometric conditions

Raw data from Ocular Response Analyzer applied for differentiation of normal and glaucoma patients

Purpose: Presented study describes new parameters calculated from the Ocular Response Analyzer (ORA) raw data. Such an approach can increase the applicability of the ORA in ophthalmic diagnosis. Among many proposed and examined by us parameters from raw data of the air pressure and applanation curves, only a few were chosen and then applied for characterizing a selected group of patients. Methods: The study included healthy subjects in a control group and patients divided into 2 groups: suspect and glaucoma. A series of four ORA measurements were taken from each subject. The raw ORA data were numerically analyzed and new parameters were calculated from the ORA curves for each measurement. Comparative analysis was carried out for the newly proposed parameters (and original parameters from the ORA device). Results: This interesting finding is that the new parameters showed a statistically significant ability to distinguish the glaucoma suspect group from healthy and glaucomatous patients. Moreover comparable or higher repeatability than for IOPg and CH was obtained. Conclusion: Raw data from the ORA enables definition and numerical analysis of new parameters, characterizing every measurement, which can be successfully used for describing an individual eye and differentiating between some specific groups of patients

Age-related changes in ocular blood velocity in suspects with glaucomatous optic disc appearance. Comparison with healthy subjects and glaucoma patients

Purpose To evaluate retrobulbar blood flow characteristics of glaucoma suspects with glaucomatous optic disc appearance (GODA) in comparison to healthy control group (CG) and primary open angle glaucoma patients (POAG) and assess the effect of age. Methods 145 patients from a single glaucoma clinic were enrolled and classified into two diagnostic groups (GODA and POAG). Third group of subjects consisted of 67 age matched individuals (CG). Retrobulbar blood velocity measurement in central retinal artery was performed using color Doppler imaging (CDI). CDI images were processed in custom software leading a range of parameter estimates from a continuous waveform signal. The effect of age on the estimated parameters was evaluated with the stepwise forward regression and ANCOVA in which age was used as a continuous factor. One-way ANOVA was used to test for the differences in the CDI parameters between the three considered groups. Correlation between restive index (RI) and pulsatility index (PI) was assessed with a bilinear fitting guaranteeing no discontinuities in RI intercept estimate. Fisher test was used to assess the applicability of a bilinear PI/RI relationship, while the statistics of the RI intercept estimate were evaluated using the bootstrap. Results ANCOVA showed significant interaction between age and group (p<0.05) for five out of nine considered CDI parameters. The RI intercept for CG and GODA groups was 0.602±0.047, and 0.574±0.044 respectively, while the RI intercept of 0.934±0.066 was found for the POAG. Conclusions The observed similarity of CG and GODA group and dissimilarity between GODA and POAG groups in terms of PI/RI relationship is remarkable. Age may play some role in the different mechanisms occurring in blood velocity dynamics in GODA and POAG subjects but it is not a strongly determining factor

Short-Time Changes of Intraocular Pressure and Biomechanics of the Anterior Segment of the Eye during Water Drinking Test in Patients with XEN GelStent

Purpose: Little is known about short-term changes in intraocular pressure (IOP) following minimally invasive glaucoma surgeries, such as post-XEN GelStent implantation. Although the importance of corneal biomechanics in glaucoma diagnostics has been reported, little work has been conducted on postoperative description of changes when the structure of the anterior segment is altered. The aim of presented study was to evaluate the changes in the biomechanical parameters of the anterior segment of the post-XEN GelStent implantation eyes. Patients and Methods: This investigator-initiated, open-label, prospective, single-center study recruited patients. Patients with primary open-angle glaucoma (POAG) after XEN GelStent implantation versus matched POAG controls (considered as control group/CG) treated pharmacologically were screened. Water loading was conducted using 10 mL of water per kilogram of body weight for &le;5 min. Goldmann applanation tonometry (GAT), corneal hysteresis (CH), and corneal resistance factor (CRF) were performed before water loading and after every 15 min up to 1 h. Results: The water drinking test (WDT) was positive in 3.7% (1 out of 27) of patients in the post-XEN group compared with 22.7% (5 out of 22) of patients in the control group (CG; p &lt; 0.05). Mean fluctuations in GAT during the WDT were higher in the CG group (3.6 &plusmn; 2.5 mmHg vs. 2.9 &plusmn; 1.3 mmHg, p &lt; 0.001). CRF and CH changed significantly only in the post-XEN group. The mean peak of CH and CRF occurred at 15 and 30 min of the test in the post-XEN group (p = 0.001). Conclusion: WDT is important to assess the ability of compensation mechanisms to reduce fluctuations in IOP after water upload. The relationship between biomechanics of the anterior segment and glaucoma may have substantial impact on surgical outcome evaluation

An example of the CDI waveform with robustly estimated parameters.

<p>An example of the CDI waveform with robustly estimated parameters.</p

Group mean (and range) values of the nine considered CDI parameters.

<p>All results for CDI parameters are included in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134357#pone.0134357.s001" target="_blank">S1 Table</a>.</p

Number of subjects, mean age, DCT IOP, OPA, HR, CCT, MD, CDR, RNFL, and systolic and diastolic blood pressure for the three considered groups.

<p>Number of subjects, mean age, DCT IOP, OPA, HR, CCT, MD, CDR, RNFL, and systolic and diastolic blood pressure for the three considered groups.</p

An example of output from the ALOKA CDI with erroneously estimated value of EDV equal to zero and subsequently misrepresented values of PI and RI.

<p>An example of output from the ALOKA CDI with erroneously estimated value of EDV equal to zero and subsequently misrepresented values of PI and RI.</p