Abstract

Purpose: To compare intraocular pressure (IOP) obtained with Tono-Pen (TP) and Goldmann applanation (GAT) using large-scale electronic health records (EHR).Design: Retrospective cohort study.Methods: A single pair of eligible TP/GAT IOP readings was randomly selected from the EHR for each ophthalmology patient at an academic ophthalmology center (2013-2022), yielding 4550 eligible measurements. We used Bland-Altman analysis to describe agreement between TP/GAT IOP differences and mean IOP measurements. We also used multivariable logistic regression to identify factors associated with different IOP readings in the same eye, including demographics, glaucoma diagnosis, and central corneal thickness (CCT). Primary outcome metrics were discrepant measurements between TP and GAT as defined by two methods: Outcome A (normal TP despite elevated GAT measurements), and Outcome B (TP and GAT IOP differences =6mmHg).Result: The mean TP/GAT IOP difference was 0.15mmHg (±5.49mmHg 95% CI). There was high correlation between the measurements (r=0.790, p<0.001). We found that TP overestimated pressures at IOP <16.5mmHg and underestimated at IOP >16.5mmHg (Fig. 4). Discrepant measurements accounted for 2.6% (N=116) and 5.2% (N=238) for outcomes A and B respectively. Patients with thinner CCT had higher odds of discrepant IOP (OR 0.88 per 25mum increase, CI [0.84-0.92], p<0.0001; OR 0.88 per 25mum increase, CI [0.84-0.92], p<0.0001 for outcomes A and B respectively).Conclusion: In a real-world academic practice setting, TP and GAT IOP measurements demonstrated close agreement, although 2.6% of measurements showed elevated GAT IOP despite normal TP measurements, and 5.2% of measurements were =6mmHg apart.

View details for DOI 10.1016/j.heliyon.2023.e18703

View details for PubMedID 37576221