Agreement profiles for rebound and applanation tonometry in normal and glaucomatous children

To investigate agreement between intraocular pressure measurements by the rebound tonometer and handheld Perkins applanation tonometer in children with and without primary congenital glaucoma and test agreement with intraocular pressure and age variations.

A prospective non-interventional comparative study done on 223 eyes of 115 children, 161 normal eyes, and 62 eyes with primary congenital glaucoma. Intraocular pressure measurements were obtained in the upright position by rebound tonometer first, followed by installation of topical anesthetic eye drops (benoxinate), then measured by Perkins applanation tonometer.

For all eyes, mean difference between Perkins applanation tonometer and rebound tonometer was -0.59 ± 2.59 mmHg, p = 0.001. Regression analysis with (r) = 0.9, (r²) = 0.79, and p < 0.001. In primary congenital glaucoma: there was a mean difference of -.79 ± 2.82 (p = 0.032), a good correlation with (r) = 0.94, (r²) = 0.87%, and 95% level of agreement: -6.34 to +4.76. In normal eyes: mean difference was -.52 ± 2.5 (p = 0.01), correlation: (r) = 0.8, (r²) = 0.64, and p = 0.001. The 95% level of agreement -5.41 and +4.36 mmHg. In intraocular pressure ⩽ 15 mmHg: mean difference -0.89 ± 2.15 mmHg, 95% level of agreement between -5.1 and +3.32 mmHg, p < 0.001. In intraocular pressure >15 mmHg: mean difference was 0.04 ± 3.28 mmHg, 95% level of agreement -6.38 and +6.46 mmHg, p = 0.914.

There is a good correlation between rebound tonometer and Perkins applanation tonometer in children with and without primary congenital glaucoma; however, rebound tonometer overestimates the intraocular pressure, and in intraocular pressure >15 mmHg there is less agreement between the two devices. Hence, in higher intraocular pressure measurement caution should be taken when interpreting rebound tonometer readings, and a confirmatory measurement using Perkins applanation tonometer is advised.