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Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
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Falsely high rebound tonometry.

Brooke Saffren1, Jade M Price2, Qiang Ed Zhang3

  • 1Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|April 26, 2021
PubMed
Summary
This summary is machine-generated.

Rebound tonometry (RBT) may overestimate intraocular pressure (IOP) in children, showing a difference of 6 mm Hg or more compared to applanation tonometry (AT). Factors like persistent fetal vasculature and larger corneal diameter increase this discrepancy.

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Area of Science:

  • Ophthalmology
  • Pediatric Medicine
  • Medical Device Technology

Background:

  • Rebound tonometry (RBT) is an alternative for measuring intraocular pressure (IOP) in pediatric patients who cannot tolerate applanation tonometry (AT).
  • RBT measurements typically exceed AT readings by 2-3 mm Hg.
  • A significant discrepancy (≥6 mm Hg) between RBT and AT readings has been observed in some children.

Purpose of the Study:

  • To identify demographic and ocular characteristics associated with a significant artifactuous discrepancy between RBT and AT intraocular pressure measurements in pediatric patients.

Main Methods:

  • Retrospective review of medical records for pediatric patients with IOP measured by RBT followed by AT within a 6-month period.
  • Exclusion criteria included intervening surgery or changes in medical management between measurements.
  • Analysis focused on identifying predictors of a greater than or equal to 6 mm Hg difference between RBT and AT readings.

Main Results:

  • 18.5% of eyes with normal IOP (≤24 mm Hg) showed a ≥6 mm Hg RBT-AT difference, with risk factors including persistent fetal vasculature (PFV), increased corneal diameter, and higher initial RBT (>20).
  • 77% of eyes with elevated IOP (>24 mm Hg) exhibited a ≥6 mm Hg RBT-AT difference, with larger corneal diameter being the sole predictor.
  • Corneal opacity or iris abnormalities were associated with a lower likelihood of significant RBT-AT difference in eyes with elevated IOP.

Conclusions:

  • A significant discrepancy (≥6 mm Hg) between RBT and AT IOP measurements can occur in pediatric patients.
  • Caution is advised when interpreting RBT values in children with PFV, increased corneal diameter, and high initial RBT readings.