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Ocular Response Analyzer Versus Goldmann Applanation Tonometry in a Population-Based Sample: The Thessaloniki Eye
Rodanthi Christina Bartzoulianou1, Anne L Coleman2, M Roy Wilson3
1From the 1st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (R.C.B., D.A.G., G.B., I.V., D.M., A.R., G.T., F.T.); Laboratory of Research and Clinical Applications in Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece (R.C.B., D.A.G., G.B., V.K., I.V., E.A., A.R., G.T., F.T.).
Purpose:
To compare corneal-compensated intraocular pressure (IOPcc) with Goldmann applanation tonometry (GAT-IOP) in an elderly cohort and assess effects of substituting GAT-IOP with IOPcc on IOP distribution, ocular hypertension prevalence, glaucoma screening, and risk modeling.
Design:
Prospective diagnostic sensitivity and specificity analysis using population-based data.
Participants:
One eye from 854 participants in the 12-year incidence phase of the Thessaloniki Eye Study.
Methods:
Participants underwent measurements of GAT-IOP and IOPcc. Agreement and screening performance (sensitivity, specificity, area under the receiver operating characteristic curve) were assessed. Two multivariable logistic regression models were constructed, 1 with GAT-IOP and 1 with IOPcc.
Main Outcome Measures:
GAT-IOP and IOPcc.
Results:
The mean age was 79.2 (SD 3.9) years; 42.4% were female. GAT-IOP was 14.3 (SD 3.3) mm Hg and IOPcc was 17.1 (SD 4.3) mm Hg. IOPcc exceeded GAT-IOP by 2.75 mm Hg (limits of agreement, -3.2 to 8.7). The prevalence of ocular hypertension (>21 mm Hg) increased from 1.3% to 10.7% when IOPcc was used instead. GAT-IOP was associated with central corneal thickness (95% CI, 0.009-0.022; P = .02), whereas IOPcc was not (95% CI, -0.001 to 0.016; P = .08). In untreated participants, GAT-IOP > 21 mm Hg had 98.6% specificity and 34.2% sensitivity; IOPcc increased sensitivity to 44.7% but reduced specificity to 88.3%. Area under the receiver operating characteristic curve values were similar (0.818 vs 0.780; P = .31). In multivariable models, IOP measures were independently associated with glaucoma, with a stronger effect size for GAT-IOP (odds ratio = 1.264, 95% CI: 1.182-1.359) than for IOPcc (odds ratio = 1.176, 95% CI: 1.116-1.241); pseudoexfoliation, family history, and body mass index were significant in both models, whereas central corneal thickness and axial length were significant only in the GAT-IOP model.
Conclusions:
Substituting GAT-IOP with IOPcc changed the risk estimates; the 2 measures are not interchangeable and standard IOPcc thresholds may overestimate ocular hypertension.
