Icare-Pro Rebound Tonometer Versus Hand-held Applanation Tonometer for Pediatric Screening

Purpose: To compare intraocular pressure (IOP) measurements obtained using the new rebound tonometer Icare-Pro (Icare,Tiolat Oy, Helsinki, Finland) and the hand-held version of the Goldmann applanation tonometer (Perkins; Clement Clarke, Haag-Streit, Harlow, United Kingdom) in healthy children during clinical practice. Methods: In this prospective study, three IOP measurements were made using each tonometer in a single session, starting with the 'care-Pro. Participants were 173 non-anesthetized patients aged 1 to 16 years. Measurements were made in both eyes but only data for the right eye were entered in the analysis. Central corneal thickness, anterior chamber depth, and axial length were also measured in each patient. Data were compared by determining interclass correlation coefficients (ICCs) for each tonometer and representing the differences detected as Bland-Altman plots. Results: Good linear correlation was observed between IOP readings obtained using the Perkins and (care-Pro tonometers (r = 0.87, P < .001), although the 'care-Pro readings were slightly higher (mean IOP difference: 0.26 +/- 1.58 mm Hg, P = .037). The 95% limits of agreement between the two methods were 2.8 to -3.4 mm Hg. The ICC was 0.857 (95% confidence interval: 0.810 to 0.893), indicating good agreement. For both tonometers, a low but significant correlation was detected between IOP and central corneal thickness or age. However, no correlation of IOP was found with axial length or anterior chamber depth. Conclusions: Pediatric IOP measurements determined using the new Icare-Pro rebound tonometer showed good correlation with those obtained using the handheld Perkins applanation tonometer in a routine clinical examination with no need for general anesthesia.