Comparison of Intraocular Pressure Measurements Obtained by Rebound, Noncontact, and Goldmann Applanation Tonometry in Children

PURPOSE: To compare intraocular pressure (TOP) among rebound, noncontact, and Goldmann applanation tonometry (GAT) and their relationships to central corneal thickness in children. DESIGN: Diagnostic protocol comparison and evaluation. METHODS: In right eyes of 419 children, mean IOP, rates of successful measurement with 3 tonometries, and intermethod agreement by Bland-Altman plot were assessed. The influences of central corneal thickness, and of average IOP of 3 tonometries on IOP differences between tonometries, were evaluated. RESULTS: The mean age was 8.89 +/- 3.41 years (3-15 years). There was significant difference in mean IOP of each tonometry; GAT showed the lowest values (P < .05). The IOP was successfully measured by noncontact tonometry in 89%, by rebound tonometry in 75%, and by GAT in 64% of children less than 10 years old, and in 100%, 98%, and 94% of children older than 10 years, respectively. The TOP of each tonometer positively correlated with central corneal thickness (P < .05). The mean differences and limits of agreement were 0.81 +/- 6.19 mm Hg (noncontact minus rebound), 2.56 +/- 4.62 mm Hg (rebound minus GAT), and 1.81 +/- 4.76 mm Hg (noncontact minus GAT): Rebound and noncontact tonometry overestimated TOP relative to GAT for thicker central corneal thicknesses. Rebound tonometry overestimated TOP relative to GAT and noncontact tonometry at higher average IOP of 3 tonometries. IncCONCLUSIONS: Rebound, noncontact, and Goldmann applanation tonometries can be considered appropriate methods for children, though noncontact tonometry is the most accessible. Given the risk of false-positive diagnosis of pediatric glaucoma, attention should be devoted to children with IOP within a suspicious range or thicker cornea. (C) 2015 by Elsevier Inc. All rights reserved.