Zusammenfassung
Hintergrund: Der Ocular Response Analyser (ORA, Reichert Ophthalmic Instruments) ist ein Non-Contact-Applanationstonometer, welches die Messung des Intraokulardrucks (IOD) als Goldmann-äquivalenten IODg und als korneal kompensierten IODcc (IOD-Wert unabhängig von kornealen Eigenschaften) erlaubt. Zusätzlich können korneale biomechanische Eigenschaften in Form der kornealen Hysterese (CH) und des kornealen Resistenzfaktors (CRF) bestimmt werden. Ziel dieser Studie war es, die Reproduzierbarkeit dieser Messwerte zu prüfen. Patienten und Methoden: Bei 49 gesunden Probanden wurde ein Auge für die Untersuchungen randomisiert ausgewählt und die Messungen mit dem ORA viermal konsekutiv vor der Goldmann-Applanationstonometrie (GAT) durchgeführt. Als Masse der Wiederholbarkeit wurden der Wiederholbarkeitskoeffizient (RC), der Variationskoeffizient (CV) und der Intraclass-Korrelationskoeffizient (ICC) für die in jeder Messreihe erhobenen Messwerte berechnet. Ergebnisse: Die CH war die variabelste und der IOPg die wiederholbarste Messung, mit einem RC von jeweils 2,61 und 1,97 und einem ICC von 0,86 und 0,92 entsprechend. CV schwankte zwischen 5,73 % für IOPg und 12,38 % für CH. ORA IOP-Messungen waren höher als GAT (IOPcc = 17,43 ± 3,23; IOPg 17,53 ± 3,0; GAT 15,75 ± 2,77 mmHg). Schlussfolgerungen: ORA-Messungen zeigen eine gute Kurzzeit-Wiederholbarkeit bei gesunden Probanden. Das Gerät scheint damit in der klinischen Routine einsetzbar zu sein.
Abstract
Background: The Ocular Response Analyser (ORA, Reichert Ophthalmic Instruments) is a non-contact applanation tonometer, providing two measures of intraocular pressure (IOP) - IOPg which represents a Goldmann equivalent IOP measure and IOPcc, representing a measure of IOP independent of corneal effects. In addition, the device provides two measures believed to represent corneal biomechanical properties: corneal hysteresis (CH) and corneal resistance factor (CRF). The aim of this study was to assess the repeatability of these measurements. Patients and Methods: One randomly chosen eye from 49 healthy volunteers was measured four times consecutively with the ORA prior to Goldmann applanation tonometry (GAT). The repeatability coefficient (RC), the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated as a measure of intrasession repeatability. Results: CH was the most variable and IOPg the most repeatable measure, with an RC of 2.61 and 1.97, respectively, and ICC of 0.86 and 0.92, respectively. CV ranged between 5.73 % for IOPg and 12.38 % for CH. ORA IOP measurements were higher than GAT (IOPcc = 17.43 ± 3.23; IOPg = 17.53 ± 3.0; GAT = 15.75 ± 2.77 mmHg). Conclusions: ORA measurements show good short-term repeatability in normal volunteers. Thus, this device appears to be applicable in clinical practice.
Schlüsselwörter
Ocular Response Analyser - korneale Hysterese - kornealer Resistenzfaktor - korneal kompensierter IOP
Key words
ocular response analyzer - corneal hysteresis - corneal resistance factor - corneal compensated IOP
References
1
Bhan A, Browning A C, Shah S. et al .
Effect of corneal thickness on intraocular pressure measurements with the pneumotonometer, Goldmann applanation tonometer, and Tono-Pen.
Invest Ophthalmol Vis Sci.
2002;
43
1389-1392
2
Bland J M, Altman D G.
Statistics notes: measurement error.
BMJ.
1996;
313
744
3
Bland J M, Altman D G.
Measurement error proportional to the mean.
BMJ.
1996;
313
106
4
Bland J M, Altman D G.
Statistic notes: Measurement error and correlation coefficients.
BMJ.
1996;
313
41-42
5
Collaborative Normal-Tension Galucoma Study Group .
Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures.
Am J Ophthalmol.
1998;
126
487-497
6
Collaborative Normal-Tension Galucoma Study Group .
The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma.
Am J Ophthalmol.
1998;
126
498-505
7
Congdon N G, Broman A T, Bandeen-Roche K. et al .
Central corneal thickness and corneal hysteresis associated with glaucoma damage.
Am J Ophthalmol.
2006;
141
868-875
8
Dielemans I, Vingerling J R, Hofman A. et al .
Reliability of intraocular pressure measurement with the Goldmann applanation tonometer in epidemiological studies.
Graefes Arch Clin Exp Ophthalmol.
1994;
232
141-144
9
Ehlers N.
On corneal thickness and intraocular pressure. II. A clinical study on the thickness of the corneal stroma in glaucomatous eyes.
Acta Ophthalmol.
1970;
48
1107-1112
10
Gordon M O, Beiser J A, Brandt J D. et al .
The Oculat Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma.
Arch Ophthalmol.
2002;
120
714-720
11
Gunvant P, O`Leary D J, Baskaran M. et al .
Evaluation of tonometric correction factors.
J Glaucoma.
2005;
14
337-343
12
Hager A, Schroeder B, Sadeghi M. et al .
The influence of corneal hysteresis and corneal resistance factor on the measurement of intraocular pressure.
Ophthalmologe.
2007;
104
484-489
13
Kass M A, Heuer D K, Higginbotham E J. et al .
The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma.
Arch Ophthalmol.
2002;
120
701-713
14
Kotecha A, Elsheikh A, Roberts C R. et al .
Corneal thickness- and age-related biomechanical properties of the cornea measured with the Ocular Response Analyser.
Invest Ophthalmol Vis Sci.
2006;
47
5337-5347
15
Kotecha A, White E T, Shewry J M. et al .
The relative effects of corneal thickness and age on Goldmann applanation tonometry and dynamic contour tonometry.
Br J Ophthalmol.
2005;
89
1572-1575
16
Leske M C, Heijl A, Hussein M. et al .
Early Manifest Glaucoma Trial Group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial.
Arch Ophthalmol.
2003;
121
48-56
17
Liu J, Roberts C J.
Influence of corneal biomechanical properties on intraocular pressure measurement: quantitative analysis.
J Cataract Refract Surg.
2005;
31
146-155
18
Luce D A.
Determining in vivo biomechanical properties of the cornea with an ocular response analyser.
J Cataract Refract Surg.
2005;
31
156-162
19
Medeiros F A, Weinreb R N.
Evaluation of the influence of corneal biomechanical properties on intraocular pressure measurements using the Ocular Response Analyser.
J Glaucoma.
2006;
15
364-370
20
Shields M B.
The non-contact tonometer. Its value and limitations.
Surv Ophthalmol.
1980;
24
211-219
21
Stodtmeister R, Kron M, Graus W.
IOP measurement and central corneal thickness.
Br J Ophthalmol.
2002;
86
120-121
22
Whitacre M M, Stein R.
Sources of error with use of Goldmann-type tonometers.
Surv Ophthalmol.
1993;
38
1-30
23
Whitacre M M, Stein R A, Hassanein K.
The effect of corneal thickness on applanation tonometry.
Am J Ophthalmol.
1993;
115
590-596
24
Wolfs R C, Klaver C C, Vingerling J R. et al .
Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam Study.
Am J Ophthalmol.
1997;
123
767-772
Myron Kynigopoulos
Clinic Pallas
Louis Giroud-Str. 20
4600 Olten
Switzerland
Phone: ++ 41/62/2 86 62 00
Fax: ++ 41/62/2 86 62 20
Email: mkynigopoulos@yahoo.com