Comparison of the rebound tonometer with the Goldmann applanation tonometer in glaucoma patients

Purpose: To determine the agreement between the measurement of intraocular pressure (IOP) by the rebound tonometer (RBT) and by the Goldmann applanation tonometer (GAT) and to find out the effect of central corneal thickness (CCT) values on IOP measurements in glaucoma patients. Methods: IOP was measured with the RBT and GAT, respectively, in 61 eyes of 61 glaucoma patients. CCT was measured using an ultrasonic pachymeter after all IOP determinations had been made. The mean IOP measurement by the RBT was compared with the measurement by the GAT, by Student's t-test. Bland-Altman analysis was performed to assess the clinical agreement between the two methods. The effect of CCT on measured IOP was explored by linear regression analysis. Results: The mean patient age was 56.7 +/- 21.1 years (range: 30-80 years). There were 32 (52.46%) women and 29 (47.54%) men in the study group. The mean IOP readings were 18.70 +/- 4.76 mmHg using the RBT, and 18.27 +/- 3.49 mmHg using the GAT. The difference was not statistically significant (mean difference 0.43 +/- 2.55, P = 0.2). A frequency distribution of the differences demonstrated that in more than 80% of cases the IOP readings differed by < 2.3 mmHg between the RBT and GAT. There was a strong correlation between the RBT and GAT readings (r = 0.852, P < 0.0001). The IOP measurements with the two methods were correlated with CCT (r = 0.40, P = 0.02 for the RBT and r = 0.48, P < 0.0001 for the GAT). The IOP increased 1.1 mmHg and 8 mmHg for every 100-mu m increase in CCT for the GAT and RBT, respectively. Conclusion: The RBT slightly overestimated the IOP value by 0.43 mmHg on average when compared with the GAT. Nevertheless, the RBT readings appeared to be more affected by the various thicknesses of different corneas when compared with those obtained using the GAT.