Academic Journal
Agreement Between Icare Home and Goldmann Applanation Tonometry in Eyes With Keratoconus: Influence of Corneal Parameters on Intraocular Pressure Measurements.
| Title: | Agreement Between Icare Home and Goldmann Applanation Tonometry in Eyes With Keratoconus: Influence of Corneal Parameters on Intraocular Pressure Measurements. |
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| Authors: | Nemet M; School of Medicine, The Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel ., Maytal A; School of Medicine, The Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel .; Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel ; and., Dubinsky-Pertzov B; School of Medicine, The Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel .; Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel ; and., Sinai NC; Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel ., Cohen S; School of Medicine, The Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel .; Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel ; and., Einan-Lifshitz A; School of Medicine, The Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel .; Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel ; and. |
| Source: | Cornea [Cornea] 2026 Oct 01; Vol. 45 (10), pp. 1210-1215. Date of Electronic Publication: 2025 Oct 02. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8216186 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1536-4798 (Electronic) Linking ISSN: 02773740 NLM ISO Abbreviation: Cornea Subsets: MEDLINE |
| Imprint Name(s): | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: New York, N.Y. : Masson Pub. USA, c1982- |
| MeSH Terms: | Keratoconus*/physiopathology , Keratoconus*/diagnosis , Tonometry, Ocular*/instrumentation , Intraocular Pressure*/physiology , Cornea*/pathology , Cornea*/physiopathology, Humans ; Cross-Sectional Studies ; Female ; Male ; Adult ; Reproducibility of Results ; Young Adult ; Middle Aged ; Adolescent |
| Abstract: | Purpose: Accurate intraocular pressure (IOP) measurement is essential for glaucoma management. However, corneal irregularities may affect the tonometer's accuracy. This study aims to assess the agreement between Icare Home (ICH) rebound tonometry and Goldmann Applanation Tonometry (GAT) in patients with keratoconus and to investigate the impact of corneal parameters and keratoconus severity on IOP measurements. Methods: In this cross-sectional study, 48 eyes of 25 patients with keratoconus underwent same-day IOP measurements with GAT and ICH. Agreement between methods was analyzed using Bland-Altman plots. Spearman rank correlation was used to assess associations between IOP and corneal parameters. Results: The mean IOP was 11.98 ± 2.52 mm Hg for GAT and 10.45 ± 2.85 mm Hg for ICH. The mean absolute difference between devices was 2.65 ± 2.16 mm Hg ( P <0.001), and the mean arithmetic difference was 1.53 ± 3.06 mm Hg ( P = 0.0018), with 54.17% of cases falling within the ±2 mm Hg. Bland-Altman analysis showed 95% limits of agreement from -4.47 to 7.53 mm Hg. ICH IOP was positively correlated with MCT (ρ = 0.389, P = 0.0063) and negatively correlated with astigmatism (ρ = -0.512, P = 0.0002), Kmax (ρ = -0.411, P = 0.0037), K1 (ρ = -0.515, P = 0.0002), and K2 (ρ = -0.43, P = 0.0023). GAT IOP showed no significant correlation with these parameters. Conclusions: ICH underestimated IOP compared with GAT, with substantial variability between the methods. Corneal parameters were significantly associated with ICH readings. These findings highlight the limited reliability of ICH in advanced keratoconus, where clinically significant measurement differences may affect patient management. (Copyright © 2025 Wolters Kluwer Health, LLC. All rights reserved.) |
| Competing Interests: | The authors have no funding or conflicts of interest to disclose. |
| References: | Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363:1711–1720. Sng CCA, Ang M, Barton K. Central corneal thickness in glaucoma. Curr Opin Ophthalmol. 2017;28:120–126. Mudie LI, LaBarre S, Varadaraj V, et al. The icare HOME (TA022) study: performance of an intraocular pressure measuring device for self-tonometry by glaucoma patients. Ophthalmology. 2016;123:1675–1684. Liu J, De Francesco T, Schlenker M, et al. Icare home tonometer: a review of characteristics and clinical utility. Clin Ophthalmol. 2020;14:4031–4045. Kadambi SV, Aishwarya M, Leelavathy C, et al. Clinical utility, feasibility of home tonometry using iCare HOME by glaucoma patients. Indian J Ophthalmol. 2023;71:2727–2732. Rabinowitz YS. Keratoconus Surv Ophthalmol. 1998;42:297–319. Santodomingo-Rubido J, Carracedo G, Suzaki A, et al. Keratoconus: an updated review. Cont Lens Anterior Eye. 2022;45:101559. Firat PG, Orman G, Doganay S, et al. Influence of corneal parameters in keratoconus on IOP readings obtained with different tonometers. Clin Exp Optom. 2013;96:233–237. Yildiz MB, Kose AO, Celik G, et al. Agreement among Goldmann Applanation tonometer, easyton transpalpebral tonometer, tonopen, and icare in patients with keratoconus. Beyoglu Eye J. 2023;8:170–176. De Bernardo M, Rosa N. Evaluation of Goldmann Applanation tonometry, rebound tonometry and dynamic contour tonometry in keratoconus. J Optom. 2018;11:130–131. Mendez-Hernandez C, Arribas-Pardo P, Cuiña-Sardiña R, et al. Measuring intraocular pressure in patients with keratoconus with and without intrastromal corneal ring segments. J Glaucoma. 2017;26:71–76. Rosentreter A, Athanasopoulos A, Schild AM, et al. Rebound, applanation, and dynamic contour tonometry in pathologic corneas. Cornea. 2013;32:313–318. Bilgeç MD, Atalay E, Sözer Ö, et al. The influence of corneal geometrical and biomechanical properties on tonometry readings in keratoconic eyes. Int Ophthalmol. 2020;40:849–857. Smedowski A, Weglarz B, Tarnawska D, et al. Comparison of three intraocular pressure measurement methods including biomechanical properties of the cornea. Invest Ophthalmol Vis Sci. 2014;55:666–673. Iliev ME, Goldblum D, Katsoulis K, et al. Comparison of rebound tonometry with Goldmann Applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol. 2006;90:833–835. Armstrong RA. Statistical guidelines for the analysis of data obtained from one or both eyes. Ophthalmic Physiol Opt. 2013;33:7–14. Brown L, Foulsham W, Pronin S, et al. The influence of corneal biomechanical properties on intraocular pressure measurements using a rebound self-tonometer. J Glaucoma. 2018;27:511–518. Quérat L, Chen E. iCare® Home vs Goldmann Applanation tonometry: agreement of methods and comparison of inter-observer variation at a tertiary eye centre. Eur J Ophthalmol. 2023;33:312–318. Ehlers N, Bramsen T, Sperling S. Applanation tonometry and central corneal thickness. Acta Ophthalmol (Copenh). 1975;53:34–43. Johnson M, Kass MA, Moses RA, et al. Increased corneal thickness simulating elevated intraocular pressure. Arch Ophthalmol. 1978;96:664–665. Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993;38:1–30. Francis BA, Hsieh A, Lai M-Y, et al. Effects of corneal thickness, corneal curvature, and intraocular pressure level on Goldmann Applanation tonometry and dynamic contour tonometry. Ophthalmology. 2007;114:20–26. Stoor K, Karvonen E, Ohtonen P, et al. Icare versus Goldmann in a randomised middle-aged population: the influence of central corneal thickness and refractive errors. Eur J Ophthalmol. 2021;31:1231–1239. Sng C, Barton K, Kim H, et al. Central corneal thickness and its associations with ocular and systemic factors in an urban West African population. Am J Ophthalmol. 2016;169:268–275. Gelaw Y. The impact of central corneal thickness on intraocular pressure among Ethiopian glaucoma patients: a cross-sectional study. BMC Ophthalmol. 2012;12:58. Spoerl E, Huhle M, Seiler T. Induction of cross-links in corneal tissue. Exp Eye Res. 1998;66:97–103. |
| Contributed Indexing: | Keywords: Goldmann Applanation Tonometry; Icare Home; corneal parameters; intraocular pressure; keratoconus |
| Entry Date(s): | Date Created: 20251114 Date Completed: 20260902 Latest Revision: 20260902 |
| Update Code: | 20260903 |
| DOI: | 10.1097/ICO.0000000000004008 |
| PMID: | 41236399 |
| Database: | MEDLINE |
| ISSN: | 1536-4798 |
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| DOI: | 10.1097/ICO.0000000000004008 |