Performance of the rebound, noncontact and Goldmann applanation tonometers in routine clinical practice

Purpose: To compare rebound tonometry (RBT) and noncontact tonometry (NCT) using Goldmann applanation tonometry (GAT) as reference. Methods: The study sample was comprised of 108 eyes of 108 subjects consecutively examined at a general ophthalmology clinic. The order of use of the three tonometers was randomized at the study outset. The difference between the methods was plotted against the mean to compare the tonometers. The hypothesis of zero bias was examined by a paired t-test and 95% limits of agreement (LoA) were also calculated. Differences with respect to GAT were assessed according to the international standard for ocular tonometers (ISO 8612). Results: Mean intraocular pressures (IOPs +/- SD) obtained using the three instruments were GAT 17.5 +/- 3.8 mmHg; RBT 18.5 +/- 5.5 mmHg and NCT 17.4 +/- 5.6 mmHg. The 95% LoA were from -7.9 to +/- 7.7 mmHg for NCT-GAT and from -6.8 mmHg to +/- 8.7 mmHg for RBT-GAT. A difference with respect to GAT under +/- 1 mmHg was observed in 11.1% of the eyes measured by NCT and 18.5% of eyes measured by RBT. According to the IOP ranges established by the ISO 8612, differences from GAT measurements greater than +/- 5 mmHg were always above the accepted level of 5%. Correlations between IOP and central corneal thickness (CCT) were significant for all three tonometers. Conclusions: The rebound and noncontact tonometer behaved similarly when used to measure IOP taking GAT measurements as the reference standard. Neither tonometer fulfilled ISO 8612 requirements. Both were similarly influenced by CCT.