IOP was measured with Goldmann applanation tonometry (Haag-Streit, Bern, Switzerland). For each eye, the median of three measurements was taken. Refraction was measured with the RM-A2000 autorefractor (Topcon, Tokyo, Japan).
Goldmann applanation tonometry
Manufactured by Haag-Streit
Sourced in Switzerland, Germany
Goldmann applanation tonometry is a device used to measure intraocular pressure (IOP) within the eye. It works by gently flattening a portion of the cornea and measuring the force required to achieve this flattening. The device provides an objective and quantitative measurement of IOP, which is a crucial parameter in the diagnosis and management of conditions such as glaucoma.
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30 protocols using goldmann applanation tonometry
1
Intraocular Pressure and Refraction Measurements
2
Comprehensive Ophthalmologic Examination for Angle Closure
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Each recruited subject underwent a comprehensive ophthalmologic examination, including visual acuity, IOP measurement by Goldmann applanation tonometry (Haag-Streit, Koniz, Switzerland), slit-lamp examination, stereoscopic evaluation of the optic disc using a 90-diopter lens (Volk Optical, Inc., Mentor, OH). Gonioscopy was performed in dimly lit room by a glaucoma specialist (H.J.W.) using a Zeiss-style four-mirror gonioscopy lens (Model G-4, Volk Optical, Inc., Mentor, OH) at 16× magnification with and without indentation. An occludable angle was defined as the invisibility of the posterior trabecular meshwork under a dynamic compression technique. Axial length and flat and steep keratometry were measured by IOLMaster biometry (Carl Zeiss Meditec, Inc., Dublin, CA). Five IOLMaster measurements with a signal-to-noise ratio of more than 100 were taken, the mean of which was used for analysis.
3
Comprehensive Ophthalmic Evaluation Protocol
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All subjects underwent a routine ophthalmic examination that included assessment of medical history, best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, gonioscopy (only patients with glaucoma), Goldmann applanation tonometry (Haag Streit AG, Bern, Switzerland), central corneal thickness (CCT; EM-3000, Tomey, Japan), axial length (AL; IOLMaster 500, Carl Zeiss Meditech, Inc., Dublin, CA), and VF testing with Humphrey automated perimetry (SITA 24-2, Carl Zeiss Meditech, Inc., Dublin, CA). The Spectralis OCT+HRA system (Heidelberg Engineering, Heidelberg, Germany) was used to measure RNFLT and RV diameters.
4
Comprehensive Ophthalmologic Evaluation and Cognitive Assessment
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All patients underwent a comprehensive ophthalmologic examination, including best-corrected VA measurement, slit lamp biomicroscopy, tonometry with Goldmann applanation tonometry (Haag-Streit AG, Switzerland), gonioscopy with a three-mirror lens OG3M (Ocular Instruments, Bellevue, WA), dilated fundoscopy using a 78 diopter lens (Volk Optical, Inc., Mentor, OH), and visual field test with HFV 750 (Carl-Zeiss Humphrey, Dublin, CA) SITA standard 24-2 using appropriated lens to correct refractive errors. The authors themselves did all examinations.
Cognitive functions were assessed by the Mini-Mental State Exam and depression symptoms were screened by the 4-Item Geriatric Depression Scale. Questionnaires were completed as an interview in an environment other than the ophthalmology office by an independent observer.
Cognitive functions were assessed by the Mini-Mental State Exam and depression symptoms were screened by the 4-Item Geriatric Depression Scale. Questionnaires were completed as an interview in an environment other than the ophthalmology office by an independent observer.
5
Measuring IOP and Hypotony Incidence
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The IOP was measured using Goldmann applanation tonometry (Haag-Streit, Köniz, Switzerland). The device had been calibrated according to manufacturer’s recommendations. The number of IOP-lowering medications was calculated by adding the number of different categories of medication. The categories were: beta-blockers, prostaglandin-analogues, carbonic anhydrase inhibitors, alfa2-agonists, and oral acetazolamide. Fixed combinations of eye drops were calculated as two separate drugs. Hypotony was defined as an IOP ≤ 4 mmHg at two or more consecutive visits (excluding one-day postoperative) during the first year of follow-up [8 (link)].
6
Cross-Sectional Study of Ocular Characteristics
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In this cross-sectional study, 223 consecutive subjects were prospectively recruited from the Singapore Indian Eye Study (SINDI), an ongoing population-based study at the Singapore Eye Research Institute (SERI). 23 Each subject underwent an interview and ocular examinations according to a standardized study protocol, including imaging of the ONH region using SD-OCT (Spectralis SD-OCT; Heidelberg Engineering GmbH, Heidelberg, Germany), measurement of intraocular pressure (IOP) using Goldmann applanation tonometry (Haag-Streit, Bern, Switzerland), vertical cup-to-disc ratio (VCDR) from slit-lamp biomicroscopy using a graticule (Haag-Streit), central corneal thickness (CCT) using ultrasound pachymetry (Mentor O&O, Inc., Norwell, MA, USA), axial length using noncontact partial coherence interferometry (Carl Zeiss Meditec AG, Jena, Germany), and corneal curvature using an autorefractor (Canon, Inc., Tokyo, Japan).
The study protocol was approved by the SingHealth Centralized Institutional Review Board and adhered to the ethical principles outlined in the Declaration of Helsinki, 2008. Written voluntary informed consent was obtained from each subject.
The study protocol was approved by the SingHealth Centralized Institutional Review Board and adhered to the ethical principles outlined in the Declaration of Helsinki, 2008. Written voluntary informed consent was obtained from each subject.
7
Standardized Ophthalmic Examination Protocol
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Each participant underwent a standardized examination. Refraction and corneal curvature were measured using an auto-keratorefractor (Canon RK 5 Auto Ref-Keratometer, Canon Inc. Ltd., Tochigiken, Japan). SE was calculated as the sum of the spherical power and half of the cylinder power. Best-corrected visual acuity was measured monocularly using a LogMAR chart (Lighthouse International, New York, USA) at a distance of 4 meters. Ocular biometry, including axial length (AL), was measured using non-contact partial coherence interferometry (IOL Master V3.01, Carl Zeiss Meditec AG, Jena, Germany). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry (Haag-Streit, Bern, Switzerland) before pupil dilation. Standardized visual field testing was performed with static automated white-on-white threshold perimetry (SITA Fast 24-2, Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Oberkochen, Germany). Slit-lamp biomicroscopy (Haag-Streit model BQ-900; Haag-Streit, Switzerland) was performed by the study ophthalmologists to examine the anterior chamber and lens after pupil dilation with tropicamide 1% and phenylephrine hydrochloride 2.5%.
8
Central Corneal Thickness and IOP
9
Comprehensive Eye Examination Protocol
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All included patients had complete medical records, including age, sex, and comprehensive eye examination results using anterior slit-lamp microscopy, Goldmann applanation tonometry (Haag-Streit, Bern, Switzerland), gonioscopy, dilated fundus examination, AL measurement (IOL Master 700; Carl Zeiss Meditec AG, Jena, Germany), and VF test with a standard 30–2 Swedish interactive threshold algorithm (Humphrey Field Analyzer, Model 750; Carl Zeiss Meditec AG). Color fundus photographs were taken at 45°, centered on the macula, using fundus cameras (Kowa Nonmyd WX; Kowa Inc., Nagoya, Japan; and DRI-OCT, Triton; Topcon, Tokyo, Japan). Optical coherence topography (OCT) images were acquired for all the patients participated (Heidelberg Engineering, Heidelberg, Germany; and DRI-OCT Triton, Topcon). The reliability of the VF test results was monitored as follows: number of fixation losses ≤ 20%, rate of false-negative results ≤ 33%, and rate of false-positive results ≤ 33%.
10
Corneal-Compensated IOP Measurement
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Goldmann applanation tonometry (Haag-Streit AG, Koeniz, Switzerland) was used to record conventional IOP (IOPGAT) and the ORA was used to generate the corneal-compensated IOP (IOPcc).5 (link) Similar to CH and CRF, the average value of four sequential measurements was recorded.
The difference between IOPcc and IOPGAT was calculated for each eye and was termed IOP bias (IOP bias=IOPcc—IOPGAT). A positive bias value indicated an underestimation by Goldmann applanation tonometry in comparison with the ORA, whereas a negative IOP bias value suggested an overestimation by the former.
The difference between IOPcc and IOPGAT was calculated for each eye and was termed IOP bias (IOP bias=IOPcc—IOPGAT). A positive bias value indicated an underestimation by Goldmann applanation tonometry in comparison with the ORA, whereas a negative IOP bias value suggested an overestimation by the former.
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