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Paolo Fogagnolo, Paolo Frezzotti, Pietro Mittica, Maurizio Digiuni, Ruggiero Paderni, Elena Vallenzasca, Luca Rossetti; Repeatibility And Reproducibility Of Applanation Resonance Tonometry. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5042.
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To assess repeatability (intra-observer variability) and reproducibility (inter-observer variability) of intraocular pressure (IOP) measurements with Applanation Resonance Tonometry (ART) and to evaluate possible influential factors.
The study included 178 patients (101 glaucoma, 63 healthy and 14 with OHT; one eye per subject) from two Italian centers (Eye Clinic of San Paolo Hospital of Milan and University of Siena). IOP was measured once with a Goldmann applanation tonometer (GAT) and twice by ART (ART1, ART2) in a randomized sequence, by a single operator to assess intra-operator variability. To assess inter-operator variability 2 operators, chosen randomly (A and B, B and C, A and C), performed 2 measurements each (in random order; i.e. A B A B; B A B A) on the same patient. Repeatability and reproducibility were assessed by the coefficient of variation (CoV) and intraclass correlation coefficient (ICC).
ART1 was 0.4±2.8 mmHg higher than ART2 (p<0.001). Results were not influenced by randomization test order. Intra-operator CoV was 7.6%±7.6%, and ICC was 0.88 (95%CI: 0.85-0.91). Inter-operator CoV ranged between 6.0%±10.8% and 8.0%±6.8%, and ICC between 0.906 and 0.917. ART1 and 2 were respectively 1.8±3.8 and 1.4±4.3 mmHg higher than GAT (p<0.001). Results were unaffected by diagnosis, age, central corneal thickness, keratometry, operator, randomization sequence.
ART repeatability and reproducibility were almost perfect. Tonometry measurements with ART tended to be overestimated compared with GAT.
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