Comparison of the utility of Pascal dynamic contour tonometry with Goldmann applanation tonometry in routine clinical practice.

PURPOSE: To compare the utility of Pascal dynamic contour tonometry with Goldmann applanation tonometry in routine practice METHODS: In a prospective study, 10 clinicians recruited 97 patients attending outpatient ophthalmology appointments. Intraocular pressure was measured with both Pascal and Goldmann tonometry in a randomized order. The time taken with each instrument, the number of measurements required to obtain a satisfactory Pascal reading (Q1 to Q3) and the quality value of this reading were recorded. Both the difficulty experienced by the clinician and patient experience for each instrument were assessed. RESULTS: Satisfactory Pascal measurements were obtained for 181 of 194 eyes (93%). For these eyes there was no significant difference in mean measured intraocular pressure between Pascal (15.95±3.20) and Goldmann (16.37±3.51) (mean difference 0.43 mm Hg, P=0.26) tonometry. The median number of attempts required to obtain a satisfactory Pascal measurement was 2 (range, 1 to 10). The time taken to obtain bilateral satisfactory Pascal readings was 2.76±1.53 minutes (range, 0.5 to 7 min), compared with 0.82±0.43 minutes (range, 0.5 to 3 min) for Goldmann tonometry (P<0.001). For these patients, clinicians scored the difficulty of tonometry as 3.24±1.97 for Pascal (1=very easy, 10=very difficult) and 1.28±0.85 for Goldmann (P<0.0001). The mean score (1=no discomfort, 10=extremely unpleasant) given by patients was 1.31±0.64 for Goldmann and 2.11±1.83 for Pascal tonometry (P<0.0001). CONCLUSIONS: Clinicians found Pascal tonometry significantly more time consuming and difficult than Goldmann tonometry in routine practice. Most eyes required repeated Pascal measurements, and for some an acceptable result was not obtained. Both types of tonometry were well tolerated by patients.