Reliability of Refraction, Keratometry, and Intraocular Pressure Measurements with an Automated All-in-one Device.

SIGNIFICANCE: This study explores the reliability of TonoRef II (Nidek, Tokyo, Japan), which represents a simple tool to obtain rapid refractometry and tonometry measurements. The present device demonstrates very high repeatability of refraction and intraocular pressure (IOP) readings as compared with subjective measurements and a higher concordance of IOP readings to Goldmann application tonometry (GAT). PURPOSE: This study aimed to evaluate the repeatability of measurements acquired with the Autorefractometer/Keratometer/Tonometer TonoRef II and assess their agreement to subjective measurements and readings of other established devices. METHODS: In a cross-sectional study, 54 eyes of 54 healthy subjects were enrolled. Each subject underwent five measurements with the TonoRef II, three measurements with the Canon RK-F1 Autorefractor Keratometer (Canon Europe NV, Amstelveen, the Netherlands), three IOP measurements with the Canon TX-F Noncontact Tonometer (Canon Inc., Tokyo, Japan), three measurements with GAT, and a thorough subjective refraction. Repeatability coefficient (r), intraclass correlation coefficient (ICC), and Bland-Altman plots were used to evaluate repeatability of readings and agreement to the subjective values. RESULTS: TonoRef II showed high repeatability (ICC >0.9) in all parameters tested (sphere, r = 0.157; cylinder, r = 0.196; IOP, r = 2.653). A strong correlation was found between TonoRef and Canon instruments (P < .001 in all parameters). Mean differences and limits of agreement (mean ± 1.96 standard deviation) were -0.01 ± 0.69 D, -0.11 ± 0.7 D, and 2.1 ± 3.4 mmHg for sphere, cylinder, and IOP, respectively. Both autorefractors achieved a very good to excellent agreement to the values obtained with the subjective refraction for most of the parameters tested, without any significant difference to each other (P > .05). Intraocular pressure measurements of TonoRef II showed higher agreement to the GAT values compared with those obtained with the Canon tonometer (ICC, 0.9114 and 0.7002, respectively; P < .001). CONCLUSIONS: Intraocular pressure and refraction readings acquired with TonoRef II demonstrate very high repeatability and agreement to the subjective measurements. Regarding IOP evaluation, TonoRef II shows higher concordance to GAT compared with another established noncontact tonometer.

Selective laser trabeculoplasty (SLT): 1-year results in early and advanced open angle glaucoma.

The purpose of this study was to examine the efficacy of selective laser trabeculoplasty (SLT) in eyes with early and more advanced stages of open angle glaucoma within 1 year of follow-up. Retrospective chart review in a consecutive series of patients treated by SLT to reduce intraocular pressure (IOP) or decrease number of topical medications in cases of discomfort and allergy. The cup-to-disc ratio of the optic nerve and the GSS 2 (glaucoma staging system 2) was used to differentiate between early (group 1) and more advanced (group 2) stages of glaucoma. At the time of SLT treatment, no new signs of glaucoma progression were seen. Only the first treated eye of every patient was included in the analysis. In group 1 (early glaucoma), 27 eyes were included. IOP reduction <21 mmHg/>20 % of the preoperative IOP-value and reduction of medication were achieved in 17 eyes (62.96 %). Successful re-treatment was necessary in 2 eyes (7.4 %). In group 2 (advanced glaucoma), 44 eyes underwent SLT. In eight eyes (18.18 %), filtrating surgery was necessary after initial SLT. In the remaining 36 eyes, IOP reduction <21 mmHg/>20 % of the baseline IOP was achieved in 26 eyes (59.09 % of 44 eyes) and IOP reduction <18 mmHg/> 30 % of the baseline IOP in 22 eyes (50 % of 44 eyes). SLT was safe and effective in nearly 2/3 of early glaucoma patients and also in 50 % of advanced glaucoma patients using stronger criteria of success. Failure of SLT in advanced glaucoma should lead to immediate filtrating surgery, which seems not to be associated with higher risk of fibrosis.

Influence of Intraocular Lens Asphericity and Blue Light Filtering on Visual Outcome, Contrast Sensitivity, and Aberrometry after Uneventful Cataract Extraction.

PURPOSE: To evaluate the effect of asphericity and blue light filter (BLF) of three different intraocular lenses (IOLs) on the visual performance, second- and third-order aberrations (defocus, coma, trefoil), and contrast sensitivity after uneventful cataract surgery. METHODS: One hundred and twenty eyes of 60 patients with clinically significant cataract were randomly assigned to receive one of the three IOL types: Bioline Yellow Accurate (aspheric, with BLF, i-medical, Germany), BioAcryl 60125 (spherical, without BLF, Biotech, France), and H65C/N (aspheric, without BLF, PhysIOL, Belgium). Each IOL was implanted in 40 eyes. Complete ophthalmologic examination, functional acuity contrast testing and wavefront analysis were performed 60 days postoperatively. RESULTS: The mean postoperative best-corrected visual acuity (BCVA) was 0.95 ± 0.08, not differing statistically among the IOL groups (P = 0.83). Mean defocus and coma values did not yield any statistically significant difference through the IOL groups varying from -0.784 to -0.614 µm and 0.129 to 0.198 µm (P = 0.79 and 0.34, respectively). Bioline Yellow Accurate IOL presented less trefoil aberrations, 0.108 ± 0.05 µm, compared to the other two IOL types (BioAcryl [0.206 ± 0.19 µm] and Physiol [0.193 ± 0.17 µm], P < 0.05). Contrast sensitivity values did not differ among the groups under all lighting conditions. Bioline Yellow IOL showed a statistically higher loss of contrast sensitivity (between mesopic and mesopic with glare conditions) compared to the BioAcryl and PhysIOL in 12 and 3 cpd spatial frequencies, respectively (P < 0.05). CONCLUSION: Bioline Yellow IOL indicated lower contrast sensitivity under mesopic conditions when glare was applied but resulted in less trefoil aberrations after uneventful cataract surgery. No further differences were noted in postoperative visual performance among three IOL groups.

Improved reproducibility of retinal nerve fiber layer thickness measurements with the repeat-scan protocol using the Stratus OCT in normal and glaucomatous eyes.

BACKGROUND: Optical coherence tomography has become within the last years an established imaging technique with many applications in ophthalmology, and an important tool which contributes to earlier and more accurate diagnosis of glaucoma. As a consequence, detection sensitivity is highly valued. The aim of this study was to assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements by the Stratus Optical Coherence Tomograph (OCT) using the Fast- and Repeat-scan protocols in normal and glaucomatous eyes. METHODS: In the clinical setting, RNFL thickness measurements were obtained from a control group of 40 subjects, consisting of 20 normal volunteers and 20 glaucoma patients. One eye was randomly chosen from each subject, and underwent five RNFL thickness measurements with the Fast- and five with the Repeat-scan protocol, which was also based on the Fast-scan mode. Reproducibility was assessed by the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) for the overall mean RNFL thickness and for each quadrant and clock hour of the peripapillary area. RESULTS: The Repeat-scan protocol yielded higher ICC and lower CV values in all quadrants and clock hours of the peripapillary area, both in normal and glaucomatous subjects. The difference in CV values between Fast- and Repeat-scan protocol measurements reached statistical significance in the temporal quadrant (P = 0.021) and in clock hour sectors 8, 9 and 12 (P = 0.022, 0.017 and 0.03 respectively). ICC (and CV) for the temporal-, superior-, nasal- and inferior-quadrant RNFL thickness was: for the Fast-scan protocol, 0.913 (7.4%), 0.925 (6.97%), 0.828 (10.31%), 0.964 (4.89%) respectively; and for the Repeat-scan protocol, 0.965 (5.08%), 0.958 (5.26%), 0.906 (8.12%) 0.968 (4.6%) respectively. CONCLUSIONS: Reproducibility of RNFL thickness measurements with the Fast- and Repeat-scan protocols by the Stratus OCT is proved to be very high both in normal and glaucomatous subjects. The Repeat-scan protocol shows higher ICC and lower CV values, statistically significant especially on the temporal side of the peripapillary area, which may indicate a higher reproducibility and greater agreement of measurements. These findings support the fact that the Repeat-scan protocol might be considered as a more precise method for evaluation of RNFL thickness.

Association of ocular hypotensive medication types with dynamic contour tonometry and Goldmann applanation tonometry measurements in a glaucoma and ocular hypertensive population.

PURPOSE: The aim of this study was to evaluate the association between different intraocular pressure (IOP)-lowering medications and IOP measurements by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in a glaucoma and ocular hypertensive population. METHODS: In a prospective, observational case series study, 410 eyes from 410 consecutive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT), were enrolled. All eyes included in the study received unaltered ocular hypotensive medication for at least 6 months before IOP measurement. All eyes underwent 2 GAT and 3 DCT measurements, and their means were used for the analysis. RESULTS: DCT-GAT IOP difference (ΔIOP) did not differ statistically significantly (P=0.49) between OAG and OHT group yielding a mean±SD of 4.26±2.02 mmHg and 4.41±2.25 mmHg, respectively. The number of IOP-lowering agents did not have any statistically significant influence on ΔIOP (p=0.177), DCT (P=0.28) and GAT (P=0.13) measurements. A statistically higher ΔIOP was revealed in monotherapy patients receiving Carbonic Anhydrase Inhibitors (CAIs) (ΔIOP=5.75 mmHg) in comparison to patients receiving Prostaglandin Analogs (ΔIOP=4.09 mm Hg) or beta Blockers (ΔIOP=3.78 mmHg) as single topical therapy (F=4.373, P=0.005). Eyes treated with CAIs as a part of the ocular hypotensive therapy yielded a significantly greater ΔIOP (P=0.0035) than those without CAIs in the therapeutic schema. CONCLUSIONS: The difference between DCT and GAT IOP measurements is found to be statistically significantly higher in patients receiving CAIs either as monotherapy or as a part of a combined ocular hypotensive treatment, while DCT and GAT readings remain unaffected. The type of diagnosis and the number of ocular hypotensive medications had no statistically significant influence on ΔIOP.

Decreased ocular pulse amplitude associated with functional and structural damage in open-angle glaucoma.

PURPOSE: To assess the relationship of ocular pulse amplitude (OPA), as measured by dynamic contour tonometry (DCT), with structural and functional damage in patients with open-angle glaucoma (OAG). METHODS: In this cross-sectional, observational study, 242 eyes of 139 patients with OAG underwent Goldmann applanation tonometry (GAT), DCT, central corneal thickness (CCT) measurement, visual fields examination (Octopus, Haag Streit), and complete ophthalmologic examination. Linear regression analysis was used to analyze the effect of OPA, DCT, GAT, and CCT to the mean defect (MD) of the visual fields and to the vertical cup to disc ratio (CDR). RESULTS: Ocular pulse amplitude was the only variable that showed a significant association with MD (slope=-1.1, p=0.012), in contrast to GAT (p=0.98), DCT (p=0.32), and CCT (p=0.42). Ocular pulse amplitude was also negatively associated with CDR (slope=-0.028, p=0.0001). Additional multiple regression analysis revealed that OPA (R2=0.12, r=-0.25, slope=-0.02, p=0.033), GAT (r=-0.27, slope=-0.01, p=0.027), and CCT (r=-0.18, slope=-0.001, p=0.012) were statistically significantly correlated to CDR, while DCT was not (r=-0.20, slope=0.003, p=0.46). Ocular pulse amplitude did not differ statistically significantly (p=0.93) between eyes with (2.79 ± 1.42) and without (2.77 ± 1.21) prior trabeculectomy. No statistically significant difference of OPA was observed between diagnosis groups (p=0.255). CONCLUSIONS: Decreased OPA seems to be correlated with increased glaucomatous functional and structural damage in OAG. Assessment of OPA by DCT could therefore serve as an important additional parameter in the evaluation of glaucoma patients.

Central corneal thickness during treatment with travoprost 0.004% in glaucoma patients.

PURPOSE: Experimental studies demonstrated an alteration of corneal collagen structure by prostaglandin analogues. The possible effect of the prostaglandin F(2alpha) analogue travoprost 0.004% on the central corneal thickness (CCT) in newly diagnosed glaucoma patients was evaluated. METHODS: Consecutive, interventional case series. Seventy-four patients/136 eyes with glaucoma were included in the statistical analysis. All patients received travoprost 0.004% (Travatan(R)) once daily in one or both eyes. CCT was measured by using noncontact optical low-coherence reflectometry prior to the treatment and after 6 and 12 months. RESULTS: Mean CCT of all treated eyes (n = 136) was 546.71 +/- 34.63 mum at baseline, 535.14 +/- 34.78 mum after 6 months, and 532.38 +/- 34.18 mum after 12 months (ANOVA, P < 0.001). Ninety-five percent of all treated eyes showed a decrease of CCT. CCT reduction mainly developed within the first 6 months of the treatment period. After 12 months, a CCT reduction >30 mum occurred in 5.1% of all treated eyes. There was a significant correlation between the magnitude of corneal thinning and the initial CCT but not between corneal thinning and IOP reductions. CONCLUSIONS: Topical therapy with the prostaglandin derivate travoprost is accompanied by a significant reduction of CCT within one year of treatment. Further clinical studies are needed to evaluate the possible long-term effects of prostaglandins on the CCT of glaucoma patients.

Long-term results after transscleral diode laser cyclophotocoagulation in refractory posttraumatic glaucoma and glaucoma in aphakia.

PURPOSE: To evaluate the long-term effect and safety of transscleral diode laser cyclophotocoagulation (TDLC) in eyes with advanced glaucoma in aphakia and posttraumatic glaucoma. PATIENTS AND METHODS: Twenty-one eyes of 21 patients with glaucoma in aphakia and 25 eyes of 25 patients with posttraumatic glaucoma were treated with TDLC between 1996 and 2004. If the intraocular pressure (IOP) remained above 21 mmHg despite medication for more than 4 weeks after TDLC, the procedure was repeated. The IOP, number of medications, visual acuity, complications and need of further surgical intervention were all recorded during the follow-up period. RESULTS: Follow-up ranged from 12 to 93 months (mean 42.0 +/- 29.2) in glaucoma in aphakia and from 12 to 73 months (mean 33.3 +/- 17.4) in posttraumatic glaucoma. TDLC was successful in 48% of aphakic eyes with glaucoma and 40% of eyes with posttraumatic glaucoma. More than one TDLC was performed in 85% of cases of glaucoma in aphakia and 76% of cases of posttraumatic glaucoma). In both groups, TDLC was more effective in older patients than younger patients. Further glaucoma surgeries other than TDLC were performed in 43% of glaucoma in aphakic cases, and 44% of posttraumatic glaucoma cases, within the follow-up period. Loss of any light perception was recorded in two aphakic eyes with glaucoma (9.5%) and three eyes with posttraumatic glaucoma (12%). No hypotonia and no phthisis occurred. CONCLUSIONS: TDLC is moderately effective in advanced posttraumatic glaucoma and glaucoma in aphakia, more effective in older than younger patients, not influenced by prior other glaucoma surgery, and despite a high re-treatment rate very safe in both groups of glaucoma. For younger patients with severe secondary glaucoma in particular, new treatment strategies are needed.