Real-world comparison between the Tonopen and Goldmann applanation tonometry in a university glaucoma clinic.

PURPOSE: To determine whether Tonopen intraocular pressure (IOP) measurements by Ophthalmic technicians are interchangeable with Goldmann applanation tonometry (GAT) by a specialist in our glaucoma clinic. METHODS: Ophthalmic technician Tonopen and glaucoma specialist GAT IOP measurements were performed on both undilated eyes of 300 consecutive patients during the same visit to our glaucoma clinic. RESULTS: Among all 600 eyes of 300 patients (age 65.4, range: 23-92 years, male: 44.3%), Tonopen and GAT IOPs were similar (15.5 ± 0.6 vs. 15.4 ± 0.7 mmHg, respectively, p = 0.63) and directly correlated (r2 = 0.58, p < 0.0001). However, among 120 patients with bilateral primary open-angle glaucoma GAT IOP was significantly higher than Tonopen in the right eyes (17.1 ± 1.1 vs. 16.2 ± 0.9 mmHg, p = 0.024) and in the left eyes (17.0 ± 1.0 vs. 16.3 ± 1.0 mmHg, p = 0.029). In all 300 right eyes, Tonopen underestimated IOP in 48.3% of eyes and overestimated in 39% (difference range: ( - )14 to ( + )12 mmHg), with IOP difference > ± 3 mmHg in 34% of eyes. In eyes with GAT IOP ≥ 22 mmHg, Tonopen IOP was significantly lower (24.7 ± 2.6, range: 11-43 mmHg vs. 28.2 ± 2.2, range: 22-43 mmHg, p = 0.0002, mean difference: - 3.6 ± 1.7 mmHg), and the Tonopen measured IOP ≤ 21 mmHg in 33.3% of eyes. In eyes with Tonopen IOP ≤ 10 mmHg GAT measured IOP of 11-17 mmHg in 65.7% of eyes. CONCLUSIONS: Tonopen may mask a third of eyes with elevated IOP and two third of eyes with potentially above-goal IOP. The Tonopen may not be interchangeable with GAT or sufficiently reliable for patient management or screening in our glaucoma clinic. However, further study is recommended to assess the limitations of the Tonopen IOP measurements in eyes with higher or lower GAT IOPs. CLINICAL TRIALS REGISTRATION: The Institutional review board, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY does not require this retrospective study to register.

Effect of EnChroma glasses on color vision screening using Ishihara and Farnsworth D-15 color vision tests.

BACKGROUND: The prevalence of color vision deficiency (CVD) is about 0.5% in females and 8% in males. Although there is no cure for CVD, specially filtered glasses are purported to improve color contrast. One recent development is the EnChroma filter. The purpose of this study was to assess the effect of the EnChroma filter on color vision screening (CVS) using Ishihara and Farnsworth D-15 color vision tests. METHODS: The medical records of patients with CVD were reviewed retrospectively. Responses to color vision testing with and without the EnChroma filter were evaluated using Ishihara and Farnsworth D-15 tests, and the overall scores were analyzed. RESULTS: A total of 38 eyes of 19 patients were included. Mean error scores of no filter compared to EnChroma were significantly reduced in 17 eyes using the Ishihara test (0.88 ± 0.03 vs 0.85 ± 0.03, P = 0.017). The error score significantly reduced only in deutans (P = 0.022), not in protans (P = 0.44). The confusion index of no filter to the EnChroma filter was significantly reduced in 20 eyes using the Farnsworth test (3.30 ± 0.15 vs 2.98 ± 0.17; P = 0.01). The confusion index significantly reduced only in protans (P = 0.01), not in deutans (P = 0.19). CONCLUSIONS: In this study cohort, the EnChroma filter significantly reduced overall error scores using the Ishihara and Farnsworth tests; error scores on Ishihara testing reduced only in deutans. Conversely, the confusion index using Farnsworth reduced only in protans. The majority of patients reported subjective increase in color perception.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Eyes With Good Central Vision.

PRECIS: This study is the first to report micropulse transscleral cyclophotocoagulation (MP-TSCPC) use in only good vision patients. MP-TSCPC significantly reduced intraocular pressure (IOP) and glaucoma medication use without any significant reduction in visual acuity at every postoperative follow-up point. PURPOSE: To evaluate outcomes of MP-TSCPC in eyes with baseline best-corrected visual acuity (BCVA) of ≥20/60. METHODS: A retrospective review of patients who underwent MP-TSCPC at Mayo Clinic and Ross Eye Institute from July 2016 to August 2017 with BCVA of ≥20/60, and a minimum of 3 months follow-up. RESULTS: A total of 61 eyes of 46 patients (68.80±17.12 y) underwent MP-TSCPC with a mean follow-up of 10.2±3.1 months. Mean IOP and mean number of glaucoma medications used were significantly reduced from baseline at every follow-up time point (P<0.0001). At month 12, mean IOP was reduced 40.2% from baseline with 85.4% of the patients having an IOP reduction of ≥20%, and mean glaucoma medication use reduced by 0.82±0.53 with 79.6% of the patients having a reduction of ≥1 medication. There was no significant reduction in BCVA from baseline at any follow-up point (P>0.05), except for 10 eyes with a vision loss of ≥2 lines and 5 out of 10 eyes had cataract progression. The probability of complete success (IOP range, 6 to 21 mm Hg or ≥20% IOP reduction; BCVA loss ≤2 lines, no reoperation for glaucoma) was 74.14%, 83.61%, 84.21%, and 75.0% at months 1, 3, 6, 12, respectively. The probability of qualified success (above criteria for IOP, no reoperation and BCVA loss >2 lines) was 81.03%, 91.80%, 94.74%, and 93.75% at months 1, 3, 6, 12, respectively. CONCLUSIONS: MP-TSCPC should be considered earlier in the management of glaucoma and can possibly be offered as an alternative to incisional glaucoma surgeries.