Ocular Response Analyzer versus Goldmann Applanation Tonometry in a Population-based Sample: The Thessaloniki Eye Study.

Abstract

To compare corneal-compensated intraocular pressure (IOPcc) with Goldmann applanation tonometry (GAT-IOP) in an elderly cohort and assess effects of substituting GAT-IOP with IOPcc on IOP distribution, ocular hypertension prevalence, glaucoma screening, and risk modeling. Prospective diagnostic sensitivity and specificity analysis using population-based data. One eye from 854 participants in the 12-year incidence phase of the Thessaloniki Eye Study. Participants underwent measurement of GAT-IOP and IOPcc. Agreement and screening performance (sensitivity, specificity, AUC) were assessed. Two multivariable logistic regression models were constructed, one with GAT-IOP and one with IOPcc. Measures GAT-IOP and IOPcc. Mean age was 79.2 (SD 3.9) years; 42.4% were female. GAT-IOP was 14.3 (SD 3.3) mmHg and IOPcc 17.1 (SD 4.3) mmHg. IOPcc exceeded GAT-IOP by 2.75 mmHg (limits of agreement, -3.2 to 8.7). Ocular hypertension prevalence (>21 mmHg) increased from 1.3% to 10.7% when IOPcc was used instead. GAT-IOP was associated with central corneal thickness (CCT) (95% CI, 0.009-0.022; p=0.02), whereas IOPcc was not (95% CI, -0.001 to 0.016; p=0.08). In untreated participants, GAT-IOP>21 mmHg showed 98.6% specificity and 34.2% sensitivity; IOPcc increased sensitivity to 44.7% but reduced specificity to 88.3%. AUCs were similar (0.818 vs 0.780; p=0.31). In multivariable models, IOP measures were independently associated with glaucoma, with stronger effect size for GAT-IOP (OR=1.264; 95% CI, 1.182-1.359) than for IOPcc (OR=1.176; 95% CI, 1.116-1.241); pseudoexfoliation, family history, and body mass index were significant in both models, whereas CCT and axial length were significant only in the GAT-IOP model. Substituting GAT-IOP with IOPcc changed risk estimates, while the measures are not interchangeable and standard IOPcc thresholds may overestimate ocular hypertension.