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Editors Selection IGR 15-2

Intraocular Pressure: IOP measurements in children

Comment by Sharon Freedman on:

51834 The use of the iCare tonometer reduced the need for anesthesia to measure intraocular pressure in children, Grigorian F; Grigorian AP; Olitsky SE, Journal of AAPOS, 2012; 16: 508-510

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The iCare rebound tonometer (iCare Finland Oy, Helsinki, Finland) ‐ a handheld tonometer that able to measure intraocular pressure (IOP) without requiring topical anesthetic ‐ has proven invaluable in the assessment of children with known or suspected glaucoma. Although the device often reports IOP to be slightly higher than measured with Goldmann applanation in cooperative children, its low rate of 'false low' IOP readings makes it an almost ideal screening tool for the pediatric population requiring IOP measurement.^1-4 Grigorian, Grigorian, and Olitsky present retrospective clinical data gathered on pediatric glaucoma patients at a single site, demonstrating that routine use of the Icare tonometer in clinic reduced the need for examination under anesthesia (EUA), while increasing successful IOP measurement in the clinic. The authors reviewed the records of consecutive children with glaucoma during three consecutive time periods relative to their use of iCare

iCare rebound tonometry makes IOP assessment in non-sedated children much easier, and that real benefit ensues, in terms of anesthetic sessions saved and even cost incurred for care of pediatric glaucoma patients

tonometry ‐ before (10 mos), during transition (5 mos), and after (10 mos) routine Icare device use clinic tonometry. They compared the number of EUAs that included an IOP measurement as well as the number of clinic visits that included an IOP measurement, respectively, between the first and third periods, noting that some patients straddled more than a single time interval. Results were reported from 87 total patients, 48 in the first, and 58 in the third time period, with similar mean age ~4.5 years. While the number of EUAs declined from the first vs. third periods (from 55 to 18, respectively, p < 0.001), the number of clinic visits including an IOP measurement increased during the same two time intervals (from 34 to 151, respectively, p < 0.001). In addition, there was a suggestion that there was a trend from the first to the third period, with results intermediate during the second learning/transition period.

Limitations relate mostly to the non-randomized, retrospective nature of the study, and the fact that while all clinic visits for the enrolled glaucoma patients could be examined, included EUAs were identified from among all EUAs done in the practice over the study period, with attempt to eliminate those performed unrelated to glaucoma/ IOP measurement. We are not told the age distribution of included glaucoma patients, which might either inflate (if most are very young) or minimize (if most are older and cooperative) the effect of Icare rebound tonometry on success of clinic IOP measurement (and corresponding decline in required EUAs). While data are not provided, the authors felt there was even distribution of new patients and overall patient numbers over the course of study period.

The results of this study support the general impression that iCare rebound tonometry makes IOP assessment in non-sedated children much easier, and that real benefit ensues, in terms of anesthetic sessions saved and even cost incurred for care of pediatric glaucoma patients.

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