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Editors Selection IGR 18-2
Clinical Examination Methods: Does it matter who measures IOP?
Comment by Florent Aptel on:
90235 Evaluating Goldmann Applanation Tonometry Intraocular Pressure Measurement Agreement Between Ophthalmic Technicians and Physicians, Mihailovic A; Varadaraj V; Ramulu PY et al., American Journal of Ophthalmology, 2020; 219: 170-176
The authors evaluated the Goldmann Applanation Tonometry Intraocular Pressure (IOP) measurement agreement between technicians and physicians, and the impact of an educational intervention for the technicians on agreement.
In the first part of the study, they evaluated IOP measurement agreement between six technicians and one of two physicians on a sample of 30 eyes per technician. In the second part of the study, the technicians underwent a dedicated training made by the physicians. The agreement between technicians was evaluated in a similar manner (30 eyes per technician) immediately after the training and six months later.
At baseline, physicians and technicians disagreed 25% and 13% of the time when measuring IOP using >2 and >3 mmHg to define disagreement. Disagreement was greater at IOPs greater than 20 mm Hg. No significant changes were noted in the frequency of disagreement between technicians and physicians immediately or six months post-intervention.
It should be noted that frequency of IOP disagreement between physicians was evaluated at baseline, and was 17% and 7% using >2 and >3 mmHg to define disagreement.
As in some countries an increasing number of clinics use technicians to perform Goldmann Applanation Tonometry IOP measurements, the findings of the study are interesting and useful. In other countries, only doctors are allowed to perform Goldmann Applanation Tonometry. This is, for example, the case in most of the European countries (only non-contact tonometry can be performed by technicians and doctor's assistants). The findings of the present study could be considered by the countries that want to increase the delegation of tasks to technicians and doctor's assistants.
The findings of the present study could be considered by the countries that want to increase the delegation of tasks to technicians and doctor's assistants
I would like to know the mean delay between the IOP measurement by the physicians and the technicians. This is a very important data, as IOP fluctuates widely long- and shortterm. Part of the disagreement could be explained by true changes of the IOP, which is not a fixed parameter.
Also, the authors stated that physician-technician agreement was based on IOP measurements taken using different Goldmann tonometers. We do not have any information about the tonometer's calibration results. Ideally, the measurements should have been performed with the same tonometers. If this is not the case, the agreement between the tonometers should have been evaluated beforehand.
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