Is pulse synchronized pneumotonometry more reproducible than routine pneumotonometry and more in agreement with Goldmann applanation tonometry?

PURPOSE This study compared the variability of intraocular pressure (IOP) measurements taken with pulse synchronized pneumotonometry (PNT) and with routine PNT (without pulse synchronization) and evaluated the agreement between PNT and Goldmann applanation tonometry (GAT). METHODS In this prospective study, 148 eyes from 78 patients were enrolled. Patients were randomized into two groups. In the first group (A), the sequence of measurements was pulse synchronized PNT, routine PNT, and GAT. In the second group (B), the sequence of measurements was routine PNT, pulse synchronized PNT, and GAT. The mean of three measurements was averaged for PNT and GAT. All the measurements were performed by the same investigator, who was masked to GAT measurements. The mean IOP measurements and intrapatient standard deviations among the three tonometers were compared using analysis of variance measurement. Bland & Altman plots were used to assess the agreement between PNT and GAT. RESULTS The variability of IOP measurements taken with pulse synchronized PNT was significantly lower than with routine PNT in both groups (1.2+/-0.7 vs 1.3+/-0.7 mmHg in group A and 1.1+/-0.9 vs 1.3+/-1.0 mmHg in group B [p<0.001], respectively). PNT measurements with and without pulse synchronization were on average +/-2 mmHg higher than GAT measurements in both groups (p<0.001). The 95% limits of agreement between PNT and GAT varied between -3.8 and 8.5 mmHg. CONCLUSIONS Pulse synchronized PNT gives more reproducible measurements than routine PNT. The agreement between PNT and GAT is poor.