Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records
Purpose: To compare intraocular pressure (IOP) obtained with Tono-Pen (TP) and Goldmann applanation (GAT) using large-scale electronic health records (EHR). Design: Retrospective cohort study. Methods: A single pair of eligible TP/GAT IOP readings was randomly selected from the EHR for each ophthalm...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S240584402305911X |
| _version_ | 1797732972490653696 |
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| author | Haiwen Gui Youchen Zhang Robert T. Chang Sophia Y. Wang |
| author_facet | Haiwen Gui Youchen Zhang Robert T. Chang Sophia Y. Wang |
| author_sort | Haiwen Gui |
| collection | DOAJ |
| description | Purpose: To compare intraocular pressure (IOP) obtained with Tono-Pen (TP) and Goldmann applanation (GAT) using large-scale electronic health records (EHR). Design: Retrospective cohort study. Methods: A single pair of eligible TP/GAT IOP readings was randomly selected from the EHR for each ophthalmology patient at an academic ophthalmology center (2013–2022), yielding 4550 eligible measurements. We used Bland-Altman analysis to describe agreement between TP/GAT IOP differences and mean IOP measurements. We also used multivariable logistic regression to identify factors associated with different IOP readings in the same eye, including demographics, glaucoma diagnosis, and central corneal thickness (CCT). Primary outcome metrics were discrepant measurements between TP and GAT as defined by two methods: Outcome A (normal TP despite elevated GAT measurements), and Outcome B (TP and GAT IOP differences ≥6 mmHg). Result: The mean TP/GAT IOP difference was 0.15 mmHg ( ± 5.49 mmHg 95% CI). There was high correlation between the measurements (r = 0.790, p < 0.001). We found that TP overestimated pressures at IOP <16.5 mmHg and underestimated at IOP >16.5 mmHg (Fig. 4). Discrepant measurements accounted for 2.6% (N = 116) and 5.2% (N = 238) for outcomes A and B respectively. Patients with thinner CCT had higher odds of discrepant IOP (OR 0.88 per 25 μm increase, CI [0.84–0.92], p < 0.0001; OR 0.88 per 25 μm increase, CI [0.84–0.92], p < 0.0001 for outcomes A and B respectively). Conclusion: In a real-world academic practice setting, TP and GAT IOP measurements demonstrated close agreement, although 2.6% of measurements showed elevated GAT IOP despite normal TP measurements, and 5.2% of measurements were ≥6 mmHg apart. |
| first_indexed | 2024-03-12T12:21:16Z |
| format | Article |
| id | doaj.art-0425d2d19ee547979bdb88d861529825 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-12T12:21:16Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-0425d2d19ee547979bdb88d8615298252023-08-30T05:52:16ZengElsevierHeliyon2405-84402023-08-0198e18703Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health recordsHaiwen Gui0Youchen Zhang1Robert T. Chang2Sophia Y. Wang3Stanford University School of Medicine, Stanford, United StatesByers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United StatesByers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United StatesByers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States; Corresponding author. 2370 Watson Court, Palo Alto, CA, 94303, United States.Purpose: To compare intraocular pressure (IOP) obtained with Tono-Pen (TP) and Goldmann applanation (GAT) using large-scale electronic health records (EHR). Design: Retrospective cohort study. Methods: A single pair of eligible TP/GAT IOP readings was randomly selected from the EHR for each ophthalmology patient at an academic ophthalmology center (2013–2022), yielding 4550 eligible measurements. We used Bland-Altman analysis to describe agreement between TP/GAT IOP differences and mean IOP measurements. We also used multivariable logistic regression to identify factors associated with different IOP readings in the same eye, including demographics, glaucoma diagnosis, and central corneal thickness (CCT). Primary outcome metrics were discrepant measurements between TP and GAT as defined by two methods: Outcome A (normal TP despite elevated GAT measurements), and Outcome B (TP and GAT IOP differences ≥6 mmHg). Result: The mean TP/GAT IOP difference was 0.15 mmHg ( ± 5.49 mmHg 95% CI). There was high correlation between the measurements (r = 0.790, p < 0.001). We found that TP overestimated pressures at IOP <16.5 mmHg and underestimated at IOP >16.5 mmHg (Fig. 4). Discrepant measurements accounted for 2.6% (N = 116) and 5.2% (N = 238) for outcomes A and B respectively. Patients with thinner CCT had higher odds of discrepant IOP (OR 0.88 per 25 μm increase, CI [0.84–0.92], p < 0.0001; OR 0.88 per 25 μm increase, CI [0.84–0.92], p < 0.0001 for outcomes A and B respectively). Conclusion: In a real-world academic practice setting, TP and GAT IOP measurements demonstrated close agreement, although 2.6% of measurements showed elevated GAT IOP despite normal TP measurements, and 5.2% of measurements were ≥6 mmHg apart.http://www.sciencedirect.com/science/article/pii/S240584402305911XOphthalmologyIntraocular pressureElectronic health recordTonometryGlaucoma |
| spellingShingle | Haiwen Gui Youchen Zhang Robert T. Chang Sophia Y. Wang Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records Heliyon Ophthalmology Intraocular pressure Electronic health record Tonometry Glaucoma |
| title | Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records |
| title_full | Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records |
| title_fullStr | Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records |
| title_full_unstemmed | Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records |
| title_short | Real-world agreement of same-visit Tono-Pen vs Goldmann applanation intraocular pressure measurements using electronic health records |
| title_sort | real world agreement of same visit tono pen vs goldmann applanation intraocular pressure measurements using electronic health records |
| topic | Ophthalmology Intraocular pressure Electronic health record Tonometry Glaucoma |
| url | http://www.sciencedirect.com/science/article/pii/S240584402305911X |
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