• AAO OTAC Pediatric Ophthalmology/Strabismus Panel, Hoskins Center for Quality Eye Care


    A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Scott R. Lambert, MD1; Michele Melia, ScM2; Angela N. Buffenn, MD MPH3; Michael F. Chiang, MD4; Jennifer L. Simpson, MD5; Michael B. Yang, MD6

    Ophthalmology, April 2013, e21-e27 © 2013 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Objective: To compare intraocular pressure (IOP) measurements in children 18 years of age and younger using rebound tonometry and applanation tonometry and the feasibility of using these techniques in children.

    Methods: Literature searches of the PubMed and the Cochrane Library databases were last conducted in June 2012 and resulted in 43 citations, including citations not in English. Of these 43 citations, 4 studies met the inclusion criterion following full text review. A level of evidence rating was assigned to each study using criteria specifically developed for this assessment.

    Results: No level I study was found in the literature search, and 2 level II and 2 level III studies were identified. Intraocular pressure was 2 to 3 mmHg higher using rebound tonometry compared with Goldmann applanation tonometry in the 2 level II studies performed in a clinic setting and in 1 level III study performed on children under general anesthesia. However, IOP was lower in 1 level III study in which noncontact applanation tonometry was compared with rebound tonometry. Bland-Altman plots showed that the difference in IOP for rebound versus Goldmann applanation tonometry increased as the IOP increased. The success rate for measuring IOP was markedly higher in children 3 years of age and younger using rebound tonometry compared with noncontact tonometry in 1 level III study.

    Conclusions: Rebound tonometry seems to be a reasonably accurate instrument that allows the IOP to be measured in many children without using general anesthesia. More data are required to better assess how the differences between instruments vary with IOP measurement.

    1R. Howard Dobbs Professor, Departments of Ophthalmology and Pediatrics, Emory University, Atlanta, Georgia
    2Jaeb Center for Health Research, Tampa, Florida
    3The Vision Center, Children's Hospital Losa Angeles; Orbit and Eye Movement Institute, Strabismus and Pediatric Ophthalmology; Fellowship Program, Pediatric Ophthalmology and Strabismus; University of Souther California Keck School of Medicine, Los Angeles, California
    4Knowles Professor of Ophthalmology & Medical Informatics and Clinical Epidemiology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
    5Department of Ophthalmology, School of Medicine, University of California, Irvine, California
    6Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, College of Medicine, Cincinnati, Ohio