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      Comparison of Aqueous Outflow Facility Measurement by Pneumatonography and Digital Schiøtz Tonography

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          Abstract

          Purpose

          It is not known if outflow facilities measured by pneumatonography and Schiøtz tonography are interchangeable. In this study we compared outflow facility measured by pneumatonography to outflow facility measured by digital Schiøtz tonography.

          Methods

          Fifty-six eyes from 28 healthy participants, ages 41 to 68 years, were included. Intraocular pressure (IOP) was measured in the sitting and supine positions with a pneumatonometer. With the subject in the supine position, IOP was recorded for 2 minutes by using a pneumatonometer with a 10-g weight and for 4 minutes by using a custom digital Schiøtz tonometer. Outflow facility was determined from the changes in pressure and intraocular volume and a standard assumed ocular rigidity coefficient for each instrument, respectively, and by using an ocular rigidity coefficient calculated by measuring pressure without and with a weight added to the pneumatonometer tip.

          Results

          The outflow facility was 0.29 ± 0.09 μL/min/mm Hg by Schiøtz tonography and 0.24 ± 0.08 μL/min/mm Hg by pneumatonography ( P < 0.001) when using the standard assumed constant ocular rigidity coefficient. Mean calculated ocular rigidity coefficient was 0.028 ± 0.01 μL −1, and outflow facility determined by using this coefficient was 0.23 ± 0.08 μL/min/mm Hg by Schiøtz tonography and 0.21 ± 0.07 μL/min/mm Hg by pneumatonography ( P = 0.003). Outflow facilities measured by the two devices were correlated when the ocular rigidity was assumed ( r = 0.60, P < 0.001) or calculated ( r = 0.70, P < 0.001).

          Conclusions

          Outflow facilities measured by pneumatonography were correlated with those measured by Schiøtz tonography, but Schiøtz tonography reported approximately 10% to 20% higher facilities when using the standard method. When ocular rigidity was determined for each eye, differences were smaller. Measurements from these devices cannot be compared directly.

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          Most cited references38

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Ocular rigidity in living human eyes.

            To measure the rigidity coefficient of a large number of subjects at clinically encountered intraocular pressures (IOPs) and to examine the possible correlation of ocular rigidity with other factors, such as the age of the patients, ocular parameters (axial length and corneal thickness), and pathologic conditions affecting the eye. The pressure-volume relationship and the ocular rigidity coefficient (K) were determined in 79 eyes undergoing cataract surgery, by injecting 200 microL of saline solution (in steps of 4.5 microL) through the limbus into the anterior chamber, while continually monitoring the IOP with a transducer, up to the limit of 60 mm Hg. Data within an IOP range of 10 to 35 mm Hg were used to calculate the scleral rigidity coefficient. All measurements were taken at the same time of day, to eliminate any possible diurnal variation. The mean ocular rigidity coefficient was 0.0126 mm Hg/microL (95% confidence interval [CI], 0.0112-0.0149). A statistically significant positive correlation between the rigidity coefficient and age of the patient was found (P = 0.02), whereas similar findings were not observed for the examined ocular parameters (axial length, P = 0.09; and corneal thickness, P = 0.12). No correlation was found for patients with diabetes mellitus (P = 0.39), age-related macular degeneration (P = 0.55), and hypertension (P = 0.45). The present study provides quantitative data on the ocular rigidity coefficient based on measurements in a large series of living human eyes. A positive correlation between the ocular rigidity coefficient and the patient's age was documented.
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              Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy subjects. A crossover study.

              To study the effects of 3 prostaglandin analogs, bimatoprost, latanoprost, and travoprost, on aqueous dynamics in the same subjects and to compare techniques of assessing outflow facility. Experimental study (double-masked, placebo-controlled, randomized paired comparison, 4-period crossover). Thirty healthy adult subjects. Bimatoprost, latanoprost, travoprost, or a placebo was administered to the left eye once a day in the evening for 7 days, after a minimum 4-week washout period between each session. Tonographic outflow facility was measured by Schiøtz tonography and pneumatonography on day 7. On day 8, the aqueous humor flow rate and fluorophotometric outflow facility were measured by fluorophotometry. Uveoscleral outflow was calculated from the aqueous humor flow rate and outflow facility using the Goldmann equation. Facility of outflow, aqueous humor flow rate, intraocular pressure (IOP), and calculation of uveoscleral outflow. All medications lowered IOP relative to a placebo. None of the drugs affected aqueous humor production. All medications increased outflow facility compared with placebo when measured by Schiøtz and 2-minute pneumatonography (P< or =0.02); the apparent increase of outflow facility measured with fluorophotometry and 4-minute pneumatonography did not reach statistical significance. In contrast, uveoscleral outflow was significantly increased by all medications when calculated from 4-minute pneumatonography data, and fluorophotometry and Schiøtz data at higher episcleral venous pressures. The apparent increase found with 2-minute pneumatonography did not reach statistical significance. These differing results in the same patients indicate that differences in measurement techniques, and not differences in mechanism of action, explain previous conflicting published reports on the mechanism of action of the prostaglandins. Bimatoprost, latanoprost, and travoprost have similar mechanisms of action. All 3 drugs reduce IOP without significantly affecting the aqueous production rate. All drugs increase aqueous humor outflow, either by enhancing the pressure-sensitive (presumed trabecular) outflow pathway or by increasing the pressure-insensitive (uveoscleral) outflow, but the assessment of the amount of flow through each pathway depends upon the measurement technique.
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                Author and article information

                Journal
                Invest Ophthalmol Vis Sci
                Invest. Ophthalmol. Vis. Sci
                iovs
                iovs
                IOVS
                Investigative Ophthalmology & Visual Science
                The Association for Research in Vision and Ophthalmology
                0146-0404
                1552-5783
                January 2017
                : 58
                : 1
                : 204-210
                Affiliations
                [1 ]Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
                [2 ]Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States
                [3 ]Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, United States
                [4 ]Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
                Author notes
                Correspondence: Arthur J. Sit, Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA; sit.arthur@ 123456mayo.edu .
                Article
                iovs-57-15-23 IOVS-16-20754
                10.1167/iovs.16-20754
                5256680
                28114581
                733fe69e-329b-4acc-8013-7ae6e6e37887

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 14 September 2016
                : 24 October 2016
                Categories
                Glaucoma

                aqueous outflow facility,tonography,ocular rigidity,tonometry

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