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The Influence of Central Corneal Thickness and Corneal Curvature on Intraocular Pressure Measured by Tono-Pen and Rebound Tonometer in Children

Sahin, Afsun MD; Basmak, Hikmet MD; Yildirim, Nilgun MD

doi: 10.1097/IJG.0b013e31806ab33e
Original Studies

Purpose To find out the effect of central corneal thickness (CCT) and radius of the corneal curvature on intraocular pressure (IOP) measurements using rebound tonometer (RBT) and Tono-Pen in healthy schoolchildren.

Methods IOP was measured with Tono-Pen and RBT, respectively, in 165 healthy schoolchildren with a mean age 9.8±3.1 (range: 7 to 12 y) years. Corneal radius of curvature (in mm) was determined using a keratometer before CCT and IOP measurements. CCT was measured using an ultrasonic pachymeter after all IOP determinations had been made. The effect of CCT, radius of the corneal curvature, and sex on measured IOP was evaluated by linear regression analysis.

Results The mean IOP readings were 17.47±2.7 mm Hg using Tono-Pen, and 16.81±3.1 mm Hg using RBT. Tono-Pen measured IOP values slightly greater than that of RBT (P=0.006). Mean CCT was found to be 561.37±33 μm. A significant association between measured IOP and CCT was found with each device (r=0.220 for the Tono-Pen, r=0.373 for the RBT; P=0.006 for the Tono-Pen and P<0.0001 for the RBT). The IOP increased 2.2 and 3.7 mm Hg for every 100-μm increase in CCT for the Tono-Pen and the RBT, respectively. The relation between IOP and CCT was not different for boys and girls. Mean radius of the corneal curvature readings was 7.68±0.41 mm (42.75±1.37 D) for both sexes. There was no significant relationship between either the mean corneal curvature readings, or CCT and IOP (r=0.02; P=0.4 for CCT and r=0.01; P=0.5 for IOP).

Conclusions Both the Tono-Pen and RBT have a systematic error in IOP readings caused by its dependence on CCT. The CCT measurements should be considered to ensure proper interpretation of IOP measurements in children, like in adults. The corneal radius of curvature had no significant effect on measured IOP with each device.

Department of Ophthalmology Eskisehir, Eskisehir Osmangazi University Hospitals, Turkey

Reprints: Nilgun Yildirim, MD, Department of Ophthalmology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey (e-mail:

Received for publication January 16, 2007; accepted April 7, 2007

© 2008 Lippincott Williams & Wilkins, Inc.