Evaluation of rebound tonometer iCare IC200 as compared with IcarePRO and Goldmann applanation tonometer in patients with glaucoma

Background:This study investigated the agreement between a new rebound tonometer,IC200,and IcarePRO and Goldmann applanation tonometry(GAT).Methods:This was a prospective cross-sectional study.We measured the intraocular pressure(IOP)in 145 eyes of 145 glaucoma patients in the sitting position using GAT,IcarePRO,and IC200.IcarePRO and IC200 measurements were also obtained in the supine position.IC200 measurement was performed using two modes:single six(IC200-single)and automatic(IC200-continuous)six-measurements mode.Results:All tonometers provided high reproducibility in both positions(all intraclass correlation coefficients>0.90),although it was highest with GAT,followed by IC200-continuous and IC200-single and then IcarePRO.In the sitting position,the mean(±SD)IOPs of GAT,IcarePRO,IC200-single,and IC200-continuous were 14.5±2.9 mmHg,13.3±3.2 mmHg,11.6±3.2 mmHg,and 11.5±3.2 mmHg,respectively.IOPs measured with IcarePRO or IC200 were significantly lower than those with GAT,particularly in patients with low IOP.IOPs measured with all tonometers were significantly elevated in the supine position as compared with the sitting position,but this difference was significantly greater with IC200-single and IC200-continuous compared with IcarePRO.IOP elevation was significant in eyes without bleb versus those with bleb,but this finding was not observed when IOP was measured with IcarePRO.The IOPs of the single and continuous modes of IC200 were interchangeable in both positions.Conclusions:GAT,IcarePRO,and IC200 had sufficiently high reproducibility,but measurements with IcarePRO may not be accurate in the supine position.Elevation of IOP in the supine position,especially in eyes with bleb,was more sensitively captured with IC200 than with IcarePRO.