Repeatability and agreement of CCT measurement in myopia using entacam and ultrasound pachymetry

AIM: To evaluate the repeatability of central corneal thickness (CCT) measurement by entacam, and agreement of CCT measured by Pentacam and ultrasound pachymetry (USP) in Chinese myopia. Thereby investigate the possibility of Pentacam as a substitute for USP in CCT measurement before refractive surgery. The effects of corneal curvature measured by Pentacam on CCT were also evaluated. METHODS: One hundred and forty-eight right eyes of 148 individual with myopia were included in this study. Three successive Pentacam CCT measurements followed by 10 successive ultrasound pachymetry were carried out in the 148 eyes. Mean of CCT taken by each device was calculated for comparison. According to the CCT measured by USP, all the 148 eyes were divided into 3 groups: <520 mu m, 520-560 mu m, >560 mu m. For all eyes and each group the CCT obtained by Pentacam and USP were compared. Anterior corneal curvature of the 148 eyes was also adopted for correlation analysis with CCT obtained by ultrasound pachymetry. In addition, CCT measurement using 60 random selected Scheimpflug images was performed by 3 skilled investigators at different time, and this was repeated for 3 times by a forth investigator to assess repeatability of Pentacam CCT measurement using Scheimpflug images. RESULTS: Intraclass correlation coefficient (ICC) analysis revealed high intraobserver repeatability (ICC=0.994, F=158.60, P<0.001) for CCT measurement by Pentacam. The interobserver (ICC=0.998, F =494.73, P <0.001) and intraobserver (ICC=0.997, F=383.98, P<0.001) repeatability for Pentacam CCT measurements using Scheimpflug images were also excellent. There was high positive correlation between the CCT values measured by Pentacam and ultrasound pachymetry (r=0.963, P<0.001). Bland-altman plots showed that the Pentacam underestimate the CCT by 8.02 mu m compared with ultrasouond pachymetry.The differences between Pentacam and USP increased as the CCT readings by USP increased (Pentacam vs USP: slope=-0.04, P< 0.05). The 95% upper and lower limits of agreement between CCT values obtained from the two devices were +9. 33 mu m and -25.37 mu m. No significant association could be found between CCT and anterior corneal curvature. CONCLUSION: Inter- and intraobserver variability for CCT measurements by Pentacam was considerably below clinically significant levels. CCT of myopia obtained by Scheimpflug camera, Pentacam, were highly correlated to that by ultrasound pachymetry. However, the values obtained are not directly interchangeable between Pentacam and ultrasound pachymetry as the 95% limits of agreement are relatively wide. Pentacam can be a useful instrument for measuring CCT in candidates to refractive surgery in clinic.

Three-year follow-up in advanced pediatric keratoconus:thin corneas may not have pachymetry properly assessed after crosslinking

AIM:To analyze the crosslinking(CXL)effects in pediatric keratoconus,and to identify the patients’corneal characteristics whose pachymetry could not be adequately evaluated by Scheimpflug method after procedure.METHODS:Consecutive pediatric patients with progressive keratoconus underwent CXL were included.Best-corrected visual acuity(BCVA)and spheric equivalent(SE)were measured before and after CXL.After CXL,groups 1 and 2 were divided based on the posterior surface Pentacam quality specifications(QS):"OK"(Group 1)and"not OK"(Group 2).The mean(RmF and RmB)and minimum(RminF and RminB)radius of curvatures of the anterior and posterior corneal surfaces,and the thinnest pachymetry(Pmin)were measured preoperatively at 3,6,12,24,and 36 mo.Haze was annotated.RESULTS:Twenty-six patients(14 men,mean age 14±1.8 y)and median Kmax of 59.9 D initially and 61.4 D preoperatively were treated.BCVA was not different before and 24 mo after CXL.Group 2 statistically differed to group 1 in that SE was more myopic before and with no difference 24 mo after CXL;RmF and RmB were steeper and Pmin was thinner pre-surgically.Group 2,in which pachymetric changes could not be adequately evaluated after surgery,presented with significant RmF flattening,a shift to hyperopia,and more haze after CXL.CONCLUSION:Patients whose pachymetry could not be adequately evaluated after CXL had steeper and thinner corneas before surgery.The predictive factors for impaired QS after CXL are RmF,RmB,and Pmin.In advanced keratoconus,alternative methods to analyze pachymetry and the posterior surface should be considered.

Monitoring of central corneal thickness after phacoemulsification—comparison of statical and rotating Scheimpflug pachymetry,and spectral-domain OCT

AIM:To explore the possibility of deploying three contactless devices(static and rotating Scheimpflug technology,spectral domain optical coherence tomography)for measuring central corneal thickness(CCT)in preoperative and postoperative examinations of cataract patients.METHODS:Totally 72 patients who had undergone surgery without complications were selected.The CCT was measured prior to the operation,as well as on the first,5th-7th and 28th day following the operation using the Nidek NT 530-P,Sirius?,and Topcon OCT-2000 devices.RESULTS:A significant postoperative increase and subsequent decrease in CCT was identified with all three devices.The correlations were highly significant and thus reflect a very good degree of comparability at all times with the exception of the rotating Scheimpflug camera.The postoperative results from the latter differed significantly from the other devices.The correlations were Sirius/Topcon(P=0.010)and Sirius/Nidek(P<0.0005).No statistically significant difference could be identified in the comparison between Topcon and Nidek(P=0.056).CONCLUSION:All three devices are suitable for postoperative monitoring of CCT.The measurement results are only comparable to a limited extent and not interchangeable in the course of treating a single patient.This is due to the different imaging technology used in the devices and the resulting modalities for conducting the measurements.

Repeatability of 3D OCT Pachymetry in Eyes with and without Contact Lens Induced Corneal Swelling

Introduction: Corneal thickness measurement is an indirect assessment of the physiological corneal function in human eye. This value, especially in the central area, is an important data for clinical diagnosis, treatment and monitoring of anterior segment pathologies. There are several technologies for non-invasively measuring corneal thickness like optical coherence tomography (OCT). However, there is little information available describing the effect of contact lens induced corneal swelling in OCT measures. The purpose of this study was to evaluate the repeatability of OCT corneal pachymetry in eyes with and without contact lens induced corneal swelling. Material and Methods: This study included five visits over one week in six healthy subjects: baseline and after sleeping with four different CL of +0.50 D, +2.00 D, +5.00 D and +8.00 D (Acuvue 2, Johnson & Johnson Vision Care) on four different days. Corneal pachymetry OCT 3D (Topcon) were measured three consecutive times during each visit. Besides, this measurement was repeated in 12 meridians (Scans #1 to #12), between 0°and 165°with 15° intervals. Results: Corneal pachymetry was significant different between before and after contact lens wear (p < 0.001 ANOVA). High repeatability was found without corneal swelling [Coefficient of variation (CV) = 0.68% p = 0.93] and with corneal swelling [CL -0.50 D (CV = 0.78% p = 0.95;590 ± 46 μm CI 95% 548 to 596), with CL + 2.00 D (CV = 0.72% p = 0.97;601 ± 46 μm CI 95% 595 to 607), with CL + 5.00 D (CV = 0.78% p = 0.66;608 ± 50 μm CI 95% 601 to 615) and with CL + 8.00 D (CV = 0.77% p = 0.97;607 ± 44 μm CI 95% 601 to 613)]. There were no differences (p = 1.00) in central corneal thickness along the 12 scans corneal [Scan #0 (593 ± 50 μm CI 95% 582 to 603), #1 (592 ± 50 μm CI 95% 581 to 603), #2 (591 ± 50 μm IC 95% 580 to 602), #3 (590 ± 49 μm CI 95% 579 to 600), #4 (590 ± 50 μm CI 95% 579 to 600), #5 (591 ± 50 μm CI 95% 581 to 602), #6 (590 ± 51 μm CI 95% 580 to 601), #7 (589 ± 50 μm CI 95% 578 to 600), #8 (590 ± 50 μm CI 95% 579 to 600), #9 (589 ± 50 μm CI 95% 579 to 600), #10 (592 ± 50 μm CI 95% 581 to 602) and #11 (591 ± 50 μm CI 95% 580 to 601). Conclusions: 3D OCT showed a high repeatability (CV < 1%) to measure central thickness in corneas with and without contact lens induced corneal swelling. This technology presents advantages over other clinical devices used to measure corneal thickness and could be the “gold standard” for future clinical studies and clinical practice for eye care practitioners.

Sirius Scheimpflug-Placido versus. ultrasound pachymetry for central corneal thickness: meta-analysis

Background:To compare the difference in central corneal thickness(CCT)measurements in normal eyes between a rotating Scheimpflug camera combined with a Placido-disk corneal topographer(Sirius,CSO,Italy)and ultrasound pachymetry(USP).Methods:A systematic literature search was conducted for relevant studies published on PubMed,Medline,EMBASE,and the Cochrane Library and ClinicalTrials.gov from inception to August 1st,2019.Primary outcome measures were CCT measurements between Sirius and USP.A random effects model was used to pool CCT measurements.Results:A total of twelve studies involving 862 eyes were included in this meta-analysis.The meta-analysis found CCT measurements between Sirius and USP to be statistically significantly different(P<0.0001).The mean difference between Sirius and USP was-11.26μm with a 95%confidence interval(CI)(-16.92μm,-5.60μm).The heterogeneity Was IP=60%(P=0.004).Conclusion:CCT measurements with the Sirius Scheimpflug-Placido topographer were statistically significantly lower than USP.However,it may be argued that the mean difference of 11.26μm is not a clinically significant difference.

Evaluation of corneal parameter changes under different accommodative stimuli with Scheimpflug imaging-based tomography

AIM:To evaluate the reliability of measurements of corneal changes with accommodation in healthy eyes using a Scheimpflug imaging-based system and how these measurements distribute in the normal population.METHODS:Prospective,non-randomized,comparative study including 27 healthy subjects(54 eyes),including emmetropia(13 eyes),myopia(17 eyes),hyperopia(4 eyes)and astigmatism(20 eyes)groups.In all cases,a complete eye examination was performed,including the analysis of corneal changes with different accommodative stimuli(+2.00,0.00 and-3.00 D)using the Pentacam AXL system.The investigation was structured in 2 phases:repeatability analysis and characterization of accommodation-related corneal changes in healthy populations.RESULTS:In the repeatability analysis,the index of height asymmetry(IHA)showed the greatest variability with the three accommodative stimuli,being the results for the rest of parameters acceptable.The group of emmetropes showed significant differences with accommodative changes in the position of maximum keratometry(Kmax;P<0.05),whereas in the astigmatism group,significant changes were not only observed in the position of Kmax,but also in minimum corneal thickness(MCT),corneal spherical aberration,and total and low order aberration root mean square(all P<0.05).Likewise,a significant difference was found in the displacement of the X position of Kmax with+2.00 D and-3.00 D in the myopia group(P=0.033)as well as in changes with+2.00 D and-3.00 D in the magnitude of the position vector of Kmax in the emmetropia group(P<0.05).No significant changes were found between accommodative stimuli in the displacement of coordinates of MCT(P≥0.109).CONCLUSION:The position of Kmax and MCT in healthy corneas can change significantly when presenting different accommodative stimuli using the accommodation mode of the Pentacam system,with different trends in these accommodation-related corneal changes between refractive errors.Likewise,the consistency of the measurements obtained with Scheimpflug has been confirmed.

Sirius Scheimpflug–Placido versus ultrasound pachymetry for central corneal thickness:meta-analysis

Background:To compare the difference in central corneal thickness(CCT)measurements in normal eyes between a rotating Scheimpflug camera combined with a Placido-disk corneal topographer(Sirius,CSO,Italy)and ultrasound pachymetry(USP).Methods:A systematic literature search was conducted for relevant studies published on PubMed,Medline,EMBASE,and the Cochrane Library and ClinicalTrials.gov from inception to August 1st,2019.Primary outcome measures were CCT measurements between Sirius and USP.A random effects model was used to pool CCT measurements.Results:A total of twelve studies involving 862 eyes were included in this meta-analysis.The meta-analysis found CCT measurements between Sirius and USP to be statistically significantly different(P<0.0001).The mean difference between Sirius and USP was−11.26μm with a 95%confidence interval(CI)(−16.92μm,−5.60μm).The heterogeneity was I^(2)=60%(P=0.004).Conclusion:CCT measurements with the Sirius Scheimpflug-Placido topographer were statistically significantly lower than USP.However,it may be argued that the mean difference of 11.26μm is not a clinically significant difference.

Eye rubbing-induced changes in intraocular pressure and corneal thickness measured at five locations, in subjects with ocular allergy

AIM: To assess the effects of eye rubbing on corneal thickness(CT) and intraocular pressure(IOP)measurements obtained 0-30 min after habitual eye rubbing in symptomatic patients.METHODS: Measurements of IOP and CT were obtained at five locations(central, temporal, superior,nasal and inferior) before, and every 5min for 30 min interval after 30 s of eye rubbing, for 25 randomly selected eyes of 14 subjects with ocular allergy and 11age-matched normals. Differences in measurements were calculated in each group [Baseline measurements minus measurements recorded at each time interval after eye rubbing(for IOP), and for each corneal location(for CT)]and comparison were then made between groups(allergic versus control) for differences in any observed effects.RESULTS: Within groups, baseline mean IOPs in the allergic patient-group(14.2 ±3.0 mm Hg) and in the control group(13.1±1.9 mm Hg) were similar at all times,after eye rubbing(P 】0.05, for all). The maximum reduction in IOP was 0.8 mm Hg in the control subjects and the maximum increase was also 0.8 mm Hg in the allergic subjects. Between groups(allergic versus control), the changes in IOP remained under 1 mm Hg at all times(P =0.2) after 30 min of eye rubbing. Between 0and 30 min of CT measurements after eye rubbing, the mean central CT(CCT), inferior CT(ICT), superior CT(SCT), temporal CT(TCT) and nasal CT(NCT) did not vary significantly from baseline values in the control and allergic-subject groups(P 】0.05, for both). Between both groups, changes in CT were similar at all locations(P 】0.05)except for the TC which was minimally thinner by about4.4 μm(P =0.001) in the allergic subjects than in the control subjects, 30 min following 30 s of eye rubbing.CONCLUSION: IOP measured in allergic subjects after30 s of habitual eye rubbing was comparable with that obtained in normal subjects at all times between 0 and30 min. Although, CT in the allergic subjects were similar to those of the control subjects at all times, it varied between +10 and-7.5 μm following eye rubbing, with the temporal cornea showing consistent reductions in thickness in the subjects with allergy. However, this reduction was minimal and was considered to not be clinically relevant.

Comparison of corneal measurements in keratoconic eyes using rotating Scheimpflug camera and scanning-slit topography

AIM: To compare the anterior segment measurements obtained by rotating Scheimpflug camera(Pentacam) and Scanning-slit topography(Orbscan IIz) in keratoconic eyes.METHODS: A total of 121 patients, 71 males(58.7%)and 50 females(41.3%)(214 eyes) with the diagnosis of keratoconus(KC) were enrolled in this study. Following diagnosis of KC by slit-lamp biomicroscopic examination, central corneal thickness(CCT), thinnest corneal thickness(TCT), anterior chamber depth(ACD),and pupil diameter(PD) were measured by a single examiner using successive instrumentation by Pentacam and Orbscan.RESULTS: There was no significant difference between the two instruments for the measurement of CCT and TCT. In contrast, scanning-slit topography measured ACD(3.46±0.40 mm vs 3.38±0.33 mm, P =0.019) and PD(4.97 ±1.26 mm vs 4.08 ±1.19 mm, P 【0.001) significantly larger than rotating Scheimpflug camera.The two devices made similar measurements for CCT(95% CI:-2.94 to5.06, P =0.602). However, the mean difference for TCT was-6.28(95% CI:-10.51 to-2.06, P =0.004) showing a thinner measurement by Orbscan than by Pentacam. In terms of the ACD, the mean difference was 0.08 mm(95%CI: 0.04 to 0.12, P 【0.001) with Orbscan giving a slightly larger value than Pentacam. Similarly, Orbscan measurement for PD was longer than Pentacam(95% CI:0.68 to 1.08, P 【0.001).CONCLUSION: A good agreement was found between Pentacam and Orbscan concerning CCT measurement while comparing scanning-slit topography and rotatingScheimpflug camera there was an underestimation for TCT and overestimation for ACD and PD.

Short and long term corneal biomechanical analysis after overnight orthokeratology

AIM: To investigate the short and long term corneal biomechanical changes after overnight orthokeratology(OK) and compare them with those occurring in subjects not wearing contact lenses.METHODS: Retrospective case control study enrolling 54 subjects that were divided into three groups 18 subjects each: control group(CG), short term(15 nights) OK(STOK) group, and long term(more than 1 y of OK wear) OK(LTOK) group. Corneal biomechanics were characterized using the Cor Vis? ST system(Oculus), recording parameters such as time [first/second applanation time(AT1, AT2)], speed [velocity of corneal apex at the first/second applanation time(AV1, AV2)], and amplitude of deformation(AD1, AD2) in the first and second corneal flattening, corneal stiffness(SPA1), biomechanically corrected intraocular pressure(b IOP) and corneal(CBI) and tomographic biomechanical indices(TBI).RESULTS: Significantly lower AD1 and standard deviate on of Ambrosio’s relational average thickness related to the horizontal profile(ARTh) values were found in the OK groups compared to CG(P<0.05). Likewise, significantly higher values of CBI were found in STOK and LTOK groups compared to CG(P<0.01). No significant differences between groups were found in integrated radius index(P=0.24), strain stress index(P=0.22), tomographic biomechanical index(P=0.91) and corneal stif fness parameter(SPA1, P=0.97). Significant inverse correlations were found between corneal thickness and CBI in STOK(r=-0.90, P<0.01) and LTOK groups(r=-0.71, P<0.01).CONCLUSION: OK does not seem to alter significantly the corneal biomechanical properties, but special care should be taken when analyzing biomechanical parameters influenced by corneal thickness such as amplitude of deformation, ARTh or CBI, because they change significantly after treatment but mainly due to the reduction and pachymetric progression induced by the corneal molding secondary to OK treatment.

Measurements of anterior segment parameters using three different non-contact optical devices in keratoconus patients

AIM:To evaluate the measurements of anterior segment parameters using three different non-contact optical devices in keratoconus patients.·METHODS:A hundred and one eyes of 55 keratoconus patients were enrolled in this study.The mean age was26.2 ±8.9 years.The inclusion criteria were keratoconus stage I to III according to the Amsler-Krumeich keratoconus classification.All the measurements were done by the same operator,under the mesopic light condition and repeated with three different optical methods;Visante,Orbscan and Pentacam.The evaluated anterior segment parameters were anterior chamber depth(ACD),central and thinnest corneal thickness(CCT and TCT) and pupil diameter(PD).·RESULTS:The mean CCT measured by Visante,Orbscan and Pentacam were as follows:462.0 ±48.1μm,463.9±60.9μm,476.5±45.3μm,respectively(P =0.873).The mean ACD values were 3.34±0.33mm,3.26±0.33mm,3.49±0.40mm,respectively(P=0.118).The mean PD measurements were 5.11 ±1.14mm,4.80 ±0.85mm,3.80 ±1.38mm,respectively(P 【0.001).The mean TCT measurements of Visante,Orbscan and Pentacam were 437.9 ±48.2μm,447.6±60.6μm and 459.9±44.0μm,respectively(P =0.214).The Visante and Orbscan measured CCT similarly,while Pentacam measured CCT thicker than the other two.The Visante measured TCT thinner than the other two devices.In ACD measurements,Orbscan was the one giving the lowest values.PD was measured differently by the devices.·CONCLUSION:Although TCT,CCT and ACD measurements acquired by Visante,Orbscan and Pentacam in keratoconus patients are similar,PDmeasurements show large differences among the devices.

Rebound Tonometry in Cataract Surgery: Comparison with Goldmann Applanation Tonometry

Purpose: to compare the rebound tonometer ICare? (RT) with the Goldmann applanation tonometer (GAT) in cataract surgery and to assess the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements. Design: retrospective, comparative study. Methods: a total of 472 patients underwent IOP measurement using RT (time 0 = RTa). GAT IOP measurement was performed 5 minutes later, followed by a second RT IOP measurement after other 5 minutes (RTa + 10 min = RTb). CCT was obtained by ultrasound pachymetry. In 106 patients IOP was measured by means of RT and GAT before clear corneal cataract surgery (RT1 and GAT1) and at one day postoperatively (RT2 and GAT2). Results: RT IOP values > 5 mmHg were overestimated, while RT IOP values Conclusion: our results showed a good agreement between measurements obtained with RT and GAT in pre and postoperative cataract surgery, although a significant statistically difference was found between RT and GAT measurements performed postoperatively. Moreover, CCT is a parameter to be considered for the IOP measurement, especially for values obtained with RT.

Scanning-slit topography in patients with keratoconus

AIM： To evaluate the anterior and posterior corneal surfaces using scanning-slit topography and to determine the diagnostic ability of the measured corneal parameters in keratoconus.METHODS： Orbscan II measurements were taken in 39 keratoconic corneas previously diagnosed by corneal topography and in 39 healthy eyes. The central minimum, maximum, and astigmatic simulated keratometry（K） and anterior axial power values were determined. Spherical and cylindrical mean power diopters were obtained at the central and at the steepest point of the cornea both on anterior and on posterior mean power maps. Pachymetry evaluations were taken at the center and paracentrally in the 3 mm zone from the center at a location of every 45 degrees. Receiver operating characteristic（ROC） analysis was used to determine the best cut-off values and to evaluate the utility of the measured parameters in identifying patients with keratoconus.RESULTS： The minimum, maximum and astigmatic simulated K readings were 44.80±3.06 D, 47.17±3.67 D and 2.42±1.84 D respectively in keratoconus patients and these values differed significantly（P〈0.0001 for all comparisons） from healthy subjects. For all pachymetry measurements and for anterior and posterior mean power values significant differences were found between the two groups. Moreover, anterior central cylindrical power had the best discrimination ability（area under the ROC curve=0.948）.CONCLUSION： The results suggest that scanning-slit topography and pachymetry are accurate methods both for keratoconus screening and for confirmation of the diagnosis.

Anterior Segment Optical Coherence Tomography Indices and Their Value in Diagnosing Corneal Ectasia

Purpose: To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. Material and Methods: Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. Results: There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. Conclusion: The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.

Determination of Central Corneal Thickness in Patients with Refractive Anomalies and Emmetropy

Aim: The purpose of this study was to compare measurements of CCT in emmetropia and patient with refractive anomalies. Methods: We represent a retrospective research which was conducted at the University Clinical Center of Kosovo (UCCK). In this study were included 80 patients, divided into two groups: test and a control group. Mean age was (M = 25.90, DS = 7.16), men (N = 41% or 51.3%) and women (N = 39% or 48%). Results: Results show that there were no differences in the CCT, Hyperopic (M = 545.21 DS = 52.24), Myopic (M = 547.90 DS = 47.93) and Emmetropic (M = 550.75 DS = 41.29). After measuring of the longitudinal axis and analyzing the data by means of Anova test, it appeared to be a significant difference between the analyzed groups, Hyperopic (M = 21.99, DS = 1.27), Myopics (M = 23.21, DS = 1.24), Emmetropic (M = 22.36, DS = 0.81). Results also revealed that there is correlation between the CCT and IOP, where increase CCT decreases IOP and vice versa (r = -0.26, p = 0.01). Conclusion: The results have shown that CCT is thinner in myopic but does not show correlation with hypermetropic and emmetropic. While during the measurement of central corneal thickness and eye tension it is found that there is a negative correlation between them. Keratometry has a negative correlation with CCT. While there was no correlation between CCT and age. Given the role of CCT in interpreting IOP values, it is recommended to perform a systematic CCT measurement in routine clinical practice, which would assist in the diagnosis of ocular hypertension.