Aktueller Stellenwert der Druckmessung: Messverfahren und Fehlerquellen

Zusammenfassung

Die Tonometrie ist für die Glaukomdiagnostik nach wie vor ein unverzichtbarer Bestandteil. Funktionelle und morphologische Untersuchungen können sehr detailliert über das Ausmaß einer glaukomatösen Schädigung Auskunft geben. Ihre Stärken liegen in der Früherkennung eines Glaukomschadens und bei manifesten Schäden in der Abschätzung der Progressionsrate durch Verlaufsuntersuchungen. Im Gegensatz dazu sind die Tonometrieverfahren weitaus unperfekter, weniger sensitiv, und sie geben keinerlei Auskunft über das Ausmaß eines Glaukomschadens. Aber: Sie liefern oft den ersten Hinweis darauf, dass überhaupt ein Glaukom vorliegen könnte, und sie sind der entscheidende Parameter, wenn es darum geht, die Dosierung einer operativen oder medikamentösen drucksenkenden Therapie zu kontrollieren, weil die Senkung des intraokularen Druckes (IOD) trotz des Wissens um zahlreiche weitere Glaukomrisikofaktoren immer noch der verbreitetste Therapieansatz ist. Dass die IOD-Senkung bei vielen Glaukomformen eine wirksame Therapie darstellt, muss an dieser Stelle nicht hinterfragt werden und wurde in zahlreichen großen epidemiologischen Studien belegt. Die Tonometrieverfahren haben sich in den letzten Jahren weiter verfeinert. Neben der weit verbreiteten Goldmann-Applanationstonometrie (GAT) und der Luftstoßtonometrie gibt es einige Anwendungsbereiche, für die sich auch die seltener verwendeten Tonometrieverfahren empfehlen. Darüber hinaus gibt es Ansätze für quasikontinuierliche Druckmessungen, welche die derzeit gängige Praxis der punktuellen IOD-Bestimmung in Zukunft überholen könnten. Es gibt eine Vielzahl von Fallstricken in der klinischen Praxis, die bei den Tonometrieverfahren zu Fehlinterpretationen und zu therapeutischen Fehlentscheidungen führen können, sodass es weiterhin wichtig erscheint, immer wieder darauf hinzuweisen.

Abstract

Tonometry is still an essential component of diagnostic testing in glaucoma. Functional and morphological investigations can provide very detailed information about the extent of glaucomatous damage. They are useful in the early detection of glaucoma damage; when damage is manifest, they are useful in estimating the rate of progression in follow-up studies. In contrast, tonometric procedures are much less perfect and sensitive and provide no information at all about the extent of glaucoma damage. However, they often provide the first evidence that glaucoma may be present at all and they are the decisive parameter in controlling surgical or medical treatment to reduce pressure, as the reduction in intraocular pressure (IOD) is still the most common approach in treating glaucoma – in spite of our awareness of numerous other risk factors for glaucoma. There is no reason to doubt that reducing IOD is an effective therapy in many forms of glaucoma, as this has been demonstrated in numerous large epidemiological studies. Tonometric procedures have become more precise in recent years. Goldmann applanation tonometry (GAT) and pneumatonometry are widely used. There are also some areas for which the rarer forms of tonometry can be recommended. Procedures for quasi-continuous pressure measurements and, in the future, these may replace the current approach of measuring IOD at discrete time points. There are a variety of snares in clinical practice, which may lead to misinterpretation and wrong therapeutic decisions, so that these must be repeatedly emphasised.

Schlüsselwörter

Glaukom - Tonometrie - Methoden - kontinuierliche Druckmessung - Fehler

Key words

glaucoma - tonometry - methods - continuous pressure measurement - errors

• Literatur

• 1 Goldmann H, Schmidt T. Über Applanationstonometrie. Ophthalmologica 1957; 134: 221-242
• 2 Kotecha A, White E, Schlottmann PG et al. Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers. Ophthalmology 2010; 117: 730-737
• 3 Bechrakis E. Über den spontanen Druckabfall bei Applanationstonometrie. Ophthalmologica 1966; 151: 604-614
• 4 Read SA, Collins MJ, Becker H et al. Changes in intraocular pressure and ocular pulse amplitude with accommodation. Br J Ophthalmol 2010; 94: 332-335
• 5 Kubota T, Nagata T, Tawara A et al. Influence of IOP measurement through the wrong eyepiece of the slit lamp on Goldmann applanation tonometry. Eur J Ophthalmol 2008; 18: 910-914
• 6 Ritch R, Reyes A. ‘Moustache glaucoma’. Arch Ophthalmol 1988; 106: 1503
• 7 Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol 1993; 38: 1-30
• 8 Arend N, Hirneiss C, Kernt M. Unterschiede in den Messergebnissen nach Goldmann-Applanationstonometrie mit und ohne Fluoreszein. Ophthalmologe 2014; 111: 241-246
• 9 Rüfer F. Fehlerquellen bei der Goldmann-Applanationstonometrie. Ophthalmologe 2011; 108: 546-552
• 10 Mark HH, Mark TL. Corneal astigmatism in applanation tonometry. Eye (Lond) 2003; 17: 617-618
• 11 Hoffmann PC, Hutz WW. Analysis of biometry and prevalence data for corneal astigmatism in 23,239 eyes. J Cataract Refract Surg 2010; 36: 1479-1485
• 12 Holladay JT, Allison ME, Prager TC. Goldmann applanation tonometry in patients with regular corneal astigmatism. Am J Ophthalmol 1983; 96: 90-93
• 13 Ehlers N, Bramsen T, Sperling S. Applanation tonometry and central corneal thickness. Acta Ophthalmol (Copenh) 1975; 53: 34-43
• 14 Whitacre MM, Stein RA, Hassanein K. The effect of corneal thickness on applanation tonometry. Am J Ophthalmol 1993; 115: 592-596
• 15 Orssengo GJ, Pye DC. Determination of the true intraocular pressure and modulus of elasticity of the human cornea in vivo. Bull Math Biol 1999; 61: 551-572
• 16 Doughty MJ, Zaman ML. Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol 2000; 44: 367-408
• 17 Kohlhaas M, Boehm AG, Spoerl E et al. Effect of central corneal thickness, corneal curvature, and axial length on applanation tonometry. Arch Ophthalmol 2006; 124: 471-476
• 18 Brandt JD, Gordon MO, Gao F et al. Adjusting intraocular pressure for central corneal thickness does not improve prediction models for primary open-angle glaucoma. Ophthalmology 2012; 119: 437-442
• 19 Aristeidou AP, Labiris G, Katsanos A et al. Comparison between Pascal dynamic contour tonometer and Goldmann applanation tonometer after different types of refractive surgery. Graefes Arch Clin Exp Ophthalmol 2010; 249: 767-773
• 20 Siganos DS, Papastergiou GI, Moedas C. Assessment of the Pascal dynamic contour tonometer in monitoring intraocular pressure in unoperated eyes and eyes after LASIK. J Cataract Refract Surg 2004; 30: 746-751
• 21 Bayer A, Sahin A, Hürmeriç V et al. Intraocular pressure values obtained by ocular response analyzer, dynamic contour tonometry, and goldmann tonometry in keratokonic corneas. J Glaucoma 2010; 19: 540-545
• 22 Turner MJ, Graham SL, Avolio AP et al. Potential effects of systematic errors in intraocular pressure measurements on screening for ocular hypertension. Eye (Lond) 2013; 27: 502-506
• 23 Sandhu SS, Chattopadhyay S, Birch MK et al. Frequency of Goldmann applanation tonometer calibration error checks. J Glaucoma 2005; 14: 215-218
• 24 Wessels IF, Oh Y. Tonometer utilization, accuracy, and calibration under field conditions. Arch Ophthalmol 1990; 108: 1709-1712
• 25 Choudhari NS, Jadhav V, George R et al. Variability in the calibration error of the Goldmann applanation tonometer. J Glaucoma 2011; 20: 492-496
• 26 Farrell SM, Dooley I, OʼConnell E et al. Comparing the Tonojet disposable tonometer with the traditional Goldmann tonometer in glaucomatous and non-glaucomatous eyes. Int Ophthalmol 2013; 33: 367-374
• 27 Osborne SF, Williams R, Batterbury M et al. Does the surface property of a disposable applanation tonometer account for its underestimation of intraocular pressure when compared with the Goldmann tonometer?. Graefes Arch Clin Exp Ophthalmol 2007; 245: 555-559
• 28 Hallberg P, Eklund A, Backlund T et al. Clinical evaluation of applanation resonance tonometry: a comparison with Goldmann applanation tonometry. J Glaucoma 2007; 16: 88-93
• 29 Ottobelli L, Fogagnolo P, Frezzotti P et al. Repeatability and reproducibility of applanation resonance tonometry: a cross-sectional study. BMC Ophthalmol 2015; 15: 36
• 30 Salvetat ML, Zeppieri M, Tosoni C et al. Repeatability and accuracy of applanation resonance tonometry in healthy subjects and patients with glaucoma. Acta Ophthalmol 2014; 92: e66-e73
• 31 Arora R, Bellamy H, Austin M. Applanation tonometry: a comparison of the Perkins handheld and Goldmann slit lamp-mounted methods. Clin Ophthalmol 2014; 8: 605-610
• 32 Barkana Y. Postural change in intraocular pressure: a comparison of measurement with a Goldmann tonometer, Tonopen XL, pneumatonometer, and HA-2. J Glaucoma 2014; 23: e23-e28
• 33 Salvetat ML, Zeppieri M, Tosoni C et al. Comparisons between Pascal dynamic contour tonometry, the TonoPen, and Goldmann applanation tonometry in patients with glaucoma. Acta Ophthalmol Scand 2007; 85: 272-279
• 34 Nakakura S, Mori E, Yamamoto M et al. Intraocular pressure of supine patients using four portable tonometers. Optom Vis Sci 2013; 90: 700-706
• 35 Waisbourd M, Shemesh G, Top LB et al. Comparison of the transpalpebral tonometer TGDc-01 with Goldmann applanation tonometry. Eur J Ophthalmol 2010; 20: 902-906
• 36 Li Y, Shi J, Duan X et al. Transpalpebral measurement of intraocular pressure using the Diaton tonometer versus standard Goldmann applanation tonometry. Graefes Arch Clin Exp Ophthalmol 2010; 248: 1765-1770
• 37 Munkwitz S, Elkarmouty A, Hoffmann EM et al. Comparison of the iCare rebound tonometer and the Goldmann applanation tonometer over a wide IOP range. Graefes Arch Clin Exp Ophthalmol 2008; 246: 875-879
• 38 Scuderi GL, Cascone NC, Regine F et al. Validity and limits of the rebound tonometer (ICare(R)): clinical study. Eur J Ophthalmol 2011; 21: 251-257
• 39 Marini M, Da PS, Accardo A et al. Comparing applanation tonometry and rebound tonometry in glaucomatous and ocular hypertensive eyes. Eur J Ophthalmol 2011; 21: 258-263
• 40 Kim KN, Jeoung JW, Park KH et al. Comparison of the new rebound tonometer with Goldmann applanation tonometer in a clinical setting. Acta Ophthalmol 2013; 91: e392-e396
• 41 Ozcura F, Yildirim N, Sahin A et al. Comparison of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in normal and glaucomatous eyes. Int J Ophthalmol 2015; 8: 299-304
• 42 Rosentreter A, Athanasopoulos A, Schild AM et al. Rebound, applanation, and dynamic contour tonometry in pathologic corneas. Cornea 2013; 32: 313-318
• 43 Leydhecker W, Akiyama K, Neumann HG. Der intraokulare Druck gesunder menschlicher Augen. Klin Monatsbl Augenheilkd Augenarztl Fortbild 1958; 133: 662-670
• 44 Dietlein TS, Jacobi PC, Krieglstein GK. Klinische Diskrepanz zwischen Schiötz- und Perkins-Tonometrie beim kindlichen Glaukom. Klin Monatsbl Augenheilkd 1996; 209: 299-303
• 45 Yilmaz I, Altan C, Aygit ED et al. Comparison of three methods of tonometry in normal subjects: Goldmann applanation tonometer, non-contact airpuff tonometer, and Tono-Pen XL. Clin Ophthalmol 2014; 8: 1069-1074
• 46 Hong J, Xu J, Wei A et al. A new tonometer–the Corvis ST tonometer: clinical comparison with noncontact and Goldmann applanation tonometers. Invest Ophthalmol Vis Sci 2013; 54: 659-665
• 47 Salvetat ML, Zeppieri M, Tosoni C et al. Corneal deformation parameters provided by the Corvis-ST pachy-tonometer in healthy subjects and glaucoma patients. J Glaucoma 2015; 24: 568-574
• 48 Böhm AG, Weber A, Pillunat LE et al. Dynamic contour tonometry in comparison to intracameral IOP measurements. Invest Ophthalmol Vis Sci 2008; 49: 2472-2477
• 49 Unterlauft JD, Schädle N, Kasper K et al. Comparison of dynamic contour tonometry and Goldmann applanation tonometry in keratoconus. Cornea 2011; 30: 1078-1082
• 50 Schneider E, Grehn F. Intraocular pressure measurement-comparison of dynamic contour tonometry and Goldmann applanation tonometry. J Glaucoma 2006; 15: 2-6
• 51 Lam AK, Tse JS. Dynamic contour tonometry over silicone hydrogel contact lens. J Optom 2014; 7: 91-99
• 52 Barkana Y, Gutfreund S. Measurement of the difference in intraocular pressure between the sitting and lying body positions in healthy subjects: direct comparison of the Icare Pro with the Goldmann applanation tonometer, Pneumatonometer and Tonopen XL. Clin Experiment Ophthalmol 2014; 42: 608-614
• 53 Agnifili L, Mastropasqua R, Frezzotti P et al. Circadian intraocular pressure patterns in healthy subjects, primary open angle and normal tension glaucoma patients with a contact lens sensor. Acta Ophthalmol 2015; 93: e14-e21
• 54 Koutsonas A, Walter P, Roessler G et al. Implantation of a novel telemetric intraocular pressure sensor in patients with glaucoma (ARGOS study): 1-year results. Invest Ophthalmol Vis Sci 2015; 56: 1063-1069