The effect of corneal edema on dynamic contour and Goldmann Tonometry

Purpose. To determine the effect of contact lens-induced corneal edema on measurements of intraocular pressure (IOP) using the Pascal dynamic contour tonometer (DCT), compared with the Goldmann tonometer. Methods. Thirty young healthy subjects (23.0 ± 3.0 years) were recruited from the student population at the University of New South Wales. Thick hydroxyethyl methacrylate contact lenses were worn monocularly for 2 hours under closed-eye conditions to induce corneal edema via hypoxia. IOP (Goldmann and Pascal DCT), ocular pulse amplitude (OPA), and central corneal thickness (CCT) were measured in both eyes before and after lens wear. Paired t-tests, Pearson correlation, and Bland-Altman plots were used to identify changes in, and relationships between, these parameters resulting from corneal edema. Results. Lens wear resulted in statistically significant changes in CCT (+48.3 ± 14.4 μm, p < 0.001), Goldmann IOP (+1.5 ± 2.8 mm Hg, p = 0.007), and Pascal DCT IOP (-0.7 ± 1.1 mm Hg, p = 0.001) but not OPA (0.0 ± 0.3 mm Hg, p = 0.721, two-tailed paired t-test). The Pascal DCT provided IOP readings that were 1.3 ± 2.0 mm Hg higher than the Goldmann IOP readings when hydration was normal, but the Goldmann tonometer provided readings that were 0.8 ± 2.5 mm Hg higher than the Pascal DCT readings when the cornea was edematous. The variation between the two instruments was weakly correlated to the change in CCT (r = -0.261, p = 0.044). Conclusions. Contact lens-induced corneal edema caused a small underestimation error in IOP measurements by the Pascal DCT, and an overestimation error in Goldmann tonometry measurements. The OPA measurement provided by the Pascal DCT is insensitive to corneal edema-induced changes in corneal properties