title: Systematic review of the agreement of tonometers with Goldmann applanation tonometry.
abstract: OBJECTIVE
  To assess the agreement of tonometers available for clinical practice with the Goldmann applanation tonometer (GAT), the most commonly accepted reference device.
  
  
  METHODS
  A systematic review and meta-analysis of directly comparative studies assessing the agreement of 1 or more tonometers with the reference tonometer (GAT).
  
  
  METHODS
  A total of 11 582 participants (15 525 eyes) were included.
  
  
  METHODS
  Summary 95% limits of agreement (LoA) were produced for each comparison.
  
  
  METHODS
  Agreement, recordability, and reliability.
  
  
  RESULTS
  A total of 102 studies, including 130 paired comparisons, were included, representing 8 tonometers: dynamic contour tonometer, noncontact tonometer (NCT), ocular response analyzer, Ocuton S, handheld applanation tonometer (HAT), rebound tonometer, transpalpebral tonometer, and Tono-Pen. The agreement (95% limits) seemed to vary across tonometers: 0.2 mmHg (-3.8 to 4.3 mmHg) for the NCT to 2.7 mmHg (-4.1 to 9.6 mmHg) for the Ocuton S. The estimated proportion within 2 mmHg of the GAT ranged from 33% (Ocuton S) to 66% and 59% (NCT and HAT, respectively). Substantial inter- and intraobserver variability were observed for all tonometers.
  
  
  CONCLUSIONS
  The NCT and HAT seem to achieve a measurement closest to the GAT. However, there was substantial variability in measurements both within and between studies.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK. j.a.cook@abdn.ac.uk
authors.forename: Jonathan Alistair
authors.initials: JA
authors.lastname: Cook
authors.forename: Adriana Paola
authors.initials: AP
authors.lastname: Botello
authors.forename: Andrew
authors.initials: A
authors.lastname: Elders
authors.forename: Alia
authors.initials: A
authors.lastname: Fathi Ali
authors.forename: Augusto
authors.initials: A
authors.lastname: Azuara-Blanco
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fraser
authors.forename: Kirsty
authors.initials: K
authors.lastname: McCormack
authors.forename: Jennifer
authors.initials: J
authors.lastname: Margaret Burr
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular / Q000295:instrumentation*