diaton tonometer clinical trials guide.pdf

7/23/2019 Diaton Tonometer Clinical Trials Guide.pdf

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Diaton Tonometer Clinical Trials Guide:

A summary of 15 Clinical Comparison Trials Related to Diaton Transpalpebral

& Transscleral Tonometer vs Goldmann, Tonopen, Non-contact, Ocular

Response Analyzer, Perkins and Pascal Dynamic Contour Tonometers in

Normal, Glaucoma, Keratoconus, post LASIK and post KPro Type 1 subjects +

Reviews, Testimonials, Manuals & User Guides, Videos: Comparison of Intraocular Pressure before and after Laser In Situ Keratomileusis

Refractive Surgery Measured with Perkins Tonometry, Noncontact Tonometry, and

Transpalpebral Tonometry. J Ophthalmol. 2015;2015:683895. doi: 10.1155/2015/683895.Epub 2015 Jun 8.

http://www.ncbi.nlm.nih.gov/pubmed/26167293

Diaton Tonometer use in Boston KPro Type 1. Clinical Study from University of Illinois

at Chicago:Agreement among Transpalpebral,Transcleral and Tactile IntraocularPressure Measurements in Eyes with Type 1 Boston Keratoprosthesis

Diaton tonometer in Keratoconus study:Tonometric Values of Intraocular Pressure,Using the Goldmann Tonometer, Tonopen and Diaton Transpalpebral Tonometer in

Keratoconus

Clinical Comparison of 3 tonometers:Comparative Agreement Among Three Methods ofTonometry: Goldmann Applanation, Transpalpebral and Dynamic Contour

Diaton tonometer use post LASIK:Diaton tonometer for intraocular pressure

measurements after laser in situ keratomileusis

Additional trials/articles can be found here:http://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diato

n_Tonometer_Goldmann_Tonopen_Applanation_Tonometers

Instructions Videos and step-by-step Easy to follow picture guides + Quick User Guide+

Training videos can be found here:https://tonometry.wordpress.com/2015/05/19/diaton-
http://www.ncbi.nlm.nih.gov/pubmed/26167293http://www.ncbi.nlm.nih.gov/pubmed/26167293http://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diaton_Tonometer_Goldmann_Tonopen_Applanation_Tonometershttp://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diaton_Tonometer_Goldmann_Tonopen_Applanation_Tonometershttp://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diaton_Tonometer_Goldmann_Tonopen_Applanation_Tonometershttps://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/http://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diaton_Tonometer_Goldmann_Tonopen_Applanation_Tonometershttp://www.tonometerdiaton.com/index.php?do=home.Comparison_clinical_trials_Diaton_Tonometer_Goldmann_Tonopen_Applanation_Tonometershttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Diaton_tonometer_for_intraocular_pressure_measurements_after_laser_in_situ_keratomileusishttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://tonometerdiaton.com/index.php?do=home.viewNews&item=AGREEMENT_TONOMETRY_GOLDMANN_APPLANATION_TRANSPALPEBRAL_DYNAMIC_CONTOUR%20_tonometershttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Transpalpebral_Transcleral_Tactile_Intraocular_Pressure_Measurements_in_Eyes_with_Type_1_Boston_Keratoprosthesishttp://www.ncbi.nlm.nih.gov/pubmed/26167293


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tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/

The following video would give you a great overview to see how quick and easy the test

really is:https://www.youtube.com/watch?v=Mfu2leF4UYw

Testimonial: Review of Advantages and Benefits of DIATON Tonometer by Dr

Mark Latina and Dr Emil Chynn

http://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton

_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefits

Comparison of Intraocular Pressure before and after Laser In Situ

Keratomileusis Refractive Surgery Measured with Perkins Tonometry,
https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://www.youtube.com/watch?v=Mfu2leF4UYwhttps://www.youtube.com/watch?v=Mfu2leF4UYwhttps://www.youtube.com/watch?v=Mfu2leF4UYwhttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefitshttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefitshttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefitshttps://youtu.be/RHDWhBTRwiAhttps://www.youtube.com/watch?v=Mfu2leF4UYw&feature=youtu.behttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefitshttp://www.tonometerdiaton.com/index.php?do=home.viewNews&item=Review_Diaton_Tonometer_by_Dr_Mark_Latina_Dr_Emil_Chynn_Advantages_Benefitshttps://www.youtube.com/watch?v=Mfu2leF4UYwhttps://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/https://tonometry.wordpress.com/2015/05/19/diaton-tonometer-manual-quick-user-guide-how-to-use-diaton-tonometer-user-videos-helpful-tips/


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Noncontact Tonometry, and Transpalpebral Tonometry.http://www.ncbi.nlm.nih.gov/pubmed/26167293

Cacho I1,Sanchez-Naves J

1,Batres L

2,Pintor J

3,Carracedo G

4.

Purpose.To compare the intraocular pressure (IOP) before and after Laser In Situ

Keratomileusis (LASIK), measured by Diaton, Perkins, and noncontact air pulse

tonometers. Methods. Fifty-seven patients with a mean age of 34.88 were scheduled for

myopia LASIK treatment. Spherical equivalent refraction (SER), corneal curvature (K),and central corneal thickness (CCT) and superior corneal thickness (SCT) were obtained

before and after LASIK surgery. IOP values before and after surgery were measuredusing Diaton, Perkins, and noncontact air pulse tonometers.

Results.The IOP values before and after LASIK surgery using Perkins tonometer and air

tonometers were statistically significant (p < 0.05). However, no significant differences

were found (p > 0.05) for IOP values measured with Diaton tonometer. CCT decreasessignificantly after surgery (p < 0.05) but no statistical differences were found in SCT (p =

0.08). Correlations between pre- and postsurgery were found for all tonometers used,

with p = 0.001 and r = 0.434 for the air pulse tonometer, p = 0.008 and r = 0.355 forPerkins, and p < 0.001 and r = 0.637 for Diaton.

Conclusion.Transpalpebral tonometry may be useful for measuring postsurgery IOP

after myopic LASIK ablation because this technique is not influenced by the treatment.

PMID: 26167293 [PubMed] PMCID: PMC4475733

Agreement among Transpalpebral,Transcleral and Tactile Intraocular

Pressure Measurements in Eyes with Type 1 Boston KeratoprosthesisJessica L.Liu,Thasarat S.Vajaranant,Maria S.Cortina,Jacob T.Wilensky. Glaucoma,

University of Illinois at Chicago, Chicago, IL

Purpose:The use of keratoprostheses (KPro) to restore vision in eyes with corneal

opacities has become increasingly popular in the last five years. Intraocular pressure(IOP) is a cardinal measurement employed in glaucoma management. This presents a

major problem since glaucoma remains a major visual limiting factor in eyes with KPro

and most forms of tonometry require an intact cornea. The purpose of this study is to

determine if transpalpebral IOP measurement can be an alternative method of measuringIOP and yield valuable data in eyes with KPro.

Methods:We retrospectively reviewed IOP measurements in patients who had receivedType 1 Boston KPro, and their IOP were estimated by three different methods during

routine visits to their cornea! surgeon. The surgeon estimated the IOP range tactilely by

palpation of the globe. A pneumatonometer (Model 30 Classic; Mentor, BioRad, SantaAna, California, USA) was used to measure IOP by placing the tonometer tip on the

sclera peripherally to the contact lens in the inferotemporal quadrant. The Diaton

tonometer (BiCOM, Inc., Long Beach, NY, USA) was used to obtain values through theupper lid in accordance with the instructions by the manufacturer. An average of two

Diaton IOP measurements was used in the analysis. Since the tactile IOP were recorded

as a range rather than a definite number, we computed the percent agreement, the

percentage of eyes in which pneumatometer or Diaton lOPs were within 2 mmHg of thetactile IOP range. Two-tailed t-test was used to compare the mean of pneumatonometer

and Diaton IOP measurements.

Results:The analysis included 23 eyes of 20 patients. The percentage agreement was

85% between tactile range and pnematonometer lOPs, and 95% between tactile range and

Diaton lOPs. Pneumatonometer consistently yielded higher IOP values, compared to
http://www.ncbi.nlm.nih.gov/pubmed/26167293http://www.ncbi.nlm.nih.gov/pubmed/26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Cacho%20I%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Cacho%20I%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Sanchez-Naves%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Sanchez-Naves%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Sanchez-Naves%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Batres%20L%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Batres%20L%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Batres%20L%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Pintor%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Pintor%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Pintor%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Carracedo%20G%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Carracedo%20G%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Carracedo%20G%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Carracedo%20G%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Pintor%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Batres%20L%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Sanchez-Naves%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/?term=Cacho%20I%5BAuthor%5D&cauthor=true&cauthor_uid=26167293http://www.ncbi.nlm.nih.gov/pubmed/26167293


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Diaton (p=0.04). The overall IOP mean SD was 17.2 6 mmHg for pneumatonometerand 13.8 5 mmHg for Diaton tonometer.

Conclusions:The presence of KPro did not appear to interfere with IOP with Diaton

tonometer, and Diaton tonometer yielded IOP readings that were similar to those

obtained by palpation. Scleral pneumotonometry yielded values that were consistentlyhigher than tactile estimates and Diaton IOP. In addition to routine IOP estimates by

palpation, transcleral and transpalpebral IOP measurements can be considered to monitor

patients with KPro.

Influence of Corneal Thickness on Tonometrical Values of IntraocularPressure,using the Goldmann tonometer and transpalpebral Diaton

tonometerFederal University of So Paulo Paulista School of Medicine Department of

Ophthalmology and Visual Sciences, Felipe Taveira Daher, MD, Augusto Paranhos

Junior,MD, PhD

Introduction:

The corneal thickness is one of the factors having influence on the tonometrical values.

Keratoconus usually evolutes with decrease of corneal thickness and, as a consequence,the tonometrical values may underestimate the real intraocular pressure.

The transpalpebral tonometer diaton surges as an equipment that may not be influencedby the corneal thickness and obtain tonometrical values closer to the real intraocular

pressure.

Purpose:

Compare intraocular pressure values acquired by three different tonometers

(Goldmann,Tonopen and transpalpebral diaton tonometer) in patients in two groups:control group and keratoconus patients. And evaluate the influence of corneal thickness

on each tonometer.

Material and methods:

Patients were divided into two groups: the control group, with patients withoutkeratoconus or corneal thinning, and the keratoconus group, with patient with

keratoconus or corneal thinning.

Patients were than submitted to an OCT pachymetry and the intraocular pressure weremeasured by three tonometers under the study (one measure with Goldmann tonometer

and Tonopen, three measures with transpalpebral tonometer). After that, ophthalmic

glycerol was applied on the corneal surface and the OCT pachymetry were repeated afterfive minutes. Finally, the intraocular pressure values were measured again, with the

Tonopen and transpalpebral tonometer, one and three retrospectively. There were

fourteen volunteers on the control group and twelve volunteers on the keratoconus group.

The concordance evaluation between the two groups was made using the Blant-Altman

graphic and the interclass correlation coefficient evaluation between three differenttonometers independently of the group was made.

Results:


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The interclass correlation coefficient was satisfactory for the three measures with thetranspalpebral tonometer (0.88- CI: 0.80 to 0.92), but not satisfactory among the three

tonometers (0.60 CI: 0.35 to 0.76).

The regression analysis of the differences shows a trend of the discordance on theextreme values of the Tonopen and the transpalpebral tonometer comparing to the

Goldmann tonometer. For the lowest intraocular pressures the transpalpebral tonometer

trends to measure the pressure higher and, for the highest pressures, the transpalpebral

tonometer trends to measure lower, which is the same for Tonopen, independently of thegroup, however the lower intraocular pressure were of the keratoconus group.

Conclusion:

The measures of the transpalpebral tonometer show satisfactory reproducibility and their

concordance with the Goldmann, mainly in the patients with keratoconus on which thepressure values were higher than the Goldmann, may trend to measure a value closer to

the real intraocular pressure, as the Goldmann tonometer underestimates the intraocular

pressure on patients with keratoconus.Tonometric Values of Intraocular Pressure, Using the Goldmann Tonometer, Tonopen

and Diaton Transpalpebral Tonometer in Keratoconus

Comparison of Accuracy of diaton Transpalpebral Tonometer Versus

Goldmann Applanation Tonometer,Dynamic Contour Tonometer and

Ocular Response AnalyzerHenry D Perry,MD,Valeriy Erichev,MD PhD; E.S. Avetisov MD;Alla Illarionova,MD,

Alexey Antonov MD

PURPOSE:To compare intraocular pressure measurements obtained with the diaton

transpalpebral tonometer with those from ocular response analyzer (ORA), dynamic(should be in same order as title)contour tonometry (DCT) and Goldmann applanation

tonometry (GAT) in patients diagnosed with primary open-angle glaucoma (POAG) and

glaucoma suspects, and to determine the effects of central corneal thickness (CCT) andcorneal hysteresis (CH) on intraocular pressure (IOP) measurements with these devices.

METHODS:40 patients (80 eyes) age 42-83 years with POAG and glaucoma suspectswere included in the study. The average of ORA (corneal compensated IOP [IOP-

ORAcc] and Goldmann-correlated IOP [IOP-ORAg]), DCT, GAT, and Diaton tonometer

levels were compared and the devices were examined with respect to CCT and CH.

Spearman's correlation tests were used for statistical analysis.

RESULTS:Mean CCT was 561,232,4mum and mean CH was 10.6+/-2.0 mmHg.

Mean IOP obtained using DCT was 18,94,1 mmHg, whereas those provided by ORAwere 18,23,4 mmHg for IOP-ORAcc and 18,43,5 mmHg for IOP-ORAg. The mean

IOP obtained using GAT and Diaton were 18,44,1 mmHg and 17,03,0 mmHg

respectively.The performed analysis of correlation between IOP meanings shows highconformity of results of Diaton with IOP-ORAcc and DCT. The differences between the

measurements of DCT, ORA and Diaton were statistically significant. Correlated rates

relations: between IOP-ORAcc and DCT 0,89; between IOP-ORAcc and Diaton 0,96;IOP-ORAcc and GAT 0,56; between GAT and Diaton 0,61; GAT and DCT 0,73; DCT

and Diaton 0,87.
http://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconushttp://tonometerdiaton.com/index.php?do=home.viewNews&item=Clinical_trial_tonometer_diaton_transpalpebral_keratoconus


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CONCLUSIONS:Transpalpebral Tonometry is an accurate method of IOPmeasurement that is also independent from the biomechanical characteristics of cornea. Itcan be recommended for IOP measurements of patients diagnosed with glaucoma

including those cases where cornea pathology or cornea characteristics have been altered.

COMPARATIVE AGREEMENT AMONG THREE METHODS OF

TONOMETRY: GOLDMANN APPLANATION, TRANSPALPEBRAL

AND DYNAMIC CONTOURLUIS A. ZARATE,Magdalena Garca-Huerta,Rafael Castaeda Diez,Mauricio

Turati,Felix Gil Carrasco,Jesus Jimenez-Roman,Jose A.Paczka.1GLAUCOMA,ASOCIACION PARA EVITAR LA CEGUERA EN

MEXICO,Mexico;2.Glaucoma;3.Asistencia e Investigacion en Glaucoma

Purpose:To investigate agreement of intraocular pressure (IOP) as measured by theGoldmann applanation tonometer (GAT), the Pascal dynamic contour tonometer (DCT),

and Diaton transpalpebral tonometer (DTT).

Methods:Device agreement was calculated by Bland-Altman analysis in 77 eyes of 40individuals (mean age 58.9 13 years) with a mixed diagnosis of glaucoma suspicion

and primary open-angle glaucoma. All measurements were performed in a random order

by the same clinician according to standard procedures.

Results:Mean IOPs S.D. were 14.4 2.9 mm Hg (GAT), 18.8 3.2 mm Hg (DCT; P

= 0.005, ANOVA), and 15.1 3.1 mm Hg (DTT). Bland-Altman analysis demonstratedthat, on average, DCT IOP measurements overestimated in approximately 3 mm Hg,

values derived from GAT and DTT, although agreement was fairly good.

Conclusions:All methods of tonometry were adequate to measure IOP in our sample.

Agreement among devices was considered good;nevertheless, DCT values of IOP were

significantly higher as compared to the other two assessed methods.

Clinical study of the influence of the anti-hypertensive drugs on the

intraocular pressure level with Non-Corneal Through-The-Eyelid

Diaton TonometerIllarionova A, Ivanov S, Savenkov M

Aim: To analyze the influence of the anti-hypertensive medicines on the intraocular

pressure (IOP) level in patients. Material and methods: 82 patients with arterial

hypertension of the 1-st and 2-nd degree with high cardiovascular risk, 10 patientsfrom this group had the Primary open-angle glaucoma. We used diuretics

(Hydrochlorothiazide 12,5-25 mg/day), calcium channel-blocking agents (Amlodipine

2,5-5 mg/day), beta-adrenergic blocking agents (Bisoprolol 2,5-5 mg/day), inhibitors of

angiotensin converting enzyme (iACE) (Enalaprilum 5-10 mg/day), nitrates (Isosorbidemononitrate 40-50 mg/day and Isosorbide dinitrate (1,25 mg/day). All the patients were

measured IOP with transpalpebral Diaton tonometer before taking the medications, 3 and24 h after taking the drugs and after 7-14 days. The IOP was measured initially during the

use of Isosorbide dinitrate as the spray (ISOKET) 30, 60 and 90 min after taking it.

Results:The reliable change of IOP wasnt detected in patients who were taking

diuretics, calcium channel inhibitors, iACE and B1-adrenergic blocking agents

neither during the acute pharmacological testing, nor during the intake of the anti-

hypertensive drugs. The IOP reduction was found during the intake of the B2-adrenergicblocking agents (mean initial IOP 19,21,3 mmHg, mean IOP after 7-14 days 16,31,4


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mmHg). The increase of IOP was observed during the intake of the nitrates (mean initialIOP 18,81,2 mmHg, mean IOP after 7-14 days 23,81,3 mmHg). According to theresults of the acute pharmacological testing the IOP increase was observed 40 min after

the intake of one dose (1,25 mg) of Isosorbide dinitrate and remained increased up to

1,5 hours on patients with POAG (mean initial IOP 22,71,8 mmHg, IOP after 40 min

26,11,9 mmHg, IOP after 90 min 25,81,9 mmHg).

Conclusions:

Portable, ergonomic ophthalmo-tonometer diaton suits perfectly in general medical

practice for IOP monitoring to make anti-hypertensive drugs treatment safe.

Transpalpebral tonometer application during intraocular pressure evaluation

in the patients with refraction anomaly before and after keratophotorefractivesurgery

by Prof. A.P. Nesterov, MD., T.B. Dzhafarli, MD., A.R.Illarionova, MD. Russian State Medical

University, Moscow.

Great success of the modern keratorefractive surgery, especially excimerlaser cornea

microsurgery (FR, LASIK, LASEK, Epi-LASIK) and its wide spread require high attention tothe eye morphophysiological rates in pre- and postoperational period. The most important rates

are still the characteristics of the cornea, such as thickness and its changes, regenerative response

of corneal tissue and its regulation, as well as the data of intraocular pressure (IOP) and theircorrelation with cornea metrical rates.

According to the data of numerous investigations, underestimation of IOP level duringapplanation tonometry in patients, which were subject to keratophotorefractive surgeries, is of

great importance in glaucoma diagnostic search. Hence, the advantages of scleral tonometry

application in this category of patients for ophthalmotone appropriate evaluation and timely

ophthalmohypertension detection are clear.

Purpose

The purpose of the study is to evaluate the clinical use of transpalpebral scleral tonometry,

reliability of its application in the patients with refraction anomaly in pre- and postoperational

period, dynamics of eye morphometric rates (pachymetry of the central corneal zone, IOP) andtheir correlative bond before and after photorefractive surgeries.

Methods

We have analyzed the results of prospective comparative case series clinical study in 98 patients

(194 eyes) with ametropia of various degrees, among which 59 persons (118 eyes) form the

group of patients, who have no keratophotorefractive surgeries in past history, and 39 patients(76 eyes), which were the subject to excimerlaser vision correction (Epi-LASIK, LASIK, FRK)

with various length of postoperational period from 7 days to 4 years.

The patients age distribution was from 18 to 53 years, the women make 61%, the men - 39%.

The following factors were exclusion criteria from the study:Cornea pathology, influencing prognosticly the applanation tonometry results;

Upper eyelid and sclera pathology, which are the contraindications for transpalpebral diaton-

tonometry.


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Before and after the surgery all patients were subject to the complete refractive examination,including keratotopography and wavefront-aberrometry (AMO, USA). In a number of patientsfor cornea state morphologic evaluation we conducted US-biomicroscopy of the corneal optical

zone before and in two months after laser correction (Picture 1).

Before and after surgery we trice measured pachymetry corneal thickness in central (4 points)zone - central corneal thickness (CCT) in each patient. We realized the study using two devices:

US-pachymeter UP 1000 by NIDEK (Japan) and -scan-pachymeter P55 by Paradigm (USA).

IOP was measured with Goldmann applanation tonometer (Rodenstok, Germany),

pneumotonometer (NIDEK, Japan) and transpalpebral scleral diaton tonometer (RSIME, Russia,picture 2) using traditional methodology (picture 3), all ophthalmotone measurements were

realized the patients being in the sitting position with time interval being 2-3 minutes betweentwo investigators.

The surgeries were carried out using excimer laser VISX Star S4 IR (AMO, USA),

microkeratome LSK Evolution II (Moria, France) and epikeratome Centurion SES (Norwood,Australia)

Statistical treatment of the received results was realized using common methods of medicalmathematical statistics. Statistic calculations were carried out using "Analysis Tools Pack".

Determination of differences reliability between the groups being compared in the presence ofnormal distribution in sampling of one-type factors was realized using two-sample t-tests.Correlation analysis by Pearson allowed detecting the character of correlations between

showings. Correlation with


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Correlation analysis of PCT and IOP results in the group of patients, examined both inpreoperational period and after photorefractive vision correction showed reliability of thiscorrelation, p2,

p


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Cornea, as thebasic optical lens of the eye, is the main element to be influenced during various, and first of alllaser, surgeries with refractive, reconstructive, optical and other purposes. Picture 2

Transpalpebral scleral diaton tonometer

Comparison of the Diaton Transpalpebral Tonometer VersusGoldmann Applanation

R. S. Davidson 1; N. Faberowski2 ; R. J. Noecker3 ; M. Y. Kahook1

1. Ophthalmology, Rocky Mountain Lions Eye Institute, Aurora, CO, USA.

2. Ophthalmology, Denver Health Medical Center, Denver, CO, USA.3. Ophthalmology, UPMC, Pittsburgh, PA, USA.

Financial Disclosure

The authors have no financial interest in the subject matter being presented

BackgroundDiaton tonometry is a unique approach to measuring intraocular pressure (IOP) throughthe Eyelid. It is a non-contact (no contact with cornea), pen like, hand-held, portable

tonometer. It requires no anesthesia or sterilization.

Purpose

To investigate the agreement in the measurement of intraocular pressure (IOP) obtained

by transpalpebral tonometry using the Diaton tonometer versus Goldmann applanation in

adult patients presenting for routine eye exams.


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MethodsRetrospective chart review of consecutive IOP measurements performed on 64 eyes of 32patients age 34-91 years with both the Diaton tonometer and Goldmann applanation.

Results between groups were examined using analysis of variance (ANOVA) where

appropriate.

Results

Mean IOP was 15.09 +/-4.31 mm Hg in the Goldmann group and 15.70 +/-4.33 mm Hg

in the Diaton group (p=0.43).

Mean IOP variation between groups was 1.74 +/-1.42 mm Hg (range 0-8). 83% of allmeasurements were within 2 mm Hg of each other.

Conclusions

The transpalpebral method of measuring IOP with the Diaton tonometer correlates well

with Goldmann applanation. Diaton applanation may be a clinically useful device for

measuring IOP in routine eye exams.http://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_

Goldmann

Comparison of the Diaton Transpalpebral Tonometer Versus Tono-Pen

Applanation

Theodore H. Curtis, M.D.1, Douglas L Mackenzie, M.D.

1, Robert J. Noecker M.D.

2, and

Malik Y. Kahook M.D.1

1The Rocky Mountain Lions Eye Institute, University of Colorado Health Sciences

Center, Aurora, CO2Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA

Financial Disclosures None of the authors have financial interests relevant to the supject discussed.

Purpose

To compare intraocular pressure (IOP) measurements obtained with Diaton trans-palpebral tonometry versus Tonopen applanation tonometry in children and adults.

Introduction

Goldmann applanation is the gold standard for IOP measurement

It has been supplanted by TonoPen applanation in many settings because of it's ease ofuse, portability, convenience, and minimal training requirements.

The TonoPen requires contact with the corneal surface, and has the risks of iatrogenic

corneal injury, spread of pathogens, and requires topical anesthetics.

Introduction

The newly-developed Diaton tonometer is a handheld device that measures pressurethrough the tarsal plate (Figures 1 & 2).

It avoids contact with the cornea and the need for topical anesthesia.

Figure 1: The Diaton Transpalpebral Tonometer

Figure 2: Using the Diaton Tonometer

Methods
http://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_Goldmannhttp://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_Goldmannhttp://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_Goldmannhttp://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_Goldmannhttp://tonometerdiaton.com/index.php?do=home.Comparison_Study_Diaton_Tonometer_Goldmann


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We looked at 74 eyes of 38 consecutive patients who received both Tonopen and Diatontonometry

TonoPen measurements were taken in the sitting position following topical anesthesia

with proparicaine.

Diaton measurements were performed in the sitting position with the patient gazing at a45

oangle, placing the eyelid margin at the superior limbus. If necessary, gentle traction

was placed on the brow to align the lid with the limbus. The device was activated when

the signaling mechanism indicated the device was vertical.

Results

Age range 3-91 years of age (mean 47.5 years).

The average IOP with the Diaton was 16.24 (+/-5.11 mm Hg; range = 7-32 mmHg).

The average IOP with the TonoPen was 16.37 (+/-4.90 mm Hg; range = 8-33 mmHg).

The mean variation between the two modalities was 1.59 mmHg (+/-1.31 mm Hg; range= 0-6 mmHg).

Eighty-one percent of all measurements were within 2 mmHg of each other (Table 1).

There was no statistically significant difference in mean IOP values obtained with thetwo devices (p=0.87). Table

Conclusions

The Diaton tonometer pressure measurements correlated well with TonoPen

measurements in this retrospective review.

We did not find problems performing the exam in children, and many were reassured bythe fact that no drops were needed.

There may be a notable benefit in patients after refractive surgery or with corneal

pathology since the Diaton does not applanate the cornea.

The Diaton tonometer appears to be a clinically useful device in the IOP measurementof both children and adults.

References

Li J, Herndon LW, Asrani SG, Stinnett S, Allingham RR. Clinical comparison of the

Proview eye pressure monitor with the goldmann applanation tonometer and the

TonoPen. Arch Opthalmol 2004;122:1117-21. Eisenberg DL, Sherman BG, McKeown CA, Schuman JS. Tonometry in adults and

children: a manometric evaluation of pneumotonometry, applanation, and TonoPen in

vitro and in vivo. Ophthalmology 1998;105:1173-81.

Diaton: digital portable tonometer of intraocular pressure through the eyelid. OperationManual. Ryazan State Instrument Making Enterprise. Ryazan, Russia.

Garcia Resua C, Giraldez Fernandez MJ, Cervino Exposito A, Gonzalez Perez J, Yebra-

Pimentel E. Clinical evaluation of the new TGDc-01 "PRA" palpebral tonometer:

comparison with contact and non-contact tonometry. Optom Vis Sci 2005;82:143-50. Troost A, Yun SH, Specht K, Krummenauer F, Schwenn. Transpalpebral tonometry:

reliability and comparison with Goldmann applanation tonometry and palpation inhealthy volunteers. Br J Ophthalmol 2005;89:280-3.

Losch A, Scheuerle A, Rupp V, Auffarth G, Becker M. Transpalpebral measurement of

intraocular pressure using the TGDc-01 tonometer versus standard Goldmannapplanation tonometry. Graefes Arch Clin Exp Opthhalmol. 2005;243:313-6.

Test report and a comparison of the pressure measurements of the digital portable

tonometer DIATON for the measurement of the intraocular pressure through the

eyelid


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Ina Conrad-Hegegerer MD., Mr. Fritz Hengerer MD.Eichenstrasse 3, 65468 Trebur, Germany

The measurements have been conducted in Germany, in our private doctor's office by

Mrs. Ina Conrad-Hegegerer MD. and Mr. Fritz Hengerer MD.The results have been obtained with the following methods:

1.Applanation tonometry by Goldmann(Splitlamp Haag Streit 900)

2.Digital portable Tonometer Diaton3.Non-Contact tonometry with Niedek Tonometer 1000

The purpose of the measurements is to evaluate the reliability of Diaton in the direct

comparison with the already established processes.

There were 2 groups of test persons: Healthy subjects and glaucoma patients. Exclusioncriteria were: Previous glaucoma patients, eyelid operations or inflammatory states of the

front eye section. Furthermore, patients were excluded where a Goldmann tonometry

could not be performed (Keratokonus, Epitheledema).

The static analysis contains:

a) Mean

b) Standard deviation

c) Median errord) Correlation coefficient (Pearson)

Table 1. shows the measurements on healthy patients, Table 2. on those with glaucoma.

The results of the statistical analysis are summarized in Table 3. and 4.

Summary:The analysis of the measurements confirms the validity of the measurements of the

digital portable Tonometer Diaton.

TRANSPALPEBRAL TONOMETER FOR INTRAOCULAR PRESSURE MEASURING

Eye diseases department of the Russian State Medical University medical faculty, Moscow,

Eye tonometry is one of the leading methods used in the patient with ophthalmopathology

checkup. The first tonometer acceptable for clinical practice was designed and described in 1884

by A.N.Maklakov [2]. The tonometers introduced earlier had serious drawbacks and were notused in clinical practice. Before this the intraocular pressure (IOP) was evaluated only

approximately with the help of eye palpation through the upper eyelid. At present palpation

method is still widely used in clinical practice. Using it a skilled ophthalmologist can evaluate

approximately whether ophthalmotone is normal (Tn), increased (T+1, T+2) or decreased (T-1, T-

2), distinguish normotension from hyper- or hypotension. The palpation method suffers from

subjectivism, uncertainty of results at ophthalmotone moderate change but at the same time it

shows the principle possibility of transpalpebral tonometry.

Intraocular pressure


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The eyeball is a reservoir of the spherical form, filled with fluid, incompressible contents. IOP is

caused by the influence of the elastic forces, arising in eye coverings while they are being

stretching.

IOP level is determined by watery moisture (WM) circulation in an eye and by pressure in

episclera veins [3]:

PO=F/C+Pv,

where PO IOP; F WM minute volume; C coefficient of easiness of WM flow-out from an

eye, Pv pressure in episclera veins.

IOP increases while moving from vertical to horizontal position and especially in Trendelenburg

position and while squeezing the necks veins because of the pressure increasing in episcleraveins (Pv) [4].

IOP is a dynamic, continuously changing value. They distinguish its system, rhythmic fluctuations

around relatively constant level and momentary changes of casual character. IOP fluctuations

around the level depend on changes in bloodfilling of intraocular vessels and on outer pressure

on the eyeball.

There are 3 types of rhythmic IOP fluctuations around the level [3]:

1.eye pulse (from 0,5 to 2,5 mm Hg),

2.respiratory waves ( from 0 to 1 mm Hg),

3.Hering-Traube waves (from 0 to 2,5 mm Hg).

The successive measurings of IOP in the same eye with a tonometer vary

from each other mainly due to the ophthalmotone rhythmic fluctuations.

Winking, pressing of the eye with orbicular muscle or external muscles of the eyeball

momentary increase IOP, provide eye massage and decrease venous congestion. At the same

time changes of orbicular and transpalpebral muscles tone during tonometry are often the

cause of error while measuring IOP level.

Statistically normal IOP varies from 9 to 21 mm Hg (on average 15-16 mm Hg). It has daily and

seasonal fluctuations. The IOP distribution in the normal population is asymmetrical (splayed to

the right). In middle age the distribution asymmetry increased. More than 3% of healthy persons

have IOP above 21 mm Hg [4]. The ophthalmotone measuring accuracy in the area of the normal

and reasonably increased (up to 30 mm Hg) IOP is especially important for a practical doctor.

Intraocular pressure regulation

Each eye is adjusted to a certain IOP level (balance pressure) which is supported by passive and

active mechanisms. IOP being increased pressure of moisture flow-out and filtration from an eye

increased, WM production being decreased its flow-out decreased and the balance pressure

restores.

Active mechanisms of IOP regulation have been not enough studied. Collaboration of

hypothalamus, adrenal glands, vegetative nervous system and local autoregulatory mechanisms

is possible.

Opthalmotonometry

The IOP measuring is based on the eyeball deformation under the influence of an outer effect.At that the values of deformation (S), the force (W) influencing the eye and IOP (Pt) as a first

approximation are connected with each other with the following dependence [5]: Pt = f(W/ S).

All tonometers fall into devices: 1) with constant and variable pressure force on the eye, 2) with

constant and variable value of eye deformation, 3) corneal, scleral and transpalpebral, (4)

applanation, impression and ballistic.

Ophthalmotonometers used in the Russian Federation

1.Maklakov tonometer and Filatov-Kalve elastotonometer.

2.Goldmann applanation tonometer (reference)


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3.Perkins and Dregger applanation tonometers

4.Grolman non-contact applanation tonometer, 1972

5.Schiotz impression tonometer

6.diaton transpalpebral tonometer

All the tonometers mentioned above (besides diaton) measure IOP through cornea.

Advantages and disadvantages of corneal tonometry

It is possible to note the following advantages of corneal tonometry: 1) it is more accessible fortonometry on an open eye then sclera; 2) between tonometer and eye cavity theres no other

structures interposition (conjunctiva, eyelid, ciliar body), but cornea; 3) corneas individual size,

thickness and crookedness are less different in comparison to other parts of eye fibrous

membrane.

At the same time corneal tonometry has serious drawbacks:

1.Cornea has high pain sensitivity and the tonometry is impossible without prior anesthesia,

which in some patients causes conjunctiva irritation, hypostasis of cornea epithelium, short-

term IOP increasing, and allergic conjunctivitis.

2.Cornea has regular spherical shape only in the central zone and flattens towards periphery; its

thickness increases from 0,5-0,6 mm in the center to 0,8 in the periphery. Besides, the existent

individual peculiarities both in corneas crookedness and thickness influence significantly on the

tonometry results [6, 12].

3.During the corneal tonometry it is very difficult to prevent the increasing of orbicular and

palpebral muscles tone, that leads to IOP increasing. The ophthalmotone increasing may be also

connected with the blood pressure increasing during the tonometers bringing near the open

eye [3].

4.It is known that a tear may contain bacteria and dangerous viruses (hepatitis B virus, herpes,

adenoviruses, AIDS). But the problem of tonometers sterilization is far from perfection [11].

5.The corneal tonometry is contraindicative in eyelids and cornea edema, nystagmus,

conjunctivitis, corneal erosions, keratitis, hypostasis and sores.

Diaton tonometer basic principles

Transpalpebral ophthalmic tonometer (diaton) was designed by a group of ophthalmologists

and engineers. There was the task to design portable and simple in use device, which couldprovide IOP measuring through the eyelid not only in ophthalmology studies but at home as

well. It should possess enough accuracy, quick operation and provide the possibility to carry out

ophthalmotone monitoring that is very important both for glaucoma diagnostics and for

controlling the effectiveness of treatment. Digital Portable Tonometer of Ocular Pressure

(diaton) designed by us fulfills all these tasks (fig.1).

Fig.1

The peculiarities of the new tonometer are that IOP measuring is realized through the eyelidthat excludes contact with conjuctiva and cornea and does not require anesthetics application.

At that the mechanical influence on the eye is realized through the eyelid on sclera. The

tonometeres position while measuring IOP is shown on fig.2.


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Fig.2

The measuring principal of the new tonometer is based on processing the rod movement

resulting from its free fall and interaction with the elastic surface of the eye to be measured.

The main problem was how to exclude the influence of an eyelid individual peculiarities on the

tonometry results. This was solved by pressing the eyelid on the area with the diameter of 1,5

mm to such extent that the pressed area of the lead acts like a rigid transfer link while the rod

interacts with the eye at the same time excluding the painful sensation. This method of

compensating the eyelid influence led to the choose of dynamic (ballistic) way of dosated

mechanical influence on the eye for evaluating its elastic peculiarities.

To determine the position in the process of its free fall from the constant height and the

interaction with eye through the eyelid the device has position sensor. Value of the points of the

rod movement function in time is remembered by the built-in processor. In diagram form the

function of the rod movement in time is shown in fig.3.

Fig.3 Function of the rod movement in time:

H change in the rod position during the free fall, t time after the fall starting, B minimum

point of the rod movement function.

For point B the following equation is true: P=F/S, where P IOP, F eye elasticity force,

influencing the rod, S the area of eye and rod interaction (area of its square). According to

Newtons second law: F=m*a, where m the rods weight, a the rods acceleration while

interacting with the eye elastic surface. Then P=m*a/S. The rods weight and the interacting


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area - S are constants So to evaluate P it is enough to measure the rod movement acceleration

(a) in point B.

Errors of IOP measuring

In clinical practice it is customary to evaluate errors of IOP measuring with the new tonometers

in comparison with the results received in the same eyes with Goldman tonometer (Reference

tonometer) and taking into consideration scatter of data received during repeated measurings

with the same tonometer [8].

Numerous studies carried out in hundreds of patients during several years show high reliabilityof IOP measurings with diaton tonometer. Scatter of results received using the new tonometer

and Goldman tonometer had no systematic character and did not exceed 4 mm Hg. In repeated

IOP measurings in healthy eyes the displays fluctuations were in the range 2-4 mm Hg [1].

According to the literature data the scatter of results while carrying out the repeated

measurings using Goldman tonometer is 2-3 mm Hg in healthy eyes [10]. While checking various

samples of Goldman tonometers produced in lots it is found the systematic difference of the

displays of 2-3 mm Hg depending on the variant of each devices double prism and spring

calibration. Eye refraction, astigmatism, corneas crookedness and thickness, width of the

moisture ring around the flattening area, hyper- or hypofluorescence of the ring [6, 7, 9]. As it

was mentioned above, the error of IOP level measuring depends on the character and value of

ophthalmotone rhythmic and casual fluctuations as well as on the tonometrists skill.

The experience of operating diaton and Goldman tonometers shows that their displays have

good correlation.

Diaton tonometer has accuracy enough for clinical purposes, requires no anesthetics and

sterilization. Besides, they are safe (can not damage the cornea), comfortable for the patients

and easy in use. They can be used not only in ophthalmology studies but at home as well.

LITERATURE

1. .., ..//..-2001-2.-.55-56

2...//..-1884.-.22-.1092-1095

3. .., .., .. :

.-.,1974

4. .. .-.,19955.Goldmann H., Schmidt T.//Opthalmologica.-1957-Bd 136.-S.221-231.

6.Mark H.H.//Am.J.Ophthalmol.-1973.-Vol.76-P.223-227

7..//Ibid.-1960.-Vol.49.-P.1149

8.Moses R.A., Liu C.H.// Ibid.-1968.-Vol.66.-P.89-94

9.Motolko M.A.//Can/J/Ophthalmol.-1982.-Vol.17.-P.93-97.

10.Phelps C.D.,Phelps G.K.//Graefes.Arch.Clin.Exp.Ophthalmol.-1976.-Vol.198.-P.39-44

11.Schottenstein M.H.//The Glaucomes/Eds R.Ritch et al.-St.Louis, 1996.-Vol.1.-P.407-428.

12.Whitacre M.M., Stein R.A., Hassanein K.//Am.J.Ophthalmol.-1993.-Vol.115.-P.592-597.

Donated DIATON Tonometer was used at Mother Theresas orphanage to

screen for Glaucoma in Tanzania a Thank You Letter +Photos are

Very Touching

A Very Touching Thank You Letter & Photos from a orphanage in Tanzania which received

Diaton tonometeras donation to screen people at Risk for Glaucoma to prevent Blindness:
http://www.tonometerdiaton.com/http://www.tonometerdiaton.com/http://www.tonometerdiaton.com/


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19/19

Thank you for your review of Diaton tonometer

clinical trials, reviews and testimonials.

For any additional information about Diaton

tonometer please visit :

http://www.TonometerDiaton.com

Or contact BiCOM Inc at

Phone: 1-877-DIATONS (877-342-8667)Email: [email protected]

Social Media - to connect with Diaton team please connect:https://plus.google.com/+TonometerDiatonPen/

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