Prospektive Reproduzierbarkeitsstudie zur Inter- und Intraobserver-Reliabilität der Rebound-Tonometrie an augengesunden Probanden

 

 Buy Article Permissions and Reprints

Zusammenfassung

Fragestellung: Um die Intra- und Interobserver-Reliabilität der iCare®-Rebound-Tonometrie bewerten zu können, wurde an augengesunden Probanden eine prospektive Reproduzierbarkeitsstudie implementiert. Material und Methoden: An je 1 Auge von 20 augengesunden Probanden wurden von 3 unabhängigen Untersucherinnen jeweils 3 aufeinanderfolgende Messungen mittels iCare®PRO vorgenommen. Zwei der Untersucherinnen waren ärztlich approbiert mit mehrjähriger Erfahrung in der Augenheilkunde, die 3. mehrjährig erfahren als Studienassistentin in der Augenheilkunde. Pro Untersucherin wurden deren 3 Messwiederholungen gemittelt und mittels eines Friedman-Tests zum Niveau 5 % gegenübergestellt als Maß der Interobserver-Reliabilität der iCare®-Rebound-Tonometrie. Abschließend wurde deren totale Reliabilität mittels Varianzkomponentenzerlegung bestimmt in einem Wertebereich von 0–100 % (100 % = maximale Reproduzierbarkeit von Einzelmessungen ohne Wirksamkeit von Inter- oder Intraobserver-Effekten). Ergebnisse: Die gemittelten Messergebnisse der Untersucherinnen ergaben sich zu im Median 15,9 mmHg (Quartilspanne 15,1–17,5 mmHg) resp. 15,1 mmHg (14,3–15,6 mmHg) für die beiden augenärztlichen Untersucherinnen sowie zu 16,8 mmHg (14,2–18,9 mmHg) für die Studienassistentin. In den gemittelten Messergebnissen der 3 Untersucherinnen zeigte sich ein signifikanter Interobserver-Effekt (Friedman p = 0,006); die Varianzkomponentenzerlegung ergab eine Reliabilität der iCare®-Rebound-Tonometrie von 35 % (95 %-Konfidenzintervall 26–44 %). Schlussfolgerung: Die Ergebnisse der iCare®-Rebound-Tonometrie zeigten in dieser Untersuchung eine signifikante Befunderabhängigkeit; konkret zeigten sich tendenziell reduzierte Messergebnisse für die in Reihenfolge zuletzt durchgeführten Messungen, ferner für die Studienassistentin eine merklich erhöhte Streuung in deren Messreihen. Die Reproduzierbarkeit der iCare®-Rebound-Tonometrie im klinischen Alltag ist damit zumindest bei Delegierung an unerfahrenes Personal zu diskutieren.

Abstract

Purpose: A prospective reliability trial was implemented to estimate the inter- and intraobserver reproducibility of iCare® rebound tonometry in healthy proband eyes. Material and Methods: Three independent observers performed three replicate measurements, respectively, by means of the iCare®PRO rebound tonometry device in 20 eyes of 20 healthy probands. Two of these observers were medical doctors with an at least two years experience in ophthalmological patient care, the third observer was a study nurse with several years practice in applying ophthalmological diagnostic procedures. Each observerʼs replicate measurements were averaged and then compared by means of a global Friedman test for interobserver bias in the parallel rebound tonometry measurements at the 5 % significance level. In addition, variance component analysis was performed on the overall repeated measurement design to estimate the iCare® reliability coefficient [%] (100 % indicating total reproducibility in absence of any inter or intra observer bias). Results: The respective observersʼ median average measurements were 15.9 mmHg (interquartile range 15.1 to 17.5 mmHg) and 15.1 mmHg (14.3 to 15.6 mmHg) for the medical doctors, furthermore 16.8 mmHg (14.2 to 18.9 mmHg) for the study nurse; the averaged measurement series showed a significant interobserver bias (Friedman p = 0.006). Variance component analysis revealed an overall iCare® reliability of 35 % (95 % confidence interval 26 to 44 %). Conclusion: In this repeated measurement design iCare® rebound tonometry measurements showed significant interobserver bias and thereby notably reduced overall reliability. In particular, the intraindividual measurement profiles showed a gradient towards smaller values during the 9 replicatesʼ series; furthermore the study nursesʼ measurements showed notably increased variability. As a consequence the routine use of iCare® rebound tonometry must be critically discussed at least when being delegated to less experienced staff.

• Literatur

• 1 Brusini P, Salvetat ML, Zeppieri M et al. Comparison of ICare tonometer with Goldmann applanation tonometer in glaucoma patients. J Glaucoma 2006; 15: 213-217
  CrossrefPubMedGoogle Scholar
• 2 Cook JA, Botello AP, Elders A et al. Systematic review of the agreement of tonometers with Goldmann applanation tonometry. Ophthalmology 2012; 119: 1552-1557
  CrossrefPubMedGoogle Scholar
• 3 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: 392-396
  CrossrefPubMedGoogle Scholar
• 4 Jablonski KS, Jeoung JW, Park KH et al. Clinical use of a new position-independent rebound tonometer. J Glaucoma 2013; 22: 763-767
  CrossrefPubMedGoogle Scholar
• 5 Krummenauer F, Förster G. The reliability analysis of nuclear imaging data. Med Inform Biom Epidemol 1999; 2: 60-71
  PubMedGoogle Scholar
• 6 Salim S, Du H, Wan J. Comparison of intraocular pressure measurements and assessment of intraobserver and interobserver reproducibility with the portable iCare rebound tonometer and Goldmann applanation tonometer in glaucoma patients. J Glaucoma 2013; 22: 325-329
  CrossrefPubMedGoogle Scholar
• 7 Schweier C, Hanson JV, Funk J et al. Repeatability of intraocular pressure measurements with Icare PRO rebound, Tono-Pen AVIA, and Goldmann tonometers in sitting and reclining positions. BMC Ophthalmol 2013; 13: e44
  CrossrefPubMedGoogle Scholar
• 8 Yamashita T, Miki A, Ieki Y et al. Central and peripheral intraocular pressure measured by a rebound tonometer. Clin Ophthalmol 2011; 5: 1113-1118
  PubMedGoogle Scholar
• 9 Martinez-de-la-Casa JM, Jimenez-Santos M, Saenz-Frances F et al. Performance of the rebound, noncontact and Goldmann applanation tonometers in routine clinical practice. Acta Ophthalmol 2011; 89: 676-680
  CrossrefPubMedGoogle Scholar
• 10 Moreno-Montañés J, Martinez-de-la-Casa JM, Sabater AL et al. Clinical evaluation of the new rebound tonometers iCare PRO and iCare ONE compared with the Goldmann tonometer. J Glaucoma 2014; [Epub ahead of print]
  PubMedGoogle Scholar
• 11 Sahin A, Niyaz L, Yildirim N. Comparison of the rebound tonometer with the Goldmann applanation tonometer in glaucoma patients. Clin Exp Ophthalmol 2007; 35: 335-339
  CrossrefPubMedGoogle Scholar
• 12 Sakata R, Numaga J. The utility of rebound tonometer in late elderly subjects. Clin Interv Aging 2014; 9: 227-232
  PubMedGoogle Scholar
• 13 Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A et al. Reproducibility and clinical evaluation of rebound tonometry. Invest Ophthalmol Vis Sci 2005; 46: 4578-4580
  CrossrefPubMedGoogle Scholar
• 14 Avitabile T, Longo A, Rocca D et al. The influence of refractive errors on IOP measurement by rebound tonometry (ICare) and Goldmann applanation tonometry. Graefes Arch Clin Exp Ophthalmol 2010; 248: 585-591
  CrossrefPubMedGoogle Scholar