Comparison of Tono-Pen and Goldmann applanation tonometers for measurement of intraocular pressure in healthy children

Academic Article


  • Purpose: To assess the agreement of intraocular pressure (IOP) measured with the Tono-Pen and the Goldmann applanation tonometer (GAT) in normal children and adolescents. Methods: A total of 439 subjects from birth to <18 years of age without anterior segment anomalies or glaucoma had their IOP measured with the two instruments by separate, masked examiners in the office or under general anesthesia. Results: On average, the Tono-Pen measured values slightly lower than the GAT for IOP <11 mm Hg and slightly higher than the GAT for IOP >11 mm Hg in the office setting. Using the average of GAT and Tono-Pen IOPs to estimate the true IOP, the average difference (GAT − Tono-Pen) was 0.4 mm Hg at IOP of 10 mm Hg and −3.0 mm Hg at IOP of 20 mm Hg. The 95% limits of agreement on the average difference between instruments were ±6.4 mm Hg in the office setting and ±6.8 mm Hg under general anesthesia. Larger differences between instruments were found with younger age. Standard error of measurement with the Tono-Pen was 1.44 mm Hg and 1.82 mm Hg for the office and anesthesia settings, respectively. Thicker corneas were associated with higher IOP with both the GAT and the Tono-Pen. Conclusions: In normal children, average differences between IOP measured by Tono-Pen and GAT were small, although there was substantial test–retest variability. Younger age was associated with larger average differences, as was higher IOP in the office setting.
  • Digital Object Identifier (doi)

    Pubmed Id

  • 16731450
  • Author List

  • Bradfield YS; Kaminski BM; Repka MX; Melia M
  • Start Page

  • 242
  • End Page

  • 248
  • Volume

  • 16
  • Issue

  • 3