골드만안압계와의 안압 비교를 통한 토노아이안압계의 임상적 유용성 확인
Reliability of the Non-contact TONO-i Tonometer Compared with the Goldmann Applanation Tonometer
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목적: 안압 자가측정을 목적으로 한 새로운 비접촉식 휴대형 안압계 토노아이(TONOI)와 골드만압평안압계(GAT)로 측정된 안압을 비교하여 토노아이안압계의 임상적 유용성에 대해 평가하고자 하였다. 대상과 방법: 정상안 35안, 녹내장 환자(원발개방각녹내장, 정상안압녹내장) 42안이 포함되었다. 모든 환자에서 토노아이안압계와 골드만압평안압계를 이용하여 안압을 측정하였다. 두 가지 안압계의 안압 측정값의 평균 차이를 비교하기 위해 paired t-test를 시행하였고, 두 가지 안압계로 측정한 안압의 일치도를 비교하기 위해 two-way random effects model을 사용하였으며, 두 안압계 측정값의차이의 양상을 구체적으로 평가하기 위해 Bland-Altman 분석 및 단순선형회귀접근법을 사용하였다. 결과: 토노아이안압계로 측정한 평균 안압은 15.9 ± 3.3 mmHg, 골드만압평안압계 평균 안압은 16.4 ± 5.1 mmHg였다. Paired t-test 결과 녹내장 환자군에서는 토노아이안압계 평균 측정값(16.7 ± 4.1)이 골드만압평안압계 평균 측정값(17.9 ± 6.1)보다 낮은 경향(p<0.001)을 보였다. 정상 대조군에서는 유의한 차이를 보이지 않았다(p=0.273). Two-way random effects model로 분석한 결과 급내상관계수(interclass correlation coefficients, 95% confidence interval)는 전체 환자군에서 0.847 (0.702-0.920), 정상 대조군에서0.882 (0.804-0.941), 녹내장 환자군에서 0.828 (0.742-0.887)로 높은 일치도를 보였다. Bland-Altman 분석에서 두 가지 안압계 측정값의 전체적인 평균 차이값은 통계적 유의성이 없었으나, 골드만압평안압계 안압 측정값이 상승할수록 두 안압계 측정값 차이의절대값이 커지는 경향을 보였다. 결론: 토노아이안압계는 골드만압평안압계와 비교 시 유의한 일치도를 보인다. 토노아이안압계는 고안압에서 안압이 다소 낮게 측정될 수 있음에 주의하면서 사용할 경우, 자가측정을 통해 안압상승 여부를 선별하는 목적으로 유용하게 사용될 수 있을 것으로 보인다.
Abstract
Purpose: The accuracy and agreement of intraocular pressure (IOP) measurements using a noncontact self-measuring tonometer, TONO-i, compared with the Goldmann applanation tonometer (GAT). Methods: A total of 35 healthy participants and 42 primary open angle or normal tension glaucoma patients were enrolled in this study. TONO-i and GAT measurements were obtained and the mean difference in IOPs was analyzed using a paired t-test. IOP agreement was calculated using the two-way random effects model. Bland-Altman analysis and simple linear regression were used to estimate the disagreement between IOP measurements. Results: The mean IOPs measured using the TONO-i and GAT were 15.9 ± 3.3 mmHg and 16.4 ± 5.1 mmHg, respectively. In glaucoma patients, the mean values measured using the TONO-i (16.7 ± 4.1 mmHg) were lower than those measured using the GAT (17.9 ± 6.1 mmHg; p < 0.001). However, there was no significant difference among the healthy participants (p = 0.273). The intraclass coefficients (95% confidence interval) for all participants, normal participants, and glaucoma patients were 0.847 (0.702-0.920), 0.882 (0.804-0.941), and 0.828 (0.742-0.887), respectively, indicating good agreement between the IOP measurements. The mean difference and limits of agreement were not statistically significant. As IOP increased, the absolute difference between the GAT and TONO-i measurements also increased. Conclusions: The TONO-i, a novel tonometer, may be used reliably for IOP self-measurement and detecting IOP elevations. However, caution must be exercised because of the possibility of underestimating high IOPs.
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