Evaluation of the Perkins® handheld applanation tonometer in the measurement of intraocular pressure in dogs and cats

Objective  To evaluate and to validate the accuracy of the Perkins^® handheld applanation tonometer in the measurement of IOP in dogs and cats.
Animals  Twenty eyes from 10 dogs and 10 cats immediately after sacrifice were used for the postmortem study and 20 eyes from 10 clinically normal and anesthetized dogs and cats were used for the in vivo study. Both eyes of 20 conscious dogs and cats were also evaluated.
Procedure  Readings of IOP postmortem and in vivo were taken using manometry (measured with a mercury column manometer) and tonometry (measured with a Perkins^® handheld applanation tonometer). The IOP measurement with Perkins^® tonometer in anesthetized and conscious dogs and cats was accomplished by instillation of proxymetacaine 0.5% and of 1% fluorescein eye drops.
Results  The correlation coefficient ( r ²) between the manometry and the Perkins^® tonometer were 0.982 (dogs) and 0.988 (cats), and the corresponding linear regression equation were y  = 0.0893 x  + 0.1105 (dogs) and y  = 0.0899 x  + 0.1145 (cats) in the postmortem study. The mean IOP readings with the Perkins^® tonometer after calibration curve correction were 14.9 ± 1.6 mmHg (range 12.2–17.2 mmHg) in conscious dogs, and were 15.1 ± 1.7 mmHg (range 12.1–18.7 mmHg) in conscious cats.
Conclusion  There was an excellent correlation between the IOP values obtained from direct ocular manometry and the Perkins^® tonometer in dogs and cats. The Perkins^® handheld tonometer could be in the future a new alternative for the diagnosis of glaucoma in veterinary ophthalmology.     

Evaluation of a rebound tonometer (Tonovet®) in clinically normal cat eyes

Objective  To determine the accuracy of and to establish reference values for a rebound tonometer (Tonovet^®) in normal feline eyes, to compare it with an applanation tonometer (Tonopen Vet^®) and to evaluate the effect of topical anesthesia on rebound tonometry.
Procedures  Six enucleated eyes were used to compare both tonometers with direct manometry. Intraocular pressure (IOP) was measured in 100 cats to establish reference values for rebound tonometry. Of these, 22 cats were used to compare rebound tonometry with and without topical anesthesia and 33 cats to compare the rebound and applanation tonometers. All evaluated eyes were free of ocular disease.
Results  Both tonometers correlated well with direct manometry. The best agreement with the rebound tonometer was achieved between 25–50 mmHg. The applanation tonometer was accurate at pressures between 0 and 30 mmHg. The mean IOP in clinically normal cats was 20.74 mmHg with the rebound tonometer and 18.4 mmHg with the applanation tonometer. Topical anesthesia did not significantly affect rebound tonometry.
Conclusions  As the rebound tonometer correlated well with direct manometry in the clinically important pressure range and was well tolerated by cats, it appears suitable for glaucoma diagnosis. The mean IOP obtained with the rebound tonometer was 2–3 mmHg higher than that measured with the applanation tonometer. This difference is within clinically acceptable limits, but indicates that the same type of tonometer should be used in follow-up examinations in a given cat.     

Intraocular pressure in normal dairy cattle

Intraocular pressure (IOP) was measured in normal dairy cows by applanation tonometry. In the first study of 15 Holstein and 17 Jersey cows the mean IOP by Mackay-Marg tonometry was 27.5 ± 4.8 mmHg (range 16–39 mmHg); no significant differences ( P < 0.92) were observed between the Holstein and Jersey breeds. In the second study of 15 Holstein and 12 Jersey cows, the mean IOPs by Mackay-Marg and TonoPen-XL tonometry were 28.2 ± 4.6 mmHg (range 19–39 mmHg) and 26.9 ± 6.7 mmHg (range 16–42 mmHg), respectively. Comparisons of the Mackay-Marg and TonoPen tonometers indicated no significant differences ( P < 0.16). The mean and range of IOP in normal dairy cows within 2 SD (95% of the population) is 27 mmHg with a range of 16–36 mmHg.     

Accuracy and reproducibility of the TonoVet® rebound tonometer in birds of prey

Objective To examine the accuracy and reproducibility of intraocular pressure (IOP) measurements obtained by the TonoVet^® rebound tonometer. Animals studied Freshly enucleated healthy eyes of 44 free‐ranging birds of prey out of the species Haliaeetus albicilla, Accipiter gentilis, Accipiter nisus, Buteo buteo, Falco tinnunculus, Strix aluco, Asio otus and Tyto alba euthanized because of unrelated health problems. Procedures IOP readings from the TonoVet^® were compared with a manometric device, with IOP being set from 5 to 100 mmHg in steps of 5 mmHg by adjusting the height of a NaCl solution reservoir connected to the eye. Reproducibility of the TonoVet^® readings was determined by repeated measurements. Results TonoVet^® and manometer values showed a strong linear correlation. In the Accipitridae, the TonoVet^® tended to increasingly overestimate IOP with increasing pressure, while in the other families, it increasingly underestimated it. In the Sparrowhawk, the values almost represent the ideal line. Reproducibility of TonoVet^® values decreases with increasing pressure in the clinically important range from 5 to 60 mmHg. Conclusion IOP values measured with the TonoVet^® demonstrated species specific deviation from the manometric measurements. These differences should be considered when interpreting IOP values. Using the regression formulae presented, corrected IOP values could be calculated in a clinical setting.     

Effect of central corneal thickness on intraocular pressure with the rebound tonometer and the applanation tonometer in normal dogs

Objective To evaluate the effect of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) with the rebound (TonoVet^®) and applanation (TonoPen XL^®) tonometers in beagle dogs. Animal studied Both eyes of 60 clinically normal dogs were used. Procedures The IOP was measured by the TonoVet^®, followed by the TonoPen XL^® in half of the dogs, while the other half was measured in the reverse order. All CCT measurements were performed 10 min after the use of the second tonometer. Results The mean IOP value measured by the TonoVet^® (16.9 ± 3.7 mmHg) was significantly higher than the TonoPen XL^® (11.6 ± 2.7 mmHg; P < 0.001). The IOP values obtained by both tonometers were correlated in the regression analysis (γ² = 0.4393, P < 0.001). Bland–Altman analysis showed that the lower and upper limits of agreement between the two devices were ?0.1 and +10.8 mmHg, respectively. The mean CCT was 549.7 ± 51.0 μm. There was a correlation between the IOP values obtained by the two tonometers and CCT readings in the regression analysis (TonoVet^® : P = 0.002, TonoPen XL^® : P = 0.035). The regression equation demonstrated that for every 100 μm increase in CCT, there was an elevation of 1 and 2 mmHg in IOP measured by the TonoPen XL^® and TonoVet^®, respectively. Conclusions The IOP obtained by the TonoVet^® and TonoPen XL^® would be affected by variations in the CCT. Therefore, the CCT should be considered when interpreting IOP values measured by tonometers in dogs.     

Comparison of the TONOVET Plus®, TonoVet®, and Tono-Pen Vet™ tonometers in normal cats and cats with glaucoma

Objectives

To determine the accuracy, precision, and clinical applicability of the ICare® TONOVET Plus (TVP) in cats.

Animals and Procedures

IOP readings obtained with the TVP were compared to values obtained concurrently with the original TONOVET (TV01) and Tono-Pen Vet™ (TP) in 12 normal cats (24 eyes) and 8 glaucomatous LTBP2-mutant cats (13 eyes) in vivo. Reproducibility of TVP readings was also assessed for three observers in the above cats. The anterior chambers of five different normal cat eyes were cannulated ex vivo. IOP was measured with the TVP, TV01, and TP at manometric IOPs ranging from 5 to 70 mmHg. Data were analyzed by linear regression, ANOVA and Bland–Altman plots. ANOVA was used to assess reproducibility of TVP readings obtained by different observers and an ANCOVA model controlled for variation of individual cats. p < .05 was considered significant.

Results

TVP values strongly correlated with TV01 values (y = 1.045x + 1.443, R² = .9667). The TP significantly underestimated IOP relative to the TVP and TV01, particularly at high IOP. IOP values obtained by 1 observer were significantly higher (~1 mmHg average) compared to the other 2 observers via ANCOVA analysis (p = .0006479 and p = .0203). Relative to manometry, the TVP and TV01 were significantly more accurate (p < .0001) and precise (p < .0070) than the TP in ex vivo eyes.

Conclusions

IOP readings obtained with the TVP and TV01 are broadly interchangeable between models and between observers, but subtle differences may be important in a research context. TP readings vastly underestimate high IOP in feline glaucoma.     

Comparison of the rebound tonometer (TonoVet) with the applanation tonometer (TonoPen XL) in normal Eurasian Eagle owls (Bubo bubo)

OBJECTIVE: To examine the feasibility and accuracy of a handheld rebound tonometer, TonoVet, and to compare the intraocular pressure (IOP) readings of the TonoVet with those of an applanation tonometer, TonoPen XL, in normal Eurasian Eagle owls. ANIMALS STUDIED: Ten clinically normal Eurasian Eagle owls (20 eyes). PROCEDURES: Complete ocular examinations, using slit-lamp biomicroscopy and indirect ophthalmoscopy, were conducted on each raptor. The IOP was measured bilaterally using a rebound tonometer followed by a topical anesthetic agent after 1 min. The TonoPen XL tonometer was applied in both eyes 30 s following topical anesthesia. RESULTS: The mean +/- SD IOP obtained by rebound tonometer was 10.45 +/- 1.64 mmHg (range 7-14 mmHg), and by applanation tonometer was 9.35 +/- 1.81 mmHg (range 6-12 mmHg). There was a significant difference (P = 0.001) in the IOP obtained from both tonometers. The linear regression equation describing the relationship between both devices was y = 0.669x + 4.194 (x = TonoPen XL and y = TonoVet). The determination coefficient (r(2)) was r(2) = 0.550. CONCLUSIONS: The results suggest that readings from the rebound tonometer significantly overestimated those from the applanation tonometer and that the rebound tonometer was tolerated well because of the rapid and minimal stress-inducing method of tonometry in the Eurasian Eagle owls, even without topical anesthesia. Further studies comparing TonoVet with manometric measurements may be necessary to employ rebound tonometer for routine clinical use in Eurasian Eagle owls.     

Comparison of the rebound tonometer (ICare) to the applanation tonometer (Tonopen XL) in normotensive dogs

OBJECTIVE: To compare intraocular pressure (IOP) measurements obtained by recently introduced rebound tonometer (ICare) and the well-known applanation tonometer Tonopen XL in normal canine eyes. METHODS: In a prospective, randomized, single-center study, IOP measurements by ICare and Tonopen XL tonometers were compared in 160 nonpathologic canine eyes (80 dogs). Complete slit-lamp biomicroscopy and indirect ophthalmoscopy were performed on each dog. Rebound tonometry was performed first and immediately after topical anesthetic drops were instilled in both eyes. One minute after the application of the topical anesthetic, applanation tonometry was performed in both eyes. The intraocular pressures obtained by use of both techniques were compared by statistical analysis. RESULTS: The mean IOP readings were 9.158 mmHg (SD 3.471 mmHg) for the ICare tonometer (x) and 11.053 mmHg (SD 3.451 mmHg) for the Tonopen XL readings (y). The mean difference in intraocular pressures (-1.905 mmHg) was within clinically acceptable limits. The correlation coefficient (r2) of the relationship within both tonometers was r2=0.7477. The corresponding linear regression between the tonometers readings was y=0.6662x+4.942. CONCLUSIONS: Intraocular pressures obtained with the ICare rebound tonometer were concordant with the IOP readings obtained by applanation Tonopen XL, but ICare values were significantly (P<0.0001) lower. Rebound tonometry could be an appropriate tonometry method for routine clinical use after its calibration for canine eyes.     

Comparison of a rebound and an applanation tonometer for measuring intraocular pressure in normal rabbits

Objective To compare intraocular pressure (IOP) measurements made on healthy adult rabbits without the effect of tranquilizers using the new applanation tonometer, Tono‐Pen Avia^®, and the rebound tonometer Tonovet^®. Methods Intraocular pressure was measured throughout the day (6:00, 9:00, 12:00, 15:00, and 18:00 h) in 38 adult New Zealand White rabbits (76 eyes). The animals were 20 males and 18 females, with a mean weight of 3.5 kg and an average age of 6 months. A complete ocular exam (including Schirmer tear test, fluorescein staining, slit‐lamp biomicroscopy, and direct ophthalmoscopy) was performed on all animals at the beginning of the trial. Rebound tonometry was performed, and after 10 min, anesthetic drops were instilled and applanation tonometry was carried out. IOP values obtained using the two techniques were analyzed statistically. Results The mean IOP was 9.51 ± 2.62 mmHg with Tonovet^®, and 15.44 ± 2.16 mmHg with the Tono‐Pen Avia^®. Significant differences between measurements with the two tonometers were observed (P < 0.001). The linear regression equation describing the relationship between the two tonometers was y = 0.4923x + 10.754 (y = Tonovet^® and x = Tono‐Pen Avia^®). High IOPs were recorded in the early measurements (6:00), but the average IOPs from both devices were statistically similar throughout the day (P = 0.086). The correlation coefficient was r² = 0.357. No significant difference in IOP regarding gender was observed. Conclusion The Tono‐Pen Avia^® recorded higher levels of IOP compared with the Tonovet^®. Early in the day, the IOP of rabbits was higher than later in the day, regardless of the tonometer used.     

Validation of the TonoVet® rebound tonometer in normal and glaucomatous cats

Objective  To validate intraocular pressure (IOP) readings obtained in cats with the TonoVet^® tonometer. Animals studied  IOP readings obtained with the TonoVet^® were compared to IOP readings determined by manometry and by the Tono‐Pen XL^? in 1 normal cat and two glaucomatous cats. TonoVet^® and Tono‐Pen XL^? readings were also compared in a further six normal and nine glaucomatous cats. Procedures  The anterior chambers of both eyes of three anesthetized cats were cannulated and IOP was varied manometrically, first increasing from 5 to 70 mmHg in 5 mmHg increments, then decreasing from 70 to 10 mmHg in 10 mmHg decrements. At each point, two observers obtained three readings each from both eyes, with both the TonoVet^® and Tono‐Pen XL^?. IOP was measured weekly for 8 weeks with both tonometers in six normal and nine glaucomatous unsedated cats. Data were analyzed by linear regression. Comparisons between tonometers and observers were made by paired student t‐test. Results  The TonoVet^® was significantly more accurate than the Tono‐Pen XL^? (P = 0.001), correlating much more strongly with manometric IOP. In the clinical setting, the Tono‐Pen XL^? underestimated IOP when compared with the TonoVet^®. Conclusions  Both the TonoVet^® and Tono‐Pen XL^? provide reproducible IOP measurements in cats; however, the TonoVet^® provides readings much closer to the true IOP than the Tono‐Pen XL^?. The TonoVet^® is superior in accuracy to the Tono‐Pen XL^? for the detection of ocular hypertension and/or glaucoma in cats in a clinical setting.     

Distribution of intraocular pressure in dogs

Intraocular pressure (IOP) was measured by four different applanation tonometers in normal dogs. By MacKay-Marg tonometry in 391 dogs (772 eyes) the mean ± SD IOP was 18.8 ± 5.5 mmHg (range 8–52 mmHg). Using Tono-Pen XL tonometry in 421 dogs (823 eyes) the mean IOP was 19.2 ± 5.9 mmHg, and the range was 4.42 mmHg. With MMAC-II tonometry in 80 dogs (158 eyes), the mean IOP was 15.7 ± 2.8 mmHg with a range of 10–30 mmHg. By pneumatonograph tonometry in 135 dogs (255 eyes), the mean IOP was 22.9 ± 6.1 mmHg and the range was 10–47 mmHg. In this study 53 breeds were represented. Of those breeds with six animals or more, no significant differences were detected in IOP between breeds ( P > 0.353) or sex ( P > 0.270). There was a significant decline of 2–4 mmHg ( P > 0.0001) in IOP as age increased from less than 2 years to greater than 6 years of age. This trend was present with all of the four tonometers. There were no significant differences between the MacKay-Marg and TonoPen-XL tonometers ( P > 0.198), but significant differences with the MMAC-II ( P > 0.001) and pneumatonograph ( P > 0.001) tonometers existed compared to the first two instruments. Based on this study and the literature, the mean IOP for the normal dog is 19.0 mmHg with a range of 11 (5%) and 29 (95%) mmHg.     

Conjunctival bacterial and fungal flora in healthy horses in the UK

Objectives To describe the bacterial and fungal flora of the normal conjunctiva of horses in the UK; to determine the effect of horse age, sex, geographic location, and housing on this flora; and to determine the most appropriate antimicrobial drug(s) for prophylactic treatment of corneal ulcers. Animal studied A total of 60 adult healthy horses were studied. Procedure Swabs of the conjunctiva were obtained from 60 horses housed in two locations within the UK. Specimens were cultured for aerobic bacteria and fungi, and sensitivity against six ophthalmic antimicrobials assessed. The effect of age, sex, location and housing on the frequency of microbial isolation was evaluated. Results Fifty‐four bacterial isolates, representing thirteen genera of bacteria were cultured from 31 (52%) horses. The most frequently isolated bacterial species was Acinetobacter sp (17/32 horses). The majority of isolates (28/54: 52%) were gram‐positive. Three genera of fungi (Mucor, Absidia and Aspergillus spp) were isolated from eight (13%) horses. There was no significant effect of geographic location, sex, age or housing on frequency of microbial isolation. Horses from which gram‐negative bacteria were isolated were significantly older than horses from which gram‐positive bacteria were isolated. High efficacy (greater than 90% of isolates sensitive in vitro) was displayed by chloramphenicol, gentamicin and tetracycline. Conclusions The microbial species isolated are comparable with studies performed in other countries, although the frequency of Acinetobacter isolation was higher which may reflect a geographic difference. The topical antimicrobials gentamicin and chloramphenicol are appropriate first line antimicrobials for empirical treatment of corneal ulcers in the UK.