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Carolyn Y. Shih, MD; Joshua S. Graff Zivin, PhD; Stephen L. Trokel, MD; James C. Tsai, MD

Arch Ophthalmol. 2004;122:1270-1275.

Objective  To evaluate the effect of central corneal thickness determination on the clinical management of patients with glaucoma and glaucoma suspect.

Methods  A cross-sectional retrospective study was performed on 188 consecutive patients. Mean ultrasound pachymetry measurements of central corneal thickness and corresponding Goldmann applanation tonometry measurements were obtained. Intraocular pressures (IOPs) were corrected using linear and mathematical (Orssengo-Pye) algorithms. Measurement-significant outcomes were defined as an IOP adjustment of 1.5 mm Hg or greater and outcomes-significant results as an IOP adjustment of 3.0 mm Hg or greater. Changes in therapy such as the use of eyedrops and addition or cancellation of laser therapy or surgery were then noted for those individuals with measurement- or outcomes-significant changes.

Results  Using the linear correction scale, 105 (55.9%) of 188 patients had at least a measurement-significant adjustment in their IOP measurements: 67 (35.6%) had adjustments between 1.5 and 3.0 mm Hg, while 38 (20.2%) had an outcomes-significant IOP adjustment (3.0 mm Hg). Among the 188 patients, 16 (8.5%) had a change in eyedrop therapy, 4 (2.1%) had a change regarding laser therapy, and 6 (3.2%) had a change in the decision regarding glaucoma surgery. Using the exponential correction (Orssengo-Pye) scale, similar percentages were obtained.

Conclusion  Pachymetry-measured central corneal thickness has a significant effect on the clinical management of patients with glaucoma and glaucoma suspect.

From the Edward S. Harkness Eye Institute, Department of Ophthalmology, College of Physicians and Surgeons (Drs Shih, Trokel, and Tsai), and Department of Health Policy and Management, Mailman School of Public Health (Dr Graff Zivin), Columbia University, New York, NY. The authors have no relevant financial interest in this article.

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