= 증례보고 = 비접촉안압계, 리바운드안압계, 토노펜, 골드만압평안압계의안압비교 대한안과학회지 214 년제 55 권제 1 호 J Korean Ophthalmol Soc 214;55(1):47-53 pissn: 378-6471 eissn: 292-9374 http://dx.doi.org/1.3341/jkos.214.55.1.47 이경식 김세경 김응권 김태임 연세대학교의과대학안과학교실및시기능개발연구소 목적 : 비접촉안압계, 리바운드안압계 (Icare R ), 토노펜 (TONO-PEN AVIA R ) 으로측정한안압을골드만압평안압계로측정한안압을기준으로비교하고임상적유용성을고찰한다. 대상과방법 : 정상안 71 안을대상으로비접촉안압계, 리바운드안압계, 토노펜, 골드만압평안압계로안압을측정하고안압계별측정값차이를비교하였다. 결과 : 리바운드안압이골드만안압과가장높은일치성을보였고 [ICC.811, 95%CI.712-.878], Bland-Altman plot 결과, 비접촉안압계에서평균차이값은가장적었으나 (+.2 mmhg) 신뢰구간은가장넓었고 (95%CI; ±5.5 mmhg), 리바운드안압계는평균차이값이다소적고 (-.7 mmhg) 변동폭이가장좁았다 (95%CI; ±3.75 mmhg). 결론 : 리바운드안압계로측정한안압은골드만압평안압계로측정한안압과우수한일치를보여골드만압평안압계로안압측정이어려운경우리바운드안압계가대체검사법이될수있을것으로기대된다. < 대한안과학회지 214;55(1):47-53> 안압측정은모든안과환자에게시행하는기본검사중하나로서, 일반인의녹내장위험성스크리닝, 녹내장환자의진단과치료효과판단및경과관찰에매우중요하다. 안압측정에서골드만압평안압계는현재까지가장표준이되는검사방법이다. 1 골드만압평안압계의정확성은각막두께와곡률과생체공학적 (biomechanical) 특성, 예를들어단단함 (rigidity), 점도 (viscosity), 탄성 (elasticity), 수화 (hydration) 에영향을받는다. 2-6 그런데이러한생체공학적인특성들은개개인마다변동성을갖고각막의병리학적특성과수술여부에따라영향을받는다. 3,4,7-9 뿐만아니라골드만압평안압계는점안마취제를이용한각막의마취가필요하고각막과접촉해야측정이가능한침습적인검사이며측정시간이오래걸리는단점이있다. 또한세극등현미경에장착되어있기때문에안과검사실에서만측정할수있어이동이힘든환자나소아의경우에는측정이용이하지않다. 그동안골드만압평안압계의이런단점을극복하고자여 Received: 213. 1. 26. Revised: 213. 8. 16. Accepted: 213. 12. 1. Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #5 Yonsei-ro, Seodaemun-gu, Seoul 12-752, Korea Tel: 82-2-2228-357, Fax: 82-2-312-541 E-mail: TIKIM@yuhs.ac 러가지대체안압계들이개발되었다. 그중하나인리바운드안압계 (Icare PRO; Icare Finland, Helsinki, Finland) 는유발과충돌 (inductive/impact) 의원리를이용하는최근에소개된안압계이다. 측정말단부가자성 ( 磁性 ) 을가진철선으로이루어진탐침과솔레노이드 (solenoid) 로구성되어있으며, 탐침의말단부는둥근플라스틱으로싸여있다. 솔레노이드내탐침의끝이초당약.2미터의속도로각막에충돌후제자리로돌아오면각막충돌시의탐침의감속시간 (deceleration time) 이안압으로변환된다. 1 안압이높을수록탐침이각막에충돌되는기간은짧고빠르게감속되며이원리를이용하여안압을계산하게된다. 11 리바운드안압계는각막난시나표면의요철 (irregularity) 에의한영향을적게받으며, 비교적적은숙련으로정확한안압을측정할수있는장점을가지고있다. 또한세극등을이용하지않아휴대가가능하고환자가누워있는자세에서도사용가능하며점안마취제를사용하지않고빠른시간내에안압을측정하면서골드만압평안압계와유사하게정확한안압측정이가능하다고보고되고있다. 1-14 다른안압계로서, 자동비접촉안압계는접촉의기회가없고점안마취가불필요하며측정이간편하다는장점이있지만안구박동이안압측정값변동의주요원인이될수있어반복측정한안압값의변동폭이 1-4 mmhg 가될수있다고되어있다. 15,16 또다른안압계로서, 토노펜역시측정이간편하고일회용라텍스덮개를사용하므로감염전파를막을수있는장점 www.ophthalmology.org 47
- 대한안과학회지 214 년제 55 권제 1 호 - 이있으나낮거나높은안압영역에서는정확성이떨어진다고되어있다. 17-2 저자들은본연구를통해임상에서흔히사용되고있는비접촉안압계와리바운드안압계, 토노펜으로측정한안압을골드만압평안압계로측정한안압과비교하여각안압계와골드만압평안압계와의일치성에대해알아보고, 임상적유용성에대해조사하고자하였다. 대상과방법 212년 1-12월본원을내원한환자중굴절교정수술과거력이있거나, 녹내장이외의다른안과적질환, 안구표면질환, 안내염증이나외상의병력이있거나, 콘택트렌즈를최근 2주이내착용한경우를제외한남녀 41명 ( 남자 19명, 여자 22명 ) 을대상으로전향적연구를시행하였다. 정상안 71안을대상으로비접촉안압계 (NT-53P, NIDEK, Aichi, Japan), 리바운드안압계 (Icare PRO; Icare Finland, Helsinki, Finland), 토노펜 (Tono-Pen AVIA, Reichert Inc., NY, USA), 골드만압평안압계 (AT 9, Haag-Streit, Bern, Switzerland) 순서로안압을측정하고각각의안압계에따른측정값을비교하였다. 모든대상군에게병력조사, 시력측정을한후비접촉안압계로양안안압을측정하고, 이후리바운드안압계를이용하여안압을측정하였으며, 그다음점안마취를하고토노펜으로안압을측정하고, 마지막으로골드만압평안압계로안압을측정하였다. 각기다른검사간에는최소 5분간의시간을두고측정하였다. 각안압계측정에서검사자의편견을막기위해비접촉안압계, 리바운드안압계, 토노펜, 골드만압평안압계각각의검사는모든대상자에대해한사람의검사자가한가지검사만하는방식으로측정되었다. 비접촉안압계는양안을 1번씩측정하였다. 측정과정에서기계상오류가표시되거나환자가눈을감아검사가안되는경우는제외되었다. 이과정에서 3안이제외되었다. 리바운드안압계는환자에게정면을주시하게한후, 숙련된검사자에의해두번측정하였다. 한번측정시마다 Icare R 리바운드안압계는탐침이 6회각막에충돌되며측정값중가장높은값과가장낮은값을뺀나머지의평균값이안압계화면에보여지게된다. 검사의신뢰성이 4가지형태 (P, P -, P- 또는 P _) 로안압측정치의앞에표시되는데, 뒤로갈수록신뢰도가떨어지는값이다. 환자가눈을감거나머리의위치가기울어져있는등측정이부정확하게된경우 P- 또는 P _ 로나타난다. 본연구에서는 P 또는 P - 만을측정치로이용하였으며, P- 또는 P _ 가나올경우에는 P 또는 P - 가나올때까지다시측정하였다. 이과정에서 P 또는 P - 가나오는데실패하여제외된안은없었다. 토노펜은.5% 염산프로파라카인과형광물질이혼합된용액을결막낭에점안하여점안마취후양안을 1회씩측정하였다. 골드만압평안압계는토노펜으로안압측정후 5분을기다렸다가추가적인.5% 염산프로파라카인점안없이숙련된검사자에의해서한번측정하였다. 환자개인특징의기술통계결과는연속형자료인경우평균 ± 표준편차로표기하였고, 범주형자료는빈도 (%) 로표기하였다. 비접촉안압계, 리바운드안압계, 토노펜으로측정한안압과골드만압평안압계로측정한안압 ( 이후각각을비접촉안압, 리바운드안압, 토노펜안압, 골드만안압으로부른다 ) 의일치성을 Intraclass Correlation Coefficient (ICC) 로확인하였고, 특히두번측정한리바운드안압은 ICC로두측정치사이의일관성을확인한후두측정치의평균값과골드만압평안압과의일치성을확인하였다. 첫번째리바운드안압과두번째리바운드안압의차이, 골드만안압과위에제안한여러안압계들의안압차이를 Bland-Altman plot으로시각화하였다. 그리고골드만안압을기준으로삼아각안압계안압의차이절대값을 <2., 2. to <4., 4. mmhg 3군으로나누어서각군별로안압계분포도를알아보았다. 검증력 8% 을목표로할경우필요한전체연구대상안수는 53안이었으며중도탈락률 2% 를고려할경우필요한연구대상안수는 66안이었다. 본연구에서는 41명의 74안을대상으로연구하였으며이중비접촉안압측정에서 3명의 3안이탈락하여최종적으로 38명의 71 안을대상으로연구를하였다. 본논문에사용된통계패키지는 SPSS version 2. (SPSS Inc, Chicago, IL, USA) 을이용하였다. Table 1. Demographic characteristics of study subjects (n = 71) Sex 결 전대상자들의평균나이는 59.41 ± 15.85 (25-89) 세였고, 남자 18명 (32안 ), 여자 2명 (39안 ) 이었다. 비접촉안압 과 Male 32 (45.1%) Female 39 (54.9%) Age 59.41 ± 15.85 NCT 13.44 ± 3.9 Icare 14.23 ± 2.86 Tono-Pen 15.65 ± 3.42 GAT 13.56 ± 3.33 Values are presented as mean ± SD. GAT = goldmann applanation tonometer; NCT = noncontact tonometer. 48 www.ophthalmology.org
- 이경식외 : 리바운드안압계 - 2. 8 Icare [1] - Icare [2] 1.5 1..5. -.5 1.21.8 6 4 2-2 5.2.2-1. -1.5-1.5 5 1 15 2 25 Average of IOP Figure 1. Bland-Altman plots of difference versus the mean plot illustrating the intersessional repeatability of IOP measurements with the Icare tonometer. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation. Table 2. Intraclass Correlation Coefficient (ICC) of IOP measurements using different tonometers comparing with GAT as standard ICC 95%CI NCT.679.53-.788 Icare.811.712-.878 Tono-Pen.749.625-.837 NCT = noncontact tonometer. 계로측정한안압 ( 비접촉안압 ) 은 13.44 ± 3.9 mmhg, 리바운드안압계로측정한안압 ( 리바운드안압 ) 은 14.23 ± 2.86 mmhg, 토노펜으로측정한안압 ( 토노펜안압 ) 은 15.65 ± 3.42 mmhg, 골드만압평안압계로측정한안압 ( 골드만안압 ) 은 13.56 ± 3.33 mmhg 였다 (Table 1). Icare로두번측정한리바운드안압값들을비교시, ICC.981, 95% 신뢰구간 (confidence interval; CI).969-.988 으로매우높은일치성을보였으며 Bland-Altman plot를시행한결과, 두번측정한리바운드안압간의평균차이값은.8 mmhg 였고, 변동폭 (95%CI) 은 ±1.13 mmhg 로아주우수하여이기계의반복성 (repeatability) 이좋음을확인할수있었다 (Fig. 1). 골드만안압을기준으로비접촉안압, 리바운드안압, 토노펜안압의일치성을확인해본결과, 리바운드안압 (ICC.811, 95%CI.712-.878) 이가장일치성이높았고다음으로토노펜안압 (ICC.749, 95%CI.625-.837), 비접촉안압 (ICC.679, 95%CI.53-.788) 순이었다 (Table 2). 골드만안압을기준으로, 비접촉안압, 리바운드안압, 토 -4-6 -4.9 5 1 15 2 25 Average of GAT and NCT Figure 2. Bland-Altman plots of agreement between Goldmann applanation tonometer and noncontact tonometer for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer valvue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation. 6 4 2-2 3.1 -.7-4 -4.4-6 5 1 15 2 25 Average of GAT and Icare Figure 3. Bland-Altman plots of agreement between Goldmann applanation tonometer and Icare for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer valvue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation. 노펜안압을비교하는 Bland-Altman plot를시행한결과, 비접촉안압은평균차이값이 +.2 mmhg 로골드만안압과가장근사한결과가나왔고, 리바운드안압은 -.7 mmhg의차이가있었으며, 토노펜은 -2. mmhg로가장차이가컸다. 또한각안압계의 95% 신뢰구간의폭을측정해본결과, 토노펜은 ±4.65 mmhg 였고, 리바운드안압은 www.ophthalmology.org 49
- 대한안과학회지 214 년제 55 권제 1 호 - 6 고 찰 4 2-2 -4-6 -8 2.6-2. -6.7 5 1 15 2 25 3 Average of GAT and Tono-Pen Figure 4. Bland-Altman plots of agreement between Goldmann applanation tonometer and Tono-Pen for normal eyes. The differences in IOP of both tonometers (Goldmann applanation tonometer value minus noncontact tonometer valvue, mm Hg) are plotted against the average of the IOP of both tonometers. The solid line represents the mean bias and the dashed lines represent ±1.96 SD confidence interval (CI) (i.e. 95% of the points should fall within these lines). SD = standard deviation. (%) 1 9 8 7 6 5 4 3 2 1 17.14 32.86 5. 9.59 27.4 63.1 28.77 41.1 3.14 NCT Icare Tonopen 4. 2. to <4. <2. Figure 5. Incidence of absolute value for IOP differences between noncontact tonometer, Tono-Pen, or Icare and Goldmann applanation tonometer (considered as a reference) measurements. ±3.75 mmhg 로가장좁았으며, 비접촉안압은 ±5.5 mmhg 로가장넓었다 (Figs. 2-4). 골드만안압을기준으로각안압계안압들의오차절대값을 <2., 2. to <4., 4. mmhg 3군으로나누어서분석한결과, 오차절대값 <2. mmhg 군이가장많았던안압는리바운드안압이었고, 다음이비접촉안압, 토노펜안압순이었다 ( 각각 63.1%, 5.%, 3.14%). 오차절대값 4. mmhg 군이가장많았던안압은토노펜안압이었고, 그다음은비접촉안압이었으며, 리바운드안압이가장적었다 ( 각각 28.77%, 17.14%, 9.59%)(Fig. 5). 본연구는정상안을대상으로순차적으로측정한비접촉안압, 토노펜안압, 리바운드안압을골드만안압을기준으로비교하여각각의일치성을평가하였다. 먼저, 본연구에서는 Icare를두번측정하여리바운드안압계의반복성이좋음을확인하였고, 2회측정값의평균값을타안압계안압과의비교에참여시키는방식으로연구를진행하였다. 리바운드안압계의반복성에대한이전연구에따르면골드만압평안압계보다는반복성이떨어지나다른상용화된안압계들보다는우수한것으로되어있다. 21 그연구에따르면골드만압평안압계의변동폭은 ±3.15 mmhg, 리바운드안압계의변동폭은 ±5.11 mmhg 였다. 21 본연구에서두번측정한리바운드안압을비교한결과, ICC.981, 95%CI.969-.988, Bland-Altman plot 상의평균차이값.8 mmhg, 변동폭 (95%CI) ±1.13 mmhg 였으며, 이전연구에서보다더우수한반복성을보여주었다. 본논문에서시행한정상안대상의분석에서, 비접촉안압, 리바운드안압, 토노펜안압중리바운드안압이골드만안압과가장우수한일치성을보였다 (ICC.811, 95%CI.712-.878)(Table 2). Bland-Altman plot 분석에서, 골드만안압과의평균차이값은비접촉안압이 +.2 mmhg 로가장근사하였으나 95% 신뢰구간은 ±5.5 mmhg 로가장넓었으며, 리바운드안압은평균차이값이 -.7 mmhg 로비접촉안압다음으로근사하였으나상당히우수한편이었고동시에 95% 신뢰구간은 ±3.75 mmhg 로세가지안압계중에서가장좁고우수함을알수있었다 (Figs. 2-4). 저자들은골드만안압과다른안압계를이용한안압의평균차이값에서 + 오차와 오차가서로상쇄되어통계적으로오차평균이 에가깝게나올수있는오류가능성을해결하기위해골드만안압을기준으로각안압계안압값들의오차절대값을 <2., 2.-<4., 4. mmhg 3군으로나누어서분석해보았다. 그결과 2. mmhg 미만으로오차가적은군이가장많았던안압계는리바운드안압계였다 (Fig. 5). 이전의연구를보아도리바운드안압은골드만안압과비교하여상관성이우수한것으로되어있다 (r=.89; p<.5). 21 한편본연구에서골드만안압과 4. mmhg 이상차이가나는군이가장많았던안압계는토노펜이었는데 28.77% 의환자에서 4. mmhg 이상의차이가나게측정되었다. Bandyopadhyay et al 22 은토노펜이골드만압평안압계와전반적으로는일치성이좋지만일부 (7.4%) 에서큰차이 (±5 mmhg) 가측정될수있으므로주의해야함을지적한바있다. 한편골드만압평안압계가반드시이상적인것만은아니 5 www.ophthalmology.org
- 이경식외 : 리바운드안압계 - 다. 골드만안압계가현재까지안압의표준측정법이고임상에서널리사용되고있기는하나, 23 이장비는 Goldmann and Schmidt 1 가 52 μm 평균중심각막두께 (mean central corneal thickness) 를기준으로보정하였기때문에각막의두께가이기준으로부터벗어나게되면측정의정확성에영향을받게되어있다. 5,24 각막난시도골드만압평안압계에서중요한오차유발요인이다. 이전의연구에따르면각막난시와골드만안압사이에.25 25 -.67 26 mmhg/diopter 정도의오차관계가있다고되어있다. 이런오차는난시축에수평과수직방향으로골드만압평안압계로안압을측정하여두값의평균값을구함으로써피할수있으나, 27 난시형태가불규칙하거나각막의모양이나두께가바뀌는조건에서는골드만압평안압계값이부정확하거나측정이아예불가하기도하다. 한편자동비접촉안압계는 Imbert-Fick 법칙을이용한것으로, 각막중심에공기분사시반사되는빛이최대가되는시점을압평안압으로기록하는방식이다. 각막의기계적영향을적게받고감염의기회가골드만압평안압계보다적으며, 점안마취가불필요하고측정시간이짧고간편하다는장점이있다. 하지만심장주기의 1/5에해당하는 5 ms 안에안압을측정하기때문에안구박동이안압측정값변동의주요원인이될수있으며반복측정한안압값의변동폭이 1-4 mmhg 가될수있다고되어있다. 15,16,28 토노펜은작고가벼운휴대가능한전자안압계이다. 골드만압평안압계처럼토노펜도압평안압방식이며전지에의해작동되고측정수치가화면에바로표시되는디지털방식이다. 사용이간편하여검사자에의한오차를줄일수있고일회용라텍스덮개를사용하므로환자간의전염성질환의전파를막을수있는장점이있다. 하지만골드만압평안압계와비교시낮은안압영역에서는 ( 9 mmhg) 낮게, 높은안압영역에서는 ( 3 mmhg) 높게측정되는경향이있다는한계가있다. 17-2 마지막으로, 리바운드안압계 (Rebound tonometer, Icare, Helsinki, Finland) 는위에언급한골드만압평안압계의단점들을극복하고자비교적최근에도입된것으로유발과충돌 (inductive/impact) 의원리를이용한다. 휴대성이좋고점안마취제없이도간편하게측정가능하면서도골드만압평안압계와유사하게정확한안압측정이가능한것이장점이다. 1-14 각막난시나표면의요철 (irregularity) 에의한영향을적게받으며, 비교적적은숙련으로정확한안압을측정할수있다. 또한세극등현미경이필요치않아서측정자세가자유로우므로환자가누워있는경우도측정이용이하다. 13,29 탐침은일회용이기때문에측정시마다쉽게교체가능하고따라서기구의각막접촉으로인한감염전파의 위험성이적으며, 무엇보다도탐침의말단부의직경이 1 mm ( 골드만압평안압계 : 3.6 mm, 토노펜 : 1.2 mm) 정도로좁기때문에다른안압계에비해서상대적으로원추각막, 각막부종, 각막궤양, 각막혼탁등의각막표면이일정하지않은환자에서도사용이좋은장점이있다. 3,31 각막표면의요철에영향을받지않는이러한특성은수술후난시가불규칙적으로심하거나표면이매끄럽지못한눈에서골드만압평안압계의대체수단이될수있는장점이다. 이번연구를통해저자들은골드만안압을기준으로비교시, 리바운드안압이비접촉안압와토노펜안압보다더우수한일치성을보이고, 평균차이값이비접촉안압보다는조금크나비교적우수하며신뢰구간의폭이세가지안압계중가장좁은것을확인하였다. 골드만압평안압계로안압측정이어려운경우리바운드안압계가대체수단이될수있을것으로기대된다. REFERENCES 1) Goldmann H, Schmidt T. [Applanation tonometry]. Ophthalmologica 1957;134:221-42. 2) Whitacre MM, Stein R. Sources of error with use of Goldmanntype tonometers. Surv Ophthalmol 1993;38:1-3. 3) Doughty MJ, Zaman ML. Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol 2;44:367-48. 4) Liu J, Roberts CJ. Influence of corneal biomechanical properties on intraocular pressure measurement: quantitative analysis. J Cataract Refract Surg 25;31:146-55. 5) Kohlhaas M, Boehm AG, Spoerl E, et al. Effect of central corneal thickness, corneal curvature, and axial length on applanation tonometry.. Arch Ophthalmol 26;124:471-6. 6) Broman AT, Congdon NG, Bandeen-Roche K, Quigley HA. Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure. J Glaucoma 27;16:581-8. 7) Luce DA. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg 25;31:156-62. 8) Vajaranant TS, Price MO, Price FW, et al. Intraocular pressure measurements following Descemet stripping endothelial keratoplasty. Am J Ophthalmol 28;145:78-6. 9) Ceruti P, Morbio R, Marraffa M, Marchini G. Comparison of dynamic contour tonometry and goldmann applanation tonometry in deep lamellar and penetrating keratoplasties. Am J Ophthalmol 28;145:215-21. 1) Fernandes P, Díaz-Rey JA, Queirós A, et al. Comparison of the ICare rebound tonometer with the Goldmann tonometer in a normal population. Ophthalmic Physiol Opt 25;25:436-4. 11) Jorge J, Fernandes P, Queirós A, et al. Comparison of the IOPen and icare rebound tonometers with the Goldmann tonometer in a normal population. Ophthalmic Physiol Opt 21;3:18-12. 12) Nakamura M, Darhad U, Tatsumi Y, et al. Agreement of rebound www.ophthalmology.org 51
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- 이경식외 : 리바운드안압계 - =ABSTRACT= Comparison of Intraocular Pressure Measured by Non-Contact Tonometer, Rebound Tonometer, Tono-Pen, and Goldmann Applanation Tonometer Kyung Sik Lee, MD, Se Kyung Kim, MD, Eung Kweon Kim, MD, PhD, Tae Im Kim, MD, PhD Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea Purpose: To compare the level of accuracy of intraocular pressure (IOP) measurements attained by non-contact tonometer (NCT), rebound tonometer (RT) Icare, and Tono-Pen (TONO-PEN AVIA ), using Goldmann Applanation tonometer (GAT) as a reference value and to explore their clinical usefulness. Methods: In a prospective study of 71 normal eyes, IOP was measured with NCT, RT, Tono-Pen and GAT. The IOP values of were then compared between the eyes. Results: RT showed statistically most significant agreement with the GAT [ICC.811, 95%CI.712-.878]. In analysis of Bland-Altman plots, NCT showed the smallest mean bias (+.2 mm Hg) and widest CI (95%CI; ±5.5 mm Hg), RT showed relatively small mean bias (-.7 mm Hg) and narrowest CI (95%CI; ±3.75 mm Hg). Conclusions: There was a significant agreement between the RT and the GAT measurements. We expect RT to be considered as a reliable alternative when IOP measurement with GAT is not feasible. J Korean Ophthalmol Soc 214;55(1):47-53 Key Words: Goldmann applanation tonometer, Rebound tonometer Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital #5 Yonsei-ro, Seodaemun-gu, Seoul 12-752, Korea Tel: 82-2-2228-357, Fax: 82-2-312-541, E-mail: TIKIM@yuhs.ac www.ophthalmology.org 53