Intraocular pressure (IOP) measurement is the cornerstone of the management of glaucoma patients. The gold standard for assessing IOP is Goldmann applanation tonometry (GAT). Recently, the dynamic contour tonometer (DCT) has become available. While both devices provide reliable IOP measurements, the results are not interchangeable. DCT has the advantage of measuring an additional parameter: ocular pulse amplitude (OPA). OPA is defined as the difference between systolic and diastolic IOP and represents the pulsatile wave front produced by the varying amount of blood in the eye during the cardiac cycle. It has been shown to vary with ocular structural parameters, such as axial length, corneal thickness, and ocular rigidity, as well as with systemic variables like heart rate, blood pressure, and left ventricular ejection fraction. Although the existence of some of these associations is still controversial, the clinical relevance of OPA has been consistently suggested, especially in glaucoma. Further research on this intriguing parameter could not only provide insight into glaucoma pathophysiology but also help integrate this variable into clinical practice.

1.
Punjabi OS, Kniestedt C, Stamper RL, Lin SC: Dynamic contour tonometry: principle and use. Clin Experiment Ophthalmol 2006;34:837-840.
2.
Kaufmann C, Bachmann LM, Robert YC, Thiel MA: Ocular pulse amplitude in healthy subjects as measured by dynamic contour tonometry. Arch Ophthalmol 2006;124:1104-1108.
3.
Alm A, Bill A: Ocular and optic nerve blood flow at normal and increased intraocular pressures in monkeys (Macaca irus): a study with radioactively labelled microspheres including flow determinations in brain and some other tissues. Exp Eye Res 1973;15:15-29.
4.
Pourjavan S, Boëlle P-Y, Detry-Morel M, De Potter P: Physiological diurnal variability and characteristics of the ocular pulse amplitude (OPA) with the dynamic contour tonometer (DCT-Pascal). Int Ophthalmol 2007;27:357-360.
5.
Grieshaber MC, Katamay R, Gugleta K, Kochkorov A, Flammer J, Orgül S: Relationship between ocular pulse amplitude and systemic blood pressure measurements. Acta Ophthalmol 2009;87:329-334.
6.
Knecht PB, Menghini M, Bachmann LM, Baumgartner RW, Landau K: The ocular pulse amplitude as a noninvasive parameter for carotid artery stenosis screening: a test accuracy study. Ophthalmology 2012;119:1244-1249.
7.
Kaufmann C: Intraocular pressure measurements using dynamic contour tonometry after laser in situ keratomileusis. Invest Ophthalmol Vis Sci 2003;44:3790-3794.
8.
Kirstein EM, Elsheikh A, Gunvant P: Tonometry - past, present and future; in Gunvant P (ed): Glaucoma - Current Clinical and Research Aspects. InTech, Rijeka, 2005.
9.
Katsimpris JM, Petropoulos IK, Pournaras CJ: Ocular pulse amplitude measurement after retinal detachment surgery. Klin Monatsbl Augenheilkd 2003;220:127-130.
10.
Flammer J, Orgül S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, Stefánsson E: The impact of ocular blood flow in glaucoma. Prog Retin Eye Res 2002;21:359-393.
11.
Burgoyne CF, Downs JC, Bellezza AJ, Suh JKF, Hart RT: The optic nerve head as a biomechanical structure: a new paradigm for understanding the role of IOP-related stress and strain in the pathophysiology of glaucomatous optic nerve head damage. Prog Retin Eye Res 2005;24:39-73.
12.
Coleman DJ, Trokel S: Direct-recorded intraocular pressure variations in a human subject. Arch Ophthalmol 1969;82:637-640.
13.
Kotecha A, Elkarmouty A, Ajtony C, Barton K: Interobserver agreement using Goldmann applanation tonometry and dynamic contour tonometry: comparing ophthalmologists, nurses and technicians. Br J Ophthalmol 2015, Epub ahead of print.
14.
Kaufmann C, Bachmann LM, Thiel MA: Comparison of dynamic contour tonometry with Goldmann applanation tonometry. Invest Ophthalmol Vis Sci 2004;45:3118-3121.
15.
Schmidt TA: The clinical application of the Goldmann applanation tonometer. Am J Ophthalmol 1960;49:967-978.
16.
Whitacre MM, Stein RA, Hassanein K: The effect of corneal thickness on applanation tonometry. Am J Ophthalmol 1993;115:592-596.
17.
Congdon NG, Broman AT, Bandeen-Roche K, Grover D, Quigley HA: Central corneal thickness and corneal hysteresis associated with glaucoma damage. Am J Ophthalmol 2006;141:868-875.
18.
Schneider E, Grehn F: Intraocular pressure measurement - comparison of dynamic contour tonometry and Goldmann applanation tonometry. J Glaucoma 2006;15:2-6.
19.
Cook JA, Botello AP, Elders A, Ali A, Azuara-Blanco A, Fraser C; Surveillance of Ocular Hypertension Study Group: Systematic review of the agreement of tonometers with Goldmann applanation tonometry. Ophthalmology 2012;119:1552-1557.
20.
Brandt JD: Corneal thickness in glaucoma screening, diagnosis, and management. Curr Opin Ophthalmol 2004;15:85-89.
21.
Erickson DH, Goodwin D, Rollins M, Belaustegui A, Anderson C: Comparison of dynamic contour tonometry and Goldmann applanation tonometry and their relationship to corneal properties, refractive error, and ocular pulse amplitude. J Am Optom Assoc 2009;80:169-174.
22.
Costin BR, Fleming GP, Weber PA, Mahmoud AM, Roberts CJ: Corneal biomechanical properties affect Goldmann applanation tonometry in primary open-angle glaucoma. J Glaucoma 2014;23:69-74.
23.
Özcura F, Yildirim N, Şahin A, Çolak E: Comparison of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in normal and glaucomatous eyes. Int J Ophthalmol 2015;8:299-304.
24.
Anderson MF, Agius-Fernandez A, Kaye SB: Comparison of the utility of Pascal dynamic contour tonometry with Goldmann applanation tonometry in routine clinical practice. J Glaucoma 2013;22:422-426.
25.
Francis BA, Hsieh A, Lai M-Y, et al: Effects of corneal thickness, corneal curvature, and intraocular pressure level on Goldmann applanation tonometry and dynamic contour tonometry. Ophthalmology 2007;114:20-26.
26.
Boehm AG, Weber A, Pillunat LE, Koch R, Spoerl E: Dynamic contour tonometry in comparison to intracameral IOP measurements. Invest Ophthalmol Vis Sci 2008;49:2472-2477.
27.
Deokule S, Vizzeri G, Medeiros FA: Repeatability and reproducibility of Goldmann applanation, dynamic contour, and ocular response analyzer tonometry. J Glaucoma 2013;22:127-132.
28.
Herndon LW, Weizer JS, Stinnett SS: Central corneal thickness as a risk factor for advanced glaucoma damage. Arch Ophthalmol 2004;122:17-21.
29.
Johnson CA, Keltner JL, Miller JP, Parish RK 2nd, Wilson MR: The Ocular Hypertension Treatment Study. Arch Ophthalmol 2002;120:714-720.
30.
Price FW, Price MO: Descemet's stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg 2006;32:411-418.
31.
Vajaranant TS, Price MO, Price FW, Wilensky JT, Edward DP: Intraocular pressure measurements following Descemet stripping endothelial keratoplasty. Am J Ophthalmol 2008;145:780-786.
32.
Jivrajka R, Schultz KL, Price MO, et al: Ocular pulse amplitude in patients with Descemet stripping endothelial keratoplasty. J Glaucoma 2014;23:142-144.
33.
Pepose JS, Feigenbaum SK, Qazi MA, Sanderson JP, Roberts CJ: Changes in corneal biomechanics and intraocular pressure following LASIK using static, dynamic, and noncontact tonometry. Am J Ophthalmol 2007;143:39-47.
34.
Kingman S: Glaucoma is second leading cause of blindness globally. Bull World Health Organ 2004;82:887-888.
35.
Jampel HD: Target pressure in glaucoma therapy. J Glaucoma 1997;6:133-138.
36.
Weinreb RN, Aung T, Medeiros FA: The pathophysiology and treatment of glaucoma: a review. JAMA 2014;311:1901-1911.
37.
Flammer J, Mozaffarieh M: What is the present pathogenetic concept of glaucomatous optic neuropathy? Surv Ophthalmol 2007;52:S162-S173.
38.
Broadway DC, Drance SM: Glaucoma and vasospasm. Br J Ophthalmol 1998;82:862-870.
39.
Stalmans I, Harris A, Vanbellinghen V, Zeyen T, Siesky B: Ocular pulse amplitude in normal tension and primary open angle glaucoma. J Glaucoma 2008;17:403-407.
40.
Boeckaert J, Vandewalle E, Stalmans I: Oximetry: recent insights into retinal vasopathies and glaucoma. Bull Soc Belge Ophtalmol 2012;319:75-83.
41.
Park HYL, Jeon SH, Park CK: Enhanced depth imaging detects lamina cribrosa thickness differences in normal tension glaucoma and primary open-angle glaucoma. Ophthalmology 2012;119:10-20.
42.
Van Keer K, Abegão Pinto L, Willekens K, Stalmans I, Vandewalle E: Correlation between peripapillary choroidal thickness and retinal vessel oxygen saturation in young healthy individuals and glaucoma patients. Invest Ophthalmol Vis Sci 2015;56:3758-3762.
43.
Cherecheanu AP, Garhofer G, Schmidl D, Werkmeister R, Schmetterer L: Ocular perfusion pressure and ocular blood flow in glaucoma. Curr Opin Pharmacol 2013;13:36-42.
44.
Stalmans I, Harris A, Fieuws S, Zeyen T, Vanbellinghen V, Siesky B: Color Doppler imaging and ocular pulse amplitude in glaucomatous and healthy eyes. Eur J Ophthalmol 2009;19:580-587.
45.
Abegão Pinto L, Vandewalle E, Willekens K, Marques-Neves C, Stalmans I: Ocular pulse amplitude and Doppler waveform analysis in glaucoma patients. Acta Ophthalmol 2014;92:e280-e285.
46.
Vulsteke C, Stalmans I, Fieuws S, Zeyen T: Correlation between ocular pulse amplitude measured by dynamic contour tonometer and visual field defects. Graefes Arch Clin Exp Ophthalmol 2008;246:559-565.
47.
Samra WA, Pournaras C, Riva C, Emarah M: Choroidal hemodynamic in myopic patients with and without primary open-angle glaucoma. Acta Ophthalmol 2013;91:371-375.
48.
Marangoni D, Falsini B, Colotto A, et al: Subfoveal choroidal blood flow and central retinal function in early glaucoma. Acta Ophthalmol 2012;90:e288-e294.
49.
Wang J, Freeman EE, Descovich D, Harasymowycz PJ, Kamdeu Fansi A, Li G, Lesk MR: Estimation of ocular rigidity in glaucoma using ocular pulse amplitude and pulsatile choroidal blood flow. Invest Ophthalmol Vis Sci 2013;54:1706-1711.
50.
Choi J, Lee J, Park SB, Lee KS, Sung KR, Kook MS: Factors affecting ocular pulse amplitude in eyes with open angle glaucoma and glaucoma-suspect eyes. Acta Ophthalmol 2012;90:552-558.
51.
Ishii K, Mori M, Oshika T: An evaluation of the effects of eyeball structure on ocular pulse amplitude in healthy subjects. Int Ophthalmol 2012;32:553-557.
52.
Detorakis ET, Pallikaris IG: Ocular rigidity: biomechanical role, in vivo measurements and clinical significance. Clin Experiment Ophthalmol 2013;41:73-81.
53.
Dastiridou AI, Ginis HS, De Brouwere D, Tsilimbaris MK, Pallikaris IG: Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of intraocular pressure. Invest Ophthalmol Vis Sci 2009;50:5718-5722.
54.
Friedenwald JS: Contribution to the theory and practice of tonometry. Am J Ophthalmol 1937;20:985-1024.
55.
Dastiridou AI, Tsironi EE, Tsilimbaris MK, et al: Ocular rigidity, outflow facility, ocular pulse amplitude, and pulsatile ocular blood flow in open-angle glaucoma: a manometric study. Invest Ophthalmol Vis Sci 2013;54:4571-4577.
56.
Dastiridou AI, Ginis H, Tsilimbaris M, et al: Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of axial length. Invest Ophthalmol Vis Sci 2013;54:2087-2092.
57.
Ethier CR: Scleral biomechanics and glaucoma - a connection? Can J Ophthalmol 2006;41:9-14.
58.
Quigley HA, Hohman RM, Addicks EM, Massof RW, Green WR: Morphologic changes in the lamina cribrosa correlated with neural loss in open-angle glaucoma. Am J Ophthalmol 1983;95:673-691.
59.
McBrien NA, Jobling AI, Gentle A: Biomechanics of the sclera in myopia: extracellular and cellular factors. Optom Vis Sci 2009;86:E23-E30.
60.
Mitchell P, Hourihan F, Sandbach J, Wang JJ: The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology 1999;106:2010-2015.
61.
Guidoboni G, Harris A, Cassani S, et al: Intraocular pressure, blood pressure, and retinal blood flow autoregulation: a mathematical model to clarify their relationship and clinical relevance. Invest Ophthalmol Vis Sci 2014;55:4105-4118.
62.
Galassi F, Giambene B, Varriale R: Systemic vascular dysregulation and retrobulbar hemodynamics in normal-tension glaucoma. Invest Ophthalmol Vis Sci 2011;52:4467-4471.
63.
Knecht PB, Menghini M, Bachmann LM, Baumgartner RW, Landau K: The ocular pulse amplitude as a noninvasive parameter for carotid artery stenosis screening: a test accuracy study. Ophthalmology 2012;119:1244-1249.
64.
Von Schulthess SR, Kaufmann C, Bachmann LM, Yanar A, Thiel MA: Ocular pulse amplitude after trabeculectomy. Graefes Arch Clin Exp Ophthalmol 2006;244:46-51.
65.
Breusegem C, Fieuws S, Zeyen T, Stalmans I: The effect of trabeculectomy on ocular pulse amplitude. Invest Ophthalmol Vis Sci 2010;51:231-235.
66.
Detorakis ET, Grammenandi E, Pallikaris IG, Tsilimbaris MK: Differences between Goldmann applanation tonometry and dynamic contour tonometry following trabeculectomy. J Ophthalmol 2010, DOI: 10.1155/ 2010/357387.
67.
Plange N, Rennings C, Herr A, et al: Ocular pulse amplitude before and after cataract surgery. Curr Eye Res 2012;37:115-119.
68.
Tabuchi H, Kiuchi Y, Ohsugi H, Nakakura S, Han Z: Effects of corneal thickness and axial length on intraocular pressure and ocular pulse amplitude before and after cataract surgery. Can J Ophthalmol 2011;46:242-246.
69.
Turk A, Mollamehmetoglu S, Imamoglu HI, Kola M, Erdol H, Akyol N: Effects of phacoemulsification surgery on ocular hemodynamics. Int J Ophthalmol 2013;6:537-541.
70.
Parikh S, Parikh R: IOP and target IOP. J Curr Glaucoma Pract 2010;4:37-43.
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