We have read with a lot of interest the article “Comparison of Intraocular Pressure Measurements Obtained by Rebound, Noncontact, and Goldmann Applanation Tonometry in Children” by Feng and associates. First of all, we would like to congratulate the authors for conducting such a thorough study, as this is a very important issue. Childhood glaucoma is a rare disease, but failure to diagnose and treat it could cause serious problems in children’s development and eventually lead to blindness. Measuring the intraocular pressure (IOP) is crucial in diagnosis of glaucoma. Currently the Goldmann applanation tonometer (GAT) is considered the gold standard for the measurement of IOP in adults, but in our experience in the pediatric population it seems very impractical. IOP measurement in children is often difficult to perform. We agree with Feng and associates that in the pediatric population we need a rapid and easy method for IOP measurement.
However, we have a few suggestions regarding the article. We believe that it would be interesting if Feng and associates divided children into 2 groups: a first group composed of children with family history of glaucoma and a second group of children without family history of glaucoma. The authors could compare whether there are any differences between the 2 groups and methods of measurement. Also the growing and developing eye in children is different compared to the fully grown adult eye. We would like to suggest comparing the axial length of the eye with intraocular pressure. We believe that it is necessary to introduce a normative scale of IOP for different stages of growing eyes.
Finally, we conclude that more public education, perhaps on a national and even international level, is necessary to try to limit the complications of untreated glaucoma.
Also, we emphasize that further studies on cohorts of children from different ethnic groups while using different methods and instruments are needed before it is possible to determine which instrument is the best for children’s eyes.