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  • Diagnostic Accuracy of Intraocular Pressure Measurement for Detection of Raised Intracranial Pressure: A Systematic Review and Meta-Analysis

    Final Number:

    Daniel Yavin MD; Judy Luu BSc, PhD; Nathalie Jette; Samuel Wiebe MD, MSc

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Intraocular pressure (IOP) has been proposed as a non-invasive method of intracranial hypertension (IC-HTN) diagnosis. We therefore conducted a systematic review and meta-analysis to determine the correlation between IOP and intra-cranial pressure (ICP) and the diagnostic accuracy of IOP for IC-HTN.

    Methods: We searched bibliographic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials); references of included studies; and conference abstracts for studies comparing IOP and invasive ICP measurement. Two independent reviewers screened abstracts, reviewed full text articles and extracted data. DerSimonian and Laird methods and bivariate random effects models were used to calculate summary estimates.

    Results: Among 355 identified potentially relevant citations, 12 studies enrolling 546 patients were aggregated. The pooled correlation coefficient between IOP and ICP was 0.44 (95%CI 0.26-0.63; I2 statistic, 97.7%, p<0.001). The summary sensitivity and specificity of IOP for IC-HTN were 72% (95%CI 36-92) and 87% (95%CI 65-96), respectively. The summary positive and negative likelihood ratios were 5.8 (95%CI 1.3-25.2) and 0.3 (95%CI 0.1-1.0), respectively. When measures were taken within an hour of another, correlation between IOP and ICP improved.

    Conclusions: Although a modest aggregate correlation was found between IOP and ICP, the measurement of IOP provides limited diagnostic accuracy for IC-HTN. The significant heterogeneity between studies suggests further investigation is required to determine the clinical utility of IOP in the detection of IC-HTN.

    Patient Care: The improved non-invasive diagnosis of intracranial hypertension will reduce patient morbidity resulting from unwarranted intracranial pressure monitoring while allowing the earlier detection and treatment of those patients suffering with elevated intracranial pressure.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the correlation between intraocular pressure and intracranial pressure; 2) Be aware of the sensitivity and specificity of intraocular pressure measurement in the detection of intracranial hypertension; 3) Discuss the limitations of the current guidelines for intracranial pressure monitoring.


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