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Evaluation of the Perkins (R) handheld applanation tonometer in the

measurement of intraocular pressure in dogs and cats

Article in Veterinary Ophthalmology · September 2009

DOI: 10.1111/j.1463-5224.2009.00702.x · Source: PubMed

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Veterinary Ophthalmology (2009) 12, 5, 277–284

Evaluation of the Perkins handheld applanation tonometer in

the measurement of intraocular pressure in dogs and cats
Silvia Franco Andrade,* Tatiana Cremonezi,† Cristiane Aparecida Miranda Zachi,† Caroline Ferreira
Lonchiati,† Juliana Dalarrosa Amatuzzi,† Keila Priscilla Sakamoto† and Paulo Augusto de Arruda Mello‡
*Department of Small Animal Medicine, Veterinary Hospital, University of Oeste Paulista (UNOESTE), Rodovia Raposo Tavares, km 572,
CEP 19001-970, Presidente Prudente, SP, Brazil; †Faculty of Veterinary Medicine, University of Oeste Paulista, Presidente Prudente, SP, Brazil;
‡Department of Ophthalmology, Faculty of Medicine, University Federal of São Paulo (UNIFESP), São Paulo, SP, Brazil

Address communications to: Abstract

S. F. Andrade
Tel.: +55 18 32292067
Fax: +55 18 32292036
e-mail: silviafranco@unoeste.br
Objective To evaluate and to validate the accuracy of the Perkins handheld applanation
tonometer in the measurement of IOP in dogs and cats.
Animals Twenty eyes from 10 dogs and 10 cats immediately after sacrifice were used
for the postmortem study and 20 eyes from 10 clinically normal and anesthetized
dogs and cats were used for the in vivo study. Both eyes of 20 conscious dogs and cats
were also evaluated.
Procedure Readings of IOP postmortem and in vivo were taken using manometry
(measured with a mercury column manometer) and tonometry (measured with a
Perkins handheld applanation tonometer). The IOP measurement with Perkins
tonometer in anesthetized and conscious dogs and cats was accomplished by instillation
of proxymetacaine 0.5% and of 1% fluorescein eye drops.
Results The correlation coefficient (r2) between the manometry and the Perkins
tonometer were 0.982 (dogs) and 0.988 (cats), and the corresponding linear regression
equation were y ¼ 0.0893x + 0.1105 (dogs) and y ¼ 0.0899x + 0.1145 (cats) in the
postmortem study. The mean IOP readings with the Perkins tonometer after
calibration curve correction were 14.9 ± 1.6 mmHg (range 12.2–17.2 mmHg) in
conscious dogs, and were 15.1 ± 1.7 mmHg (range 12.1–18.7 mmHg) in conscious cats.
Conclusion There was an excellent correlation between the IOP values obtained from
direct ocular manometry and the Perkins tonometer in dogs and cats. The Perkins
handheld tonometer could be in the future a new alternative for the diagnosis of
glaucoma in veterinary ophthalmology.
Key Words: applanation tonometer, cats, dogs, intraocular pressure, ocular manometry,
Perkins tonometer

with a digital instrument or column of water or mercury

INTRODUCTION
The early detection of increased IOP is an important factor
regarding treatment success and favorable prognosis in
glaucoma, which is an ocular disease with great potential to
cause irreversible blindness.1–6 Dogs and cats have either
primary or secondary glaucoma, but in cats, glaucoma is
usually secondary, as a consequence of inflammations
(usually to uveitis) or neoplasias.1,3,5
IOP can be measured by invasive, or direct (manometry),
or non-invasive, or indirect (tonometry), techniques.4 Ocular
manometry is considered as ‘the golden standard’ of IOP
measurement, as it measures the real IOP. This method consists
of cannulation of the anterior chamber and measurement
in mmHg. It is an invasive procedure used experimentally,
for instance, in the study of glaucoma or of drugs that inter-
fere with IOP or in the validation and study of tonometer
accuracy.7–13
In veterinary medicine, tonometric IOP measurement is
accomplished mainly by indentation, applanation, or rebound
techniques.1,3–5,14,15 The handheld tonometers used most in
routine veterinary ophthalmic care are the applanation
tonometer (Tonopen XL).1,3,5 The other methods that use
portable tonometers are indentation (Schiotz)1,3 and, more
recently, rebound (TonoVet).12,14
Applanation tonometry is based on the principle that the
force required to flatten a certain area of the surface of a

 2009 American College of Veterinary Ophthalmologists

278 a n d r a d e ET AL.
sphere is the same as the pressure inside that sphere (Law of
Imbert-Fick).2 In human ophthalmology, applanation tonometry
for the Goldmann method is most commonly used and
considered as the standard method for IOP measurement,
as it is accurate and practical. The Goldmann method is a
variable force tonometer consisting of a double prism, with
a 3-mm formation of semicircles of fluorescein, that is
adjusted during the tonometry, and is used often in human
ambulatory practice.2,6
The Perkins handheld applanation tonometer utilizes
the Goldmann method,2 and has a small source of blue light
for the formation of semicircles of fluorescein (Fig. 1). This
instrument requires some practice in order to achieve perfect
readings.6 The scale of the tonometer ranges from 0 to 5,
with smaller divisions of 0.2, and the examination should be
started with the scale at number 1 (Fig. 1e). In humans, readings
measured on this scale are multiplied by 10.2,6 The accuracy
of this type of applanation tonometer depends on several
factors, such as the excessive use of fluorescein, excessive
pressure of the prism on the cornea, incorrect calibration,
anatomical and biomechanical characteristics of the cornea
(thickness, diameter, hydration, elasticity, viscosity, etc.),
pathologies (such as edema and cornea ulceration, which
can generate incorrect readings), evaluation technique,
apnea, muscular contraction, and contact with the adnexal
structures, etc.6,16–18
The few studies using the Perkins tonometer in domestic
animals have been performed in cattle,8 rabbits and cats,10
and rabbits.11,12 One study11 used rabbits to compare the
effectiveness and accuracy of three types of tonometers,
including the Tono-Pen XL, Perkins, and Ocular Blood
Flow (OBF) pneumatonometer. In this study, the Perkins
tonometer demonstrated the best accuracy in IOP measure-
ment. In another recent study,12 also done in rabbits, the
 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284
Figure 1. The Perkins applanation handheld
tonometer: (a) Forehead rest; (b) Doubling prism;
(c) Scale; (d) Milled thumb-wheel; (e) Viewing lens;
(f) Detail of scale (0 to 5) each risk corresponds to
0.2. The exam should be started with the scale at
number 1; (g) Schematic draw of the correct
formation of the fluorescein semicircles show in the
viewing lens; (h) Picture of the formation of the
fluorescein semicircles in the viewing lens in the
OD of dog number 4 of the in vivo study.
authors compared the accuracy of IOP measurements using
the Perkins, Tono-Pen XL, and TonoVet tonometers,
and again, the Perkins tonometer showed the best accuracy
in IOP measurement in rabbits.
The Perkins tonometer costs, on average, three to five
times less than the Tono-Pen, and could represent an
interesting alternative for the IOP exam in dogs and cats.
However, at present, there are no reports of the use of this
tonometer in dogs and there has only been one report of
the use of the Perkins tonometer in cats, an old report from
198410 that used the Alcon pneumatonograph (PTG) and
Perkins tonometer on rabbits and cats. This report empha-
sizes use of the PTG on rabbits more than the Perkins
tonometer on cats; therefore, more research is needed
on this.
The objective of this study was to evaluate and validate the
accuracy of the Perkins handheld applanation tonometer
in the measurement of IOP in dogs and cats. To do so, IOP
readings from this tonometer, in mmHg, were converted
using the calibration curve generated using values measured
via manometry with a mercury column manometer (postmortem
study). The tonometry was then validated by comparing the
values of IOP in mmHg from this tonometer with the mano-
metric values (in vivo study) in this species. Also, the IOP
measurement was evaluated in conscious dogs and cats in a
clinical set.
MATERIALS AND METHODS
This experiment was approved by the Ethical Committee of
UNOESTE (Protocol no. 022/07 and no. 023/07), and of
UNIFESP (Protocol no. 1417/07). For the postmortem and
in vivo study the animals were obtained from the kennel
and cat pound of the UNOESTE. The conscious animals

were obtained from the clinic of Veterinary Teaching Hospital
of UNOESTE, Presidente Prudente, SP, Brazil. Only
normal eyes were used in this study after being submitted to
ophthalmic exams.
For the postmortem study, both eyes from 10 mixed-breed
adult dogs (four males and six females, 2–8 years of age,
mean weight 9.2 ± 5.8 kg) and 10 mixed-breed adult cats
(five males and five females, years of age, mean weight
3.3 ± 0.8 kg), were obtained immediately after sacrifice from
several cases authorized for necropsy. For the in vivo study,
both eyes from 10 clinically normal and anesthetized mixed-
breed adult dogs (five males and five females, 2–5 years of
age, mean weight 11.9 ± 4.6 kg) and 10 clinically normal and
anesthetized mixed-breed adult cats (five males and five
females, 1–5 years of age, mean weight of 3.6 ± 0.7 kg) were
used. For the IOP measurement in conscious animals, 20
dogs (four Miniature Poodle, three Dachshund, two Border
Collie, one Basset Hound, one Cocker Spaniel and nine mixed-
breed; 11 males and nine females; 1–12 years of age; mean
weight 17.3 ± 11.6 kg) and 20 cats (five Siamese, four
Persian and 11 mixed-breed; eight males and 12 females;
1–11 years of age; mean weight of 3.2 ± 0.8 kg) were used.
For the postmortem study, to manipulate and measure
IOP manometrically, the eyelids were separated with eyelid
speculum, and the eye was cannulated with a 23-gauge
needle (Embramac, Itapira, SP, Brazil), approximately 2 mm
lateral to the limbal area, at the 10 o’clock position in the OD
and the 2 o’clock position in the OS. Cyanoacrylate
glue (Superbond, Loctite, Itapevi, SP, Brazil) was applied
around the needle to prevent leakage of the aqueous humor.
The needle was connected via a polyethylene tube to a three-
way stopcock, which was also connected to a reservoir of
10 mL physiological saline solution 0.9% (Fresenius Kabi,
Campinas, SP, Brazil) and a mercury column manometer
(Unitec, Rio de Janeiro, RJ, Brazil) that was in the zero
position in relation to the center of the eye. The calibration
curve for manometry vs. tonometry was determined by
raising the IOP artificially in 5 mmHg increments to reach
50 mmHg (5–50 mmHg) in open stopcock mode. Three
IOP readings were measured with the Perkins tonometer
(Clement Clarke, Harlow, UK), and the mean was calculated.
Prior to the tonometer IOP reading, one drop of 1% fluorescein
eye drops were instilled (Allergan, Guarulhos, SP, Brazil) for
the formation of the fluorescein semicircles.
For the in vivo study, the dogs and cats were anesthetized
with diazepam (Compaz, Sigma Pharma, Hortolândia, SP,
Brazil), 0.5 mg/kg i.v., and thiopental (Thiopentax, Itapira, SP,
Brazil), 12.5 mg/kg i.v. The cornea was topically anesthetized
with two drops of proxymetacaine 0.5% (Anestalcon, Allergan).
Manometry and tonometry measurements (Fig. 3a,b) were
taken as described for the postmortem study.
After the IOP readings were made, the fine needle was
removed from the anterior chamber and soon afterward,
cyanoacrylate glue was instilled with a 25 · 7 mm needle (Injex,
Ourinhos, SP, Brazil) at the site of the corneal puncture,
to protect against perforation.19,20 After the procedure, the
 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284
u s e o f t h e p e r k i n s t o n o m e t e r i n d o g s a n d c a t s 279
animals were given one drop of antibiotic eye drops
(chloramphenicol-Visalmin, Bunker, São Paulo, SP) and
anti-inflammatory eye drops (diclofenac sodium – Still,
Allergan), twice daily, for 1 week, and were evaluated through
daily basic ophthalmic exams (ophthalmoscopy, pupillary
light reflex, Schirmer tear test and fluorescein test) until the
induced corneal lesion healed.
For the clinical set study, the cornea of the animals was
topically anesthetized with two drops of proxymetacaine
0.5% (Anestalcon, Allergan) (Fig. 2a) and were instilled
one drop of 1% fluorescein eye drops (Allergan) (Fig. 2b) for
the formation of the fluorescein semicircles, and then three
IOP readings were measured with the Perkins tonometer
and the mean was calculated (Fig. 2c,d).
To avoid transmission of infectious ocular diseases, after
each use of the Perkins tonometer, the prism was removed
and washed in a 0.9% physiologic saline solution. It was then
submerged for 10 min in a solution of 3% hydrogen peroxide
and washed again in 0.9% saline solution and dried with
sterile gauze.21
The mean values of IOP measurement obtained using ocular
manometry and tonometry in the postmortem and in vivo
study, and the Perkins tonometer reading and the Perkins
tonometer reading correct by the calibration curve in the
conscious animals, were compared and analyzed by Student
t-tests. A significance level of P < 0.05 was adopted. Linear
regression analysis was performed to analyze the relationship
between manometry vs. tonometry IOP measurements. A
correlation coefficient (r2) was calculated.22 The Bland–Altman
assessment for agreement was used to compare the two
methods of IOP measurement. A range of agreement was
defined as mean bias ±2 standard-deviation.23
RESULTS
The correlation coefficient (r2) between the manometry measure-
ments and the Perkins tonometer measurements were 0.982
(dogs) and 0.988 (cats), and the corresponding linear regression
equation were y ¼ 0.0893x + 0.1105 (dogs) and y ¼ 0.0899x +
0.1145 (cats) in the postmortem study (Figs. 3 and 4).
The results of IOP measurements taken via manometry
and the applanation tonometer in the in vivo study are shown in
Table 1 and Table 2. In the in vivo study the mean IOP readings
in dogs were 14.5 ± 2.8 mmHg (range 9.0–18.0 mmHg) with
the manometer and were 15.3 ± 2.9 mmHg (range 10.0–
17.8) with the Perkins tonometer after calibration curve
correction, and in cats were 15.0 ± 1.7 mmHg (range 13.0–
18.0 mmHg) with the manometer and were 16.4 ± 2.6 mmHg
(13.1–20.9 mmHg) with the Perkins tonometer after calibra-
tion curve correction. In the in vivo study, in both species,
there was no significant difference (P > 0.05) between the IOP
measurements obtained via manometry and those obtained
by the Perkins applanation handheld tonometer and
corrected by the calibration curve (Tables 1 and 2).
The mean IOP readings with the Perkins tonometer
after calibration curve correction in conscious dogs and cats
280 a n d r a d e ET AL.

Figure 2. Use of the Perkins tonometer in normal eyes of conscious dog (female Basset Hound) and conscious cat (male mixed-breed) in the ambulatory
of the Veterinary Teaching Hospital of UNOESTE. (a) Instillation of two drops of proxymetacaine 0.5% eye drops; (b) Instillation of one drop of 1%
fluorescein eye drops; (c) and (d) Use of the Perkins tonometer after the instillation of the two eye drops.

Table 1. Values of in vivo IOP in mmHg by ocular manometry and the Perkins tonometer* in dogs (n ¼ 10)

Mean Perkins Mean Perkins Mean Mean Perkins Mean Perkins

Animal Manometry Manometry tonometer tonometer Manometry tonometer tonometer
number reading OD reading OS reading OD reading OS reading reading correct†
1 10.0 10.0 1.0 1.0 10.0 1.0 10.0
2 9.0 9.0 1.0 1.0 9.0 1.0 10.0
3 17.0 16.0 1.7 1.5 16.5 1.6 16.7
4 15.0 15.0 1.6 1.6 15.0 1.6 16.7
5 15.0 15.0 1.4 1.4 15.0 1.4 14.4
6 18.0 18.0 1.6 1.7 18.0 1.7 17.3
7 14.0 15.0 1.7 1.7 14.5 1.7 17.8
8 16.0 16.0 1.6 1.5 16.0 1.6 16.2
9 15.0 15.0 1.5 1.6 15.0 1.6 16.2
10 15.0 15.0 1.6 1.7 15.0 1.7 17.3
Mean±SD 14.4 ± 2.8a 14.4 ± 2.8a 1.5 ± 1.7b 1.5 ± 1.7b 14.4 ± 2.8a 1.5 ± 0.3b 15.3 ± 2.9a

Minimum 9.0 9.0 1.0 1.0 9.0 1.0 10.0

Maximum 18.0 18.0 1.7 1.7 18.0 1.7 17.8
Mean ± SD: different superscript letters indicate significant differences.
*Three IOP readings were measured with the Perkins tonometer and the mean was calculated.
†As determined from the calibration curve (y ¼ 0.0893x + 0.1105) (see Fig. 3).

 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284

 u s e o f t h e p e r k i n s t o n o m e t e r i n d o g s a n d c a t s 281

Table 2. Values of in vivo IOP in mmHg by ocular manometry and the Perkins tonometer* in cats (n ¼ 10)

Mean Perkins Mean Perkins Mean Mean Perkins Mean Perkins

Animal Manometry Manometry tonometer tonometer Manometry tonometer tonometer
number reading OD reading OS reading OD reading OS reading reading correct†
1 18.0 18.0 1.6 1.6 18.0 1.6 16.5
2 18.0 18.0 2.0 2.0 18.0 2.0 20.9
3 14.0 14.0 1.6 1.6 14.0 1.6 16.5
4 14.0 14.0 1.9 1.9 14.0 1.9 19.8
5 15.0 16.0 1.7 1.8 15.5 1.8 18.2
6 16.0 15.0 1.6 1.5 15.5 1.5 16.0
7 14.0 14.0 1.6 1.3 14.0 1.5 14.8
8 13.0 13.0 1.3 1.3 13.0 1.3 13.1
9 14.0 14.0 1.5 1.4 14.0 1.5 14.8
10 14.0 14.0 1.3 1.3 14.0 1.3 13.1
Mean±SD 15.0 ± 1.8a 15.0 ± 1.8a 1.6 ± 0.2b 1.6 ± 0.3b 15.0 ± 1.7a 1.6 ± 0.2b 16.4 ± 2.6a

Minimum 13.0 13.0 1.3 1.3 13.0 1.3 13.1

Maximum 18.0 18.0 2.0 2.0 18.0 2.0 20.9
Mean ± SD: different superscript letters indicate significant differences.
*Three IOP readings were measured with the Perkins tonometer and the mean was calculated.
†As determined from the calibration curve (y ¼ 0.0893x + 0.1105) (see Fig. 3).

Figure 3. Statistical values for regression lines of IOP readings using the
Perkins applanation tonometer vs. direct ocular manometry in 10 dogs
(a) and in 10 cats (b).

assisted in ambulatory of Veterinary Teaching Hospital are

shown in Tables 3 and 4. In conscious dogs the IOP readings
after calibration curve correction were 14.9 ± 1.6 mmHg
(range 12.2–17.2 mmHg), and in conscious cats were
15.1 ± 1.7 mmHg (range 12.1–18.7 mmHg).
The anesthetic recovery was fast and calm in the in vivo
study, besides the anesthetic protocol did not affect IOP
measurements and the corneal lesions induced by the anterior Figure 4. Bland-Altman plot comparing the IOP readings in mmHg of
chamber cannulation closed with the cyanoacrylate glue Perkins tonometer and manometer in 10 dogs (a) and 10 cats (b).

 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284

282 a n d r a d e ET AL.

Table 3. Values of IOP in mmHg by the Perkins tonometer* in healthy eyes of conscious dogs (n ¼ 20) assisted at the ambulatory of the Veterinary
Teaching Hospital of the University of Oeste Paulista, Presidente Prudente, SP, Brazil

Mean Perkins Mean Perkins Mean Perkins Mean Perkins Mean Perkins Mean Perkins
Animal tonometer tonometer tonometer tonometer reading tonometer reading tonometer reading
number reading OD reading OS reading correct† OD correct† OS correct†
1 1.4 1.4 1.4 14.4 14.4 14.4
2 1.6 1.6 1.6 16.6 16.6 16.6
3 1.5 1.6 1.6 15.5 16.6 16.0
4 1.5 1.5 1.5 15.5 15.5 15.5
5 1.6 1.5 1.6 16.6 15.5 16.0
6 1.6 1.6 1.6 16.6 16.6 16.6
7 1.4 1.4 1.4 14.4 14.4 14.4
8 1.7 1.6 1.7 17.8 16.6 17.2
9 1.4 1.4 1.4 14.4 14.4 14.4
10 1.4 1.4 1.4 14.4 14.4 14.4
11 1.2 1.2 1.2 12.2 12.2 12.2
12 1.6 1.5 1.6 16.6 15.5 16.0
13 1.2 1.2 1.2 12.2 12.2 12.2
14 1.4 1.4 1.4 14.4 14.4 14.4
15 1.2 1.2 1.2 12.2 12.2 12.2
16 1.4 1.5 1.5 14.4 15.5 15.0
17 1.6 1.6 1.6 16.6 16.6 16.6
18 1.3 1.3 1.3 13.3 13.3 13.3
19 1.6 1.6 1.6 16.6 16.6 16.6
20 1.4 1.4 1.4 14.4 14.4 14.4
Mean±SD 1.5 ± 0.2a 1.4 ± 0.1a 1.5 ± 0.2a 15.0 ± 1.7b 14.9 ± 1.5b 14.9 ± 1.6b

Minimum 1.2 1.2 1.2 12.2 12.2 12.2

Maximum 1.7 1.6 1.7 17.8 16.6 17.2
Mean ± SD: different superscript letters indicate significant differences.
*Three IOP readings were measured with the Perkins tonometer and the mean was calculated.
†As determined from the calibration curve (y ¼ 0.0893x + 0.1105) (see Fig. 3).

treatment. Following the application of antibiotics and
nonsteroid anti-inflammatory eye drops, the lesions resolved
well within 24 h after the experiment.
It was relatively easy the IOP measurement with the Perkins
tonometer in conscious animals in the ambulatory routine.
Only three dogs and two cats needed a more firm manual
restrain for the IOP measurement.
DISCUSSION
In veterinary medicine, IOP measurement is most often
performed via the applanation method, using handheld
tonometers such as the Tonopen, which facilitate the execution
of this exam in animals.1,3–5 Most of these tonometers were
originally manufactured for use in humans. Therefore, before
they are used in animals, they need to be validated based on
manometry measurements, especially given the differences
found in animal corneas, such as differences in corneal diameter,
thickness, curvature and viscoelastics properties, as well in
other factors, such as surface tension and lacrimal film charac-
teristics, when compared to human corneas.4,8–10
A significant barrier to the popularization of this exam in
the veterinary setting has been the high cost of tonometers
like the Tonopen and Tonovet, especially in poor countries.
In human medicine, the Goldmann methodology using the
handheld Perkins tonometer is often used in clinics and for
bedridden patients and those patients unable to complete a
fixed exam.2,6 This method is attractive because it carries a
much more accessible cost, around three to five times less
than that of the Tono-Pen and TonoVet. Until now, the
Goldmann methodology has not been examined extensively
in the veterinary setting, with only a few studies reporting work
in cats, cattle and rabbits. However, these few studies, per-
formed mainly in rabbits, have shown an excellent correlation
in IOP measurements.8,10–12
Anecdotally, some veterinary ophthalmologists have
suggested that, in animals, the Goldmann methodology is
impossible, because the animal cannot be restrained ade-
quately to permit the formation of the semicircles. However,
if this were actually so, this exam would also be very difficult
in children. Yet this exam is frequently utilized in children,2,6
and, because the exam lasts only seconds, it is, in fact, easy to
execute. In our experiment, we could notice that the ability
to use the Perkins tonometer was acquired in a few days,
inside of the minimum patterns of appropriate quality of the
exam, what turns the same reasonably feasible. Besides, this
tonometer can be used in any position, is extremely resistant,
easy to calibrate and disinfect.
The correlation coefficient for the use of the Perkins
tonometer in dogs (r2 ¼ 0.982) and cats (r2 ¼ 0.988) was

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 u s e o f t h e p e r k i n s t o n o m e t e r i n d o g s a n d c a t s 283

Table 4. Values of IOP in mmHg by the Perkins tonometer* in healthy eyes of conscious cats (n ¼ 20) assisted at the ambulatory of the Veterinary
Teaching Hospital of the University of Oeste Paulista, Presidente Prudente, SP, Brazil

Mean Perkins Mean Perkins Mean Perkins Perkins Perkins Mean Perkins
Animal tonometer tonometer tonometer tonometer reading tonometer reading tonometer reading
number reading OD reading OS reading correct* OD correct* OS correct*
1 1.7 1.7 1.7 17.6 17.6 17.6
2 1.4 1.6 1.5 14.3 16.5 15.4
3 1.4 1.5 1.5 14.3 15.4 14.9
4 1.4 1.4 1.4 14.3 14.3 14.3
5 1.4 1.4 1.4 14.3 14.3 14.3
6 1.6 1.6 1.6 16.5 16.5 16.5
7 1.4 1.5 1.5 14.3 15.4 14.9
8 1.8 1.8 1.8 18.7 18.7 18.7
9 1.5 1.4 1.5 15.4 14.3 14.9
10 1.4 1.4 1.4 14.3 14.3 14.3
11 1.6 1.8 1.6 16.5 18.7 17.6
12 1.2 1.2 1.2 12.1 12.1 12.1
13 1.6 1.6 1.6 16.5 16.5 16.5
14 1.4 1.4 1.4 14.3 14.3 14.3
15 1.5 1.5 1.5 15.4 15.4 15.4
16 1.5 1.6 1.6 15.4 16.5 15.6
17 1.4 1.4 1.4 14.3 14.3 14.3
18 1.5 1.5 1.5 15.4 15.4 15.4
19 1.3 1.3 1.3 13.2 13.2 13.2
20 1.2 1.2 1.2 12.1 12.1 12.1
Mean±SD 1.5 ± 0.2a 1.5 ± 0.2a 1.5 ± 0.2a 15.0 ± 1.7b 15.3 ± 1.9b 15.1 ± 1.7b

Minimum 1.2 1.2 1.2 12.1 12.1 12.1

Maximum 1.8 1.8 1.8 18.7 18.7 18.7
Mean ± SD: different superscript letters indicate significant differences.
*Three IOP readings were measured with the Perkins tonometer and the mean was calculated.
†As determined from the calibration curve (y ¼ 0.0893x + 0.1105) (see Fig. 3).

considered excellent (Fig. 3). The Bland-Altman graph
also reveals a good correlation between IOP readings of
Perkins tonometer and manometer (Fig. 4). In humans,2,6
tonometer IOP readings are multiplied by 10. We have found
that, based on our calibration curve for dogs (y ¼ 0.0893x +
0.1105) and cats (y ¼ 0.0899x + 0.1145), we can approximate
the equation and multiply IOP measurements by a factor
of 10 for dogs and cats as well. This would facilitate the use
of the Perkins tonometer for obtaining IOP measurements
in ambulatory veterinary practice.
The mean IOP values in dogs measured with the Perkins
tonometer in the in vivo study (15.2 ± 3.0, range 10.0–
17.8 mmHg) and in conscious dogs (14.9 ± 1.6, range
12.2–17.2 mmHg) are smaller of those reported by
Gellat and MacKay,24 measured with the Tono-Pen XL
(19.2 ± 5.9 mmHg) and the Mackay-Marg (18.8 ± 5.5 mmHg).
However, the values measured by the Perkins tonometer
are closer of the real IOP values measured by manometry
(14.4 ± 2.8, range 9.0–18.0 mmHg). In this study, we didn’t
compare the Perkins tonometer with others tonometers in
conscious animals; therefore, more research should be made
in this sense to prove the accuracy of the Perkins tonometer
in a clinical set.25
In cats, the mean value of IOP measurements using
the tonometer, corrected by the calibration curve to
16.4 ± 2.6 mmHg (in vivo study) and 15.1 ± 1.7 mmHg
(conscious cats), are very close to the values report by
Nagy et al.26 with IOPcc (cornea-compensated IOP) of
16.0 ± 5.4 mmHg.
In the present study, the use of the mercury column
manometer, instead of an electronic monitor, was shown to
be an accurate, practical and low cost option for experimental
IOP measurement, and was in agreement with other
reports.13 The advantages observed with the use of the
Perkins tonometer in the measurement of IOP in dogs and
cats were accuracy, reproducibility, maintenance, calibration,
and disinfection of the prism tonometer. The disadvan-
tages were the limit of IOP reading of the Perkins tonome-
ter (upper limit of 50 mmHg) and a larger time training
necessary for the correctly use of the tonometer.
The results of our experiment demonstrate that the Per-
kins handheld applanation tonometer could be in the
future an excellent tool for glaucoma detection or
experimental work in dogs and cats, and could possibly
increase the popularity of this ophthalmic exam in small
animal clinics because of its more accessible cost as com-
pared to other tonometers currently used in veterinary
clinics. More researches should be made comparing this
tonometer with others tonometers, such as the Tonopen
or the Tonovet, in conscious dogs and cats, to prove
your accuracy in the IOP measurement in the clinical
setting.

 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284

284 a n d r a d e ET AL.

ACKNOWLEDGMENT 13. Passaglia CL, Guo X, Troy JB. Tono-Pen XL calibration curves for
cats, cows and sheep. Veterinary Ophthalmology 2004; 7: 261–264.
The authors thank the post-graduate program of UNOESTE 14. Knollinger AM, La Croix NC, Barrett PM et al. Evaluation of a
and UNIFESP for financial support and orientation, respectively, rebound tonometer for measuring intraocular pressure in dogs and
and Dr Rogério Giuffrida for statistical analysis. horses. Journal of American Veterinary Medical Association 2005; 227:
244–248.
15. Görig C, Roel TI, Stades FC et al. Comparison of the use of new
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 2009 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 12, 277–284

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