Title : Goldmann Applanation Tonometer (GAT) Simulator: a novel approach to training
Abstract:
Introduction: Measurement of intraocular pressure (IOP) is critical for the management of glaucoma. The current gold standard measurement apparatus is the Goldmann Applanation Tonometer, a tool which utilizes the Imbert-Fick Principle where intraocular pressure equals the contact force required to flatten, divided by the area of contact on an infinitely thin-walled sphere. One disadvantage of GAT is the high operator skill requirement. IOP is frequently checked by an ophthalmic technician or nurse and devices such as Ocular Response Analyzer (ORA) have shown to be easier to operate than GAT due to automation. Furthermore, an unskilled practitioner can cause harm to a patient during performance of GAT by potentially causing a corneal abrasion. Numerous other techniques have been developed, such as Tonopen, Ocular Blood Flow tonograph (OBF), Non-Contact Tonometer (NCT), and Transpalpebral Tonometer, due to the complicated technical aspects of GAT. However, GAT remains to be the most accurate IOP check technique across ophthalmology practices, as the interobserver reliability is lower for other techniques. While GAT is the gold standard for IOP measurement it also requires a high skill of operation, thus appropriate training is critical. Present day training requires a courageous volunteer to act as a patient. Physical models acting as artificial globes have been developed for training but require materials that may not be easily accessible and have associated costs. Methods: A website was created using HTML and Javascript ES6, tested on Google Chrome version 103.0, hosted on GitHub. The code is publicly available at https://github.com/ryerrabelli/TonometrySimulation. Results: We developed an online application which mimics the steps of GAT and is free to use for trainees at gatsim.com. Trainees can now train on our model before seeing patients, which may ultimately improve outcomes. To our knowledge, this is the first time ever an online simulation of Goldmann Applanation Tonometry has been developed. This will allow individuals to train and learn the mechanics of GAT via an easy-to-use online application. We hope such technology will improve the skills of trainees, hasten the time to reach expertise, and minimize potential patient complications.
