Review Article

A Comprehensive Meta-analysis on Intra Ocular Pressure and Central Corneal Thickness in Healthy Children


Background: Glaucoma is the major ophthalmic public health issue and a leading basis of blindness. Elevated intraocular pressure (IOP) is still a foremost risk factor in development and progression of glaucoma. Central corneal thickness (CCT) may play as the risk factor for the progression of glaucoma, closely associated with IOP especially in pediatric age group. This study performed a pioneering investigation combining the outcomes of multiple studies using a meta-analytic approach.

Methods: Nineteen published articles between 1980 and 2015 were designated by searching Scopus, PubMed, and Google Scholar and analyzed with random effects model while I² statistics employed to find out heterogeneity. Subsequently, the information statistically analyzed by Stata software ver. 11.20.

Results: The mean IOP has been documented to 16.22 mmHg (95% CI: 15.48-16.97) in all races subgroups. Analyzing the data by race-based subgroups revealed the lowest IOP of 12.02 mmHg (95% CI: 11.40-12.64) in Indian children while IOP of 17.38 mmHg (95% CI: 15.77-18.98) documented in black children as the highest measurement. The mean CCT was 553.69 micrometer (95% CI: 551.60-555.78) among all races. Lowest CCT of 536.60 mm (95% CI: 531.82-541.38) has been documented in mixed Malay-Indian children whereas Chinese children ought to the highest CCT value of 557.68 mm (95% CI: 553.10-562.25).

Conclusion: Findings of published studies were inconsistent when considered independently; however, meta-analysis of these results showed a significant correlation between CCT and IOP. Owing to non-uniform methods used to measure IOP and CCT in studies, data were stratified into various subgroups according to the instruments used to measure IOP and CCT.



Heidary F, Heidary R, Jamali H, Gharebaghi R (2015). Afraid of the Dark; Raising Awareness of Societies Each Year during World Glaucoma Week. Iran J Public Health, 44(5):716-7.

Copt RP, Thomas R, Mermoud A (1999). Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma. Arch Ophthalmol, 117(1):14-6.

Aghaian E, Choe JE, Lin S, Stamper RL (2004). Central corneal thickness of Caucasians, Chinese, Hispanics, Filipinos, African Americans, and Japanese in a glaucoma clinic. Ophthalmology, 111(12):2211-9.

Heidary F, Gharebaghi R, Wan Hitam WH, Naing NN, Wan-Arfah N, Shatriah I (2011). Central corneal thickness and intraocular pressure in Malay children. PLoS One, 6(10):e25208.

Haider KM, Mickler C, Oliver D, Moya FJ, Cruz OA, Davitt BV (2008). Age and racial variation in central corneal thickness of preschool and school-aged children. J Pediatr Ophthalmol Strabismus, 45(4):227-33.

Muir KW, Jin J, Freedman SF (2004). Central corneal thickness and its relationship to intraocular pressure in children. Ophthalmology, 111(12):2220-3.

Muir KW, Duncan L, Enyedi LB, Freedman SF (2006). Central corneal thickness in children: Racial differences (black vs. white) and correlation with measured intraocular pressure. J Glaucoma, 15(6):520-3.

Doughty MJ, Laiquzzaman M, Müller A, Oblak E, Button NF (2002). Central corneal thickness in European (white) individuals, especially children and the elderly, and assessment of its possible importance in clinical measures of intra-ocular pressure. Ophthalmic Physiol Opt, 22(6):491-504.

Hikoya A, Sato M, Tsuzuki K, Koide YM, Asaoka R, Hotta Y (2009). Central corneal thickness in Japanese children. Jpn J Ophthalmol, 53(1):7-11.

Lim L, Gazzard G, Chan YH, Fong A, Kotecha A, Sim EL, Tan D, Tong L, Saw SM (2008). Cornea biomechanical characteristics and their correlates with refractive error in Singaporean children. Invest Ophthalmol Vis Sci, 49(9):3852-7.

Tong L, Saw SM, Siak JK, Gazzard G, Tan D (2004). Corneal thickness determination and correlates in Singaporean schoolchildren. Invest Ophthalmol Vis Sci, 45(11):4004-9.

Sahin A, Basmak H, Yildirim N (2008). The influence of central corneal thickness and corneal curvature on intraocular pressure measured by tono-pen and rebound tonometer in children. J Glaucoma, 17(1):57-61.

Krzyżanowska-Berkowska P, Asejczyk-Widlicka M, Pierscionek B (2012). Intraocular pressure in a cohort of healthy eastern European schoolchildren: variations in method and corneal thickness. BMC Ophthalmol, 2;12:61.

Song Y, Congdon N, Li L, Zhou Z, Choi K, Lam DS, Pang CP, Xie Z, Liu X, Sharma A, Chen W, Zhang M (2008). Corneal hysteresis and axial length among Chinese secondary school children: the Xichang Pediatric Refractive Error Study (X-PRES) report no. 4. Am J Ophthalmol, 145(5):819-26.

Sakalar YB, Keklikci U, Unlu K, Alakus MF, Yildirim M, Dag U (2012). Distribution of central corneal thickness and intraocular pressure in a large population of Turkish school children. Ophthalmic Epidemiol, 19(2):83-8.

Huang Y, Lin S, Ma D, Wang Z, Du Y, Lu X, Zhang M (2013). Corneal biomechanical properties and associated factors in school-age children. Eye Sci, 28(1):34-9.

Bueno-Gimeno I, Gene-Sampedro A, Piñero-Llorens DP, Lanzagorta-Aresti A, España-Gregori E (2014). Corneal biomechanics, retinal nerve fiber layer, and optic disc in children. Optom Vis Sci, 91(12):1474-82.

Yildirim N, Sahin A, Basmak H, Bal C (2007). Effect of central corneal thickness and radius of the corneal curvature on intraocular pressure measured with the Tono-Pen and noncontact tonometer in healthy schoolchildren. J Pediatr Ophthalmol Strabismus, 44(4):216-22.

Pediatric Eye Disease Investigator Group (2011). Central corneal thickness in children. Arch Ophthalmol, 129(9):1132-8.

Sihota R1, Tuli D, Dada T, Gupta V, Sachdeva MM (2006). Distribution and determinants of intraocular pressure in a normal pediatric population. J Pediatr Ophthalmol Strabismus, 43(1):14-8; quiz 36-7.

Wei W, Fan Z, Wang L, Li Z, Jiao W, Li Y (2014). Correlation analysis between central corneal thickness and intraocular pressure in juveniles in Northern China: the Jinan city eye study. PLoS One, 22;9(8):e104842.

Huang Y, Lin S, Ma D, Wang Z, Du Y, Lu X, Zhang M (2013). Corneal biomechanical properties and associated factors in school-age children. Eye Sci, 28(1):34-9.

Bovelle R, Kaufman SC, Thompson HW, Hamano H (1999). Corneal thickness measurements with the Topcon SP-2000P specular microscope and an ultrasound pachymeter. Arch Ophthalmol, 117:868–870.

Suzuki S, Oshika T, Oki K, Sakabe I, Iwase A, Amano S, Araie M (2003). Corneal thickness measurements: scanning-slit corneal topography and noncontact specular microscopy versus ultrasonic pachymetry. J Cataract Refract Surg, 29(7):1313-8.

Doughty MJ, Zaman ML (2000). Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol, 44(5):367-408.

Heidary F, Gharebaghi R, Wan Hitam WH, Shatriah I (2010). Nerve fiber layer thickness. Ophthalmology, 117(9):1861-2.

IssueVol 46 No 6 (2017) QRcode
SectionReview Article(s)
Central corneal thickness Intraocular pressure Children Correlation Meta-analysis

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How to Cite
FARVARDIN M, HEIDARY F, SAYEHMIRI K, GHAREBAGHI R, JABBARVAND BEHROOZ M. A Comprehensive Meta-analysis on Intra Ocular Pressure and Central Corneal Thickness in Healthy Children. Iran J Public Health. 2017;46(6):724-732.