Objective: To compare the reproducibility of measurements obtained with a new pachymetry instrument, the Topcon specular microscope (Topcon SP- 2000P; Topcon America Corp, Paramus, NJ), with those obtained by ultrasound pachymetry. Methods: Corneal thickness was measured in 40 eyes of 40 patients 3 times each with the Topcon SP-2000P and an ultrasound pachymeter. (DGH 500; DGH Technology Inc, Exton, Pa) by 2 separate investigators. Comparisons included average thickness as measured by each instrument, average thickness for each instrument as measured by each investigator, and differences in thickness due to corneal abnormalities. Results: Mean corneal thickness measured by the Topcon instrument was significantly less (32 μm; P<.001) than the mean value obtained with the ultrasound pachymeter. Similarly, mean values obtained with the 2 instruments by the 2 investigators were significantly different (P<.001 and .008 for investigators 1 and 2, respectively), with the Topcon value less than the ultrasound value in both cases. Both instruments detected abnormalities in corneal thickness equally well. However, the measurements obtained with the Topcon instrument by the 2 investigators were more consistent (no significant difference [P= .32]) than those obtained with the ultrasound unit (difference was significant [P= .02]). Conclusions: The new noncontact Topcon specular microscope provides measurements of corneal thickness that are somewhat less than those of ultrasound pachymetry, but that seem to be more consistent from one operator to another, possibly as a result of the elimination of observer bias induced by probe placement required by the ultrasound unit. This consistency may be important in the comparison of measurements by different operators over time in patients being followed up after refractive surgery or other therapeutic interventions.