Welcome to question of the day #303

Welcome to question of the day #303

I’m not licensed to use ophthalmic drugs during an eye examination but want to measure the intraocular pressure of my patients. What can I do?

Well, you could use a non-contact tonometer that uses an air puff to measure the intraocular pressure but having worked in practice last week I have an alternative that I like, and judging from the reaction of my patients it’s popular with them as well.

I was using the iCare IC100 Tonometer and I recommend it for community practice. It does involve very mild contact with the cornea so check that your license allows you to undertake a procedure that makes contact with the cornea. It is a very small area of the cornea that is contacted and the chance of any corneal damage is negligible.

The Icare ic100 tonometer is used in the diagnosis, follow-up, and screening of glaucoma. It is based on an induction-based rebound method, which allows intraocular pressure to be measured accurately, rapidly, and without an anaesthetic.

Single-use probes are used for measurement and there is no risk of microbiological contamination. The probe is moved forward very quickly, makes contact with the cornea, and then rebounds. It is the action of the rebound that the device converts into a pressure value.

It’s handheld, light, and battery-operated. It can be used by a trained clinical assistant before the main eye examination.

Once the probe is aligned with the eye and the measure button is continually pressed six consecutive readings are automatically taken. The software discards the highest and the lowest of the six readings and averages the remaining four to give an intraocular pressure reading. The process is repeated for the other eye.

The practitioner is warned by a red light in the probe holder if the probe is too close or too far from the eye and when an erroneous reading is taken. A reading cannot be taken when the probe is too close or too far.

The ideal distance between the probe and the cornea is 4-8 mm and a green light at the base of the probe will illuminate when the probe is in this range.

I ask each patient to look across the room to a spotlight I illuminate on the test chart and to keep their eyes wide open and try not to blink. For most patients, it doesn’t matter if they blink as each measurement episode is quicker than a blink.

It takes around 30 seconds to obtain an average reading for both eyes.

It has several language options and the language of choice can be easily set.

When I mentioned to my patients last week that I needed to measure the pressure in their eyes but wouldn’t need to use the ‘puff of air test’ I could see them physically relax. Many were grateful that I could measure their eye pressure without puffing any air into it.

Once I’d measured their pressures using the iCare 100 they were amazed at the speed and the comfort.

I love it and my patients love it.