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The iCare Tonometer: A Kinder, Gentler Way To Measure IOP

by Marcia Dettloff, OD on May 17, 2011

I stopped using the dreaded “air-puff test” to measure intraocular pressure (or what some people call the “glaucoma” test) way back in 1998.  While most patients preferred the Tonopen, some just couldn’t stand the idea of anything touching their eye, even if they were numb.  Others think any type of eye drop is torture. Fortunately, we now have the iCare tonometer to measure IOP without shooting a puff of air into your eye or using numbing drops.

The iCare tonometer consists of a handle with a tiny white plastic ball that is brought very close to the eye.  Then it taps on the cornea faster than a blink.  The patient only feels a quick tickle, if anything, so it can be used without anesthetic.  That’s especially helpful with young children.  Since I started using the iCare tonometer in late March, I haven’t had any patients that couldn’t do it.

To prove how painless it is, I asked a young patient of mine, who let’s just say is not fond of anything touching her eyes, if she would let me videotape her while I measured her IOP with my new iCare tonometer. This was the first time she had the test done so you are seeing her natural, unrehearsed reaction. 

That was a piece of cake, right? Note: my technique has improved since I taped this but I promised Mary she’d be a web star so I didn’t retape it!

While the iCare tonometer is a precise instrument, it is primarily used as fast, easy screening tool.  Any unusual readings warrant repeat testing with Goldmann tonometry, the gold standard for IOP measurement, which does require the use of an anesthetic eye drop.  Goldmann tonometry is also preferred for monitoring IOP in glaucoma suspects and patients with glaucoma.

Also be aware that IOP is just one factor,(possibly the least important), that we consider when diagnosing glaucoma.   While it is frequently used as a “glaucoma” screening test at health fairs, patients with high IOPs can be normal and patients with normal IOPs can have glaucoma.

Since patients with glaucoma frequently do not have symptoms until significant damage has occurred, it is important to receive regular comprehensive eye exams where we also take into consideration medical history and risk factors along with the assessment of the optic nerve, drainage structures of the eye, corneal thickness, visual fields (a measure of your peripheral vision), stereo photos of the optic nerve and laser scans of the optic nerve and nerve fiber layer as indicated. 

If has been over two years since your last comprehensive eye exam please call 919-481-4682 to schedule an appointment today.

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