Non-Contact Tonometry

Patrick Corpora English 202C.017 October 25, 2012

The Non-Invasive Method of Measuring Eye Pressure and its Application in the Field of Optometry

Figure 1: A Non-Contact Tonometer

Audience and Scope

The purpose of this technical document is to provide the reader with a general understanding of how optometrists (eye doctors) measure a patients eye pressure to check for various diseases of the eye. The document will focus on how a non-contact tonometer measures intraocular eye pressure and the implications this eye pressure has on ones health. After reading this document, the reader will know the process behind Non-Contact Tonometry and the benefits it possesses over other methods for measuring eye pressure. The intended audience of this audience is optometry school students who will be using this technique to measure their patients eye pressure in the future. This document could be included in their textbooks on optometric examinations. The information in this document will provide the students with a better understanding of the technology behind the instruments that they use on patients.

Introduction
Tonometry is the science of measuring the pressure of the fluids in the eyes (intraocular pressure). Optometrists and other health care professionals use tonometers to find this pressure. Tonometers are instruments that measure intraocular pressure in units of mmHg. These instruments can be handheld or are built onto the doctors microscope apparatus. There are several types of tonometry, which include: Applanation (Goldmann) Tonometry Electronic Indentation Tonometry Non-Contact Tonometry (Pneumotonometry) Indentation (Schioz) Tonometry

What is a healthy eye pressure? When optometrists are using tonometry, they hope to find eye pressure readings between 10 mmHg Figure 2: The Probe of a Goldmann Tonometer and 21 mmHg. Most statistics show that healthy eyes have an intraocular pressure of 15.5 mmHg. However, yearly examinations are recommended to establish a base-line pressure so that changes in eye health can be accurately detected.

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Eye pressures above the 21 mmHg threshold are risk factors for: o Glaucoma o Optic Nerve Damage Eye pressures below the 10 mmHg threshold are symptoms of: o Fluid leakage in the eye o Actual deflation of the eyeball

What is Glaucoma?
Glaucoma is a very serious disease of the eye that is signaled by an elevated intraocular pressure. Glaucoma is a result of increased pressure in the eye constricting the optic nerve and damaging it. This leads to vision loss and can sometimes degrade the eye to become blind. Glaucoma is the second leading cause of blindness in the United States.

Figure 3: A Healthy Eye vs. An Eye with Glaucoma

What is Non-Contact Tonometry?

Non-Contact Tonometry is a method of using a non-invasive technique to measure the intraocular pressure of the eye. As its name indicates, Non-Contact Tonometry uses a forceful air stream to indirectly measure the pressure of the eye and avoid physical contact with the cornea and an optometric instrument. Non-Contact Tonometry is commonly known in the field as the puff test, as literally a puff of air is blown into the patients eye to deflate the cornea.

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Non-Contact Tonometry was first developed by Bernard Grolman as an alternative method to Goldmann Tonometry which uses a probe to press on the cornea of the eye to directly measure eye pressure. Previously, the non-contact tonometry method was seen as invalid and its results un-reliable. Non-Contact Tonometry has since been proved to be as accurate as the Goldmann method and is common practice in most offices across America.

But How Does This Work?

How is it possible to measure the pressure inside of someones eye without applying a probe or other sensor directly to the cornea? The answer lies in the process of Non-Contact Tonometry. The Set-Up The optometrist first manipulates and adjusts the tonometer so that the patients chin rests on the ledge and their face is brought as far forward as possible into the slit-lamp apparatus. This ensures that the patient will not move and alter the alignment of the sensors in the tonometer. Finally, the patient should be asked to open their eyes as wide as they can to ensure that the optometrist can get an excellent look at their pupil and into their cornea. The Puff The distinction of non-contact tonometry is simply defined with the puff test. Next, a welldefined stream of air is released from the tonometer and is aimed at the cornea; at the same time a light is shined upon the eye. The puff of air is extremely brief, no longer than a millisecond. The Flattened Cornea The cornea will flatten due to the pressure of the air stream. The softer the eye is, the less time that it will take to flatten the cornea and thus be characterized with lower intraocular pressure. The harder the eye is then the longer it will take to flatten the cornea and thus, the eye is characterized with higher intraocular pressure. This, however, is a general relationship and does not quantify what the actual intraocular pressure is.

Figure 4: Using a Non-Contact Tonometer

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The Light Source

Figure 5: The Light from the Tonometer

The way that the intraocular pressure is measured is through a light source. The patient stares at the source of light while the stream of air is blown at their cornea. The light is then reflected off of the cornea at a specific angle towards a sensor in the tonometer. As the cornea is being flattened, the angle that the light is being reflected at changes. Once the cornea is flattened, the light will be reflected in such a way that the sensor absorbs the light at a maximal amount. The time that it takes to reach maximum absorption is recorded in the instrument. This time is digitally converted into an intraocular pressure in units of mmHg and is read through the optometrists scope on the tonometer.

The Benefits of Non-Contact Tonometry

Results are available within seconds, which makes it a viable method when working at vision screenings when performing exams on a great number of people in a minimal amount of time. Eyes do not need to be anesthetized (no eye drops needed). Easiest method when testing children. No threat of spreading communicable diseases.

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Conclusion
Tonometry, in any form, is extremely important to the field of optometry and to diagnosing patients who have risky intraocular pressures. Whether the pressure inside of the eye is too low or too high, great implications for ones overall health are involved. Glaucoma is a very serious disorder that can ultimately lead one to become completely blind; a nightmare that scares most into frequently visiting their optometrists. Glaucoma can be combated by early detection and its mainly found by checking eye pressure through the use of tonometry. Non-Contact Tonometry is a special type of tonometry that is extremely efficient in checking for symptoms of glaucoma and other diseases related to intraocular pressure. The puff test, as it is commonly known to most that have undergone it, has many benefits over other methods of tonometry including the omission of numbing eye drops during examination and the fact that there is no threat of spreading infectious diseases through contamination. It is imperative that annual full optometric examinations are completed to check for variations from the individuals baseline and so that ocular diseases do not go unnoticed.

Works Consulted

http://www.frankshospitalworkshop.com/equipment/documents/ophthalmology/wikipedia/Tonometry.pdf http://www.webmd.com/eye-health/tonometry http://www.austenoptometrists.co.uk/glaucoma.htm http://www.journalofoptometry.org/en/modalities-of-tonometry-and-their/articulo/13188752/ http://www.opt.indiana.edu/riley/HomePage/NonContact/TEXT_Non_Contact.html http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002587/ http://www.opticalheritagemuseum.org/pdfs/AOTechReports/AOTechnicalReportNonContactTonometer. pdf Figure 1: http://buyophthalmicequipment.com/wp-content/uploads/2009/05/nt-4000-large.png Figure 2: http://en.wikipedia.org/wiki/Ocular_tonometry Figure 3: http://afeyecare.blogspot.com/2008/12/according-to-world-health-organization.html Figure 4: http://www.drberck.com/exams.htm Figure 5: http://www.medindia.net/health-screening-test/images/Applanation-tonometry.jpg

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