The College of Optometrists

hi there, in my first exam i was told i could sign iff a coupl e form my next quarter if i was prepared, which i duely thought i was. the question i was asked on contact tonometry was- on which pressures along, using a goldmann, would you refer?in my exam i discussed how it shoudlnt jst be pressure but fields and optic disc alone, but i didnt getthe competency. i cannot seem to find an exact answer, and the ophtalmologists who i work with said it was a combination of all three..was wondering if uanyone can expand on this?also, does anyoneknow the date of the final day exams? many thanks!

IOP is a risk factor.

So pressures under 21mmhg with disk defects or field loss would be classified as normal tension glaucoma

Pressures over 22 with disk and or field loss would be POAG

Pressures over 25 with normal fields or and disks is ocular hypertension. Which caries a risk of progression of ten percent into glaucoma over 20 years.

The pressures which need referal would be a diural variation greater than 6mm hg

A pressure difference between the eyes of greater than 5 mmhg (especially if the pressures are high)

A pressure over 28 mmhg I would personally refer for second opinion.

Any pressure in cases of narrow angle and aching eyes at night or halos.

A pressure over 21 mmhg where the sibling has glaucoma, or there is other significant extra risk

Thats my ideas anyway - - hope it helps -steve

The assessor is looking for you to understand that there are at least three occasions you would refer a patient on pressures alone without having to refer to fields or discs.

Very high pressures, I would agree with Stephen anything over 28mmHg

Very low pressures anything under 10mmHg could incdicate a retinal detachment or penetrating injury or leaking post surgical wound.

Asymmetry of more than 5mmHg.

You also need to be aware that you would be concerned with IOPS greater than 21mmHG with Goldmann and Perkins whereas a non contact you wouldn't tend to be concerned until over 24mmHG.