Ocular Pessure test advice please

[lcogrady]

Hi there

Could anyone help me beofre my consultant loses his rag with me?

What are they trying to put in my eye when they do a pressure test. Doctors have tried countless times and I always flinch and they give up but now I've had a graft I am guessing it is important.

thank you

Lucy x

[rosemary johnson]

Yes, it is now important - IOP (internal eye pressure) can rise spontaneously after a graft, or it can rise as an adverse reaction to the anti-rejection drops. pssibly to dangerous levels, ie. the pressure could get so high it damages your retina.
When you say what are they putting in, do you mean, the little machine they use, or the drops they use first?
When most of them test mine, first they put in a drop which is a yellow-orange dye and a local anaesthetic, which is supposed to mean you don't fell the machine working.
I find that they never leave the anaesthetic long enough to work, so I feel the gadget, and then when they've finished I get all the itching feeling as the anaesthetic wears on. I really do wish they'd just use an ordinary fluorette (orange dye) tab and forget the anaesthetic!
They then shine blue light at your eye, and come closer and closer with a gadget under the blue light, looking like a big glowing bright blue ring - yes?
The gadget is a little box with an adjustment knob, and a stalk, to which they fit disposable "heads" for each person.
The "head" has two part-circles, embossed towards you (ie, raised from the plastic of the rest of the head).
They move the whole gadget closer to you until the two part-circles just touch the surface of your eye. They then adjust the adjustment knob on the front of the gadget so that the two part circles press harder onthe surface until it is pressing hard enough for the circle to be completed - ie, between the ends of the two part-circles.
They then take the gadget off the slit lamp, if it's my new consultant she finds her reading glasses again (!) and reads the scale off the adjustment knob on the front of the gadget to see how far they have had to turn it and that is the reading.
That's the modern machine thingy they use on me.
Older techniques used another gadget which blew a puff of air at the eye and watched how much the cornea deflected in the "wind".
An even less "modern high tech" method is to get you to look down, lay a thumb along the upper eyelid and press and say, "Hmm, that feels like a 15" - that's what the guy who saw me the dayafter the op did!!!!
It is possible to use the gadgets as I described with white light - but the only time someone has yet done that with me, the white light was too bright and painful and I was flinching madly from the bright light.
SOmeone normally has to hold my eyelid open so i don't blink - but then, they normally have to do that with me, anyway1
If you're flinching from the feel of the thing touching, get them to use the anaesthetic drops if they are not doing so - and to wait a bit longer till they have worn on properly if they aren't doing.
On the other hand, if the sting fromt he drops is more of a problem, you could try asking them to use an ordinary fluorette.
Or just grit your teeth!
Rosemary

[lcogrady]

Hi Rosemary

Thank you so much for your answer,

I think I am being a wuss. It is the blue light coming towards me and the consultant always gets as far as it touching my cornea and i flinch. I think I am worried that it is going to hurt. He does put the anesthetic in first and no, I dont think he leaves them in long enough before. He does hold my eyelid open for me but he does not have the best bedside manner and seems to be in a constant rush. The other day I felt more like an Inconvenience than a patient in fact he upset me so much I cried when I walked out of the clinic. I do think I was a bit emotional that day also.

Lucy x

[GarethB]

Next time try asking to see how the test is done on one opf the medical staff. You can see how painless it is.

I have the problem of flinching away but my cornea is very sensitive so most the time the puff of air is used.

Over the past 20 years I have been treated by many optoms and there are about 3 that I trust with touching my eyes.

[rosemary johnson]

Lucy, you're not a wuss, particularly not just after a graft when your eye is quite likely to be more sensitive anyway. And you're more likely to be generally strung up, emotional (and still probably working bits of anaesthetic out of the system).
Next time, do insist they leave a bit longer for the drops to take effect. The first person who used the gadget on me left long enough, and I never felt it touch at all, though almost always have since - that first guy was in A&E when I went in with the thing hurting madly the morning after I'd been having nightmares and thought I'd tried to attack it in my sleep! After not feeling it at all the first time, the next times it wasn't so bad - apart from the bright light.
Do ask them to show you how the gadget works, too - and if you like, ask to keep the head! (It has touched you, so will be thrownaway inthe clinical waste otherwise).
It sounds like your surgeon could be a lot more human to his patients, and not see you all as interesting eyes on legs!
Rosemary

[Graeme Stevenson]

You are NOT behaving like a WUSS.I would expect a rather more gentle approach from a knowledgeable Ophthalmologist.I think perhaps it is you who could justifiably lose the rag with the consultant.
The measurements are being done to asses if the Intra Ocular Pressure(IOP) is raised which can lead to Glaucoma.
Goldman tonometry is regarded as the "gold" standard in measuring IOP. It does however involve touching the cornea very lightly hence the reason for the anaesthetic drops. It does tend to be the most accurate although like all IOP measurements can be influenced by corneal thickness.
Other less invasive methods include NCT where the "puff of air" is fired at the cornea and although this tends to give most a little fright it is not at all painfull. Generally this is regarded as being less accurate than the contact measurement althtough with modern instruments it is perhaps not as poor a measurement as the Ophthalmologists seem to think. NCT is far easier for both patient and practitioner alike and certainly can be a very useful method of monitoring changes in IOP.

[Andrew MacLean]

I'm afraid that this IOP test is something to which we all have to become accustomed. After a graft they give us steroid drops to prevent or reduce any swelling, and steroid drops can cause increased IOP so they have to be extra vigilant to identify and correct any hint of glaucoma.

It isn't pleasant and the anesthetic drops they use sting like crazy. That said, I have never really enjoyed the puff of air that Graeme rightly describes as pain free, but it always gives me a fright, even although I know it is coming!

As to the hospital test; like everything else you have to learn to tolerate it. We all wish you well.

Andrew

[lcogrady]

Thank all for yor replies

I am def going to be a bit stronger when I see him again in a couple of weeks and feel much better about the test. I am very sensitive about my eye at the moment, especially after stupidly rubbing it by accident last night OUCH!! I have seen my consultant as both a private and NHS patient and well, he is a lot nicer when you are paying £150 a go shall we say! However, I cannot fault the job he has done on my graft and prehaps he was havig a bad morning He is nicer tham my last consultant who wouldnt talk to me only my mum (I was 17 years old!)

I do feel much more comfortable about giving it a go so thank you again

Lucy xx

[rosemary johnson]

Hallo Lucy,
Sorry to hear about the painful experience of eye rubbing! It took me a few weeks longer to do more than a slight first touch and stop hurried - but I woke up one early-hours in the middle of a horrible nightmare full of surgical gowns and faceless shapes in blue scrubs with the eye hurting like billy-oh - and wasn't sure if I'd been dreaming rubbing my eye, really rubbing my eye while I was dreaming, or been trying to tear it out like I'd been hallucinating doing.
About 6 weeks post-graft and was still so sore the next day I ended up in A&E and met those blue rings pressure testing gadgets for the first time.
Which brings me back onto topic...
Bottom line is, the pressure measurement is not itself the "disease"; it is only a rough guide to whether they need to be worried about whether the thing causing the high reading is causing other problems - like, possibly stressing and even damaging your retina.
It is only a rough guide because someone with a good strong healthy eye and retina will stand a pressure reading above "normal" and someone else might be getting retina problems when the reading is not high enough to be outside normal bounds.
Bottom line is, the only way to tell whether or not you are actually getting problems worth worrying about is to get the glaucoma expert to have a lok at the back of your eye - and they might say "It's all fine" even if the reading were higher than it should be, or ifyou're really unlucky might say there's something to worry about even with a reading that isn't sky high.
So..... if you really can't stand the blue light machine, they'll just have to get the glaucoma guys to check you out.
You might find, actually, that they are much more understanding and supportive about the blue-light gadgets than the corneal surgeon ....... this eing more their field - and probably more used to people nervous about the gadgets.
If all is well, then checking the back of your eye is OK shouldn't take 2 minutes, and they shouldn't need to put drops in or anything like that (unless, possibly, they do find something "funny").
They use a thick lens looking like a fat glass pebble, which makes the light from the slit lamp into a very narrow vertical burning bright wire. If you are very light sensitive, you may find this more painful than the pressure measuring gadget.
Again, I've ofund the glaucoma guy manages to do this both quicker and less painfully than eithe rthe corneal clinic people or, for that matter, the neuro-ophthalmologist (another story!) - who said she'd get the light onto y blind spot and then it would be so painful, but it didn't make any difference.
Of course, the drawback of this is that it means yet more hanging round in hospital waiting rooms, waiting to see someone else, when you'd far rather get out of there and go and do something less boring instead!
Rosemary

[lcogrady]

As luck will have it I work for the University of Kent and just down the corridor from my office there is lab full of doctors that do R&D for ophthalogic equipment specialising in retinas that can pick up on the first stages of any damage so they have said they will scan me anyway. My GP also holds a glucoma screening clinic twice a week so I think I will arrange an appointment with him too as I have every trust in him.

I will give my consultant another chance first when | go back in a couple of weeks as I am much more alert than a week ago!

Thanks again

Lucy