Article Date: 2/1/2009

IOP Measurements Without the Air Puff
instrumental strategies

IOP Measurements Without the Air Puff

This handheld device delivers accurate IOP measurement.

RANDALL THOMAS, O.D., M.P.H., F.A.A.O.

The iCare tonometer is based on a measuring principle called rebound technology, in which a very light probe is used to make momentary contact with the cornea and onboard sensors measure the IOP. The touch of the probe is so gentle patients often don't even feel it.

Using the Tonometer

It is the first technology that has come along that meets my requirements of quality, is atraumatic for patients and is easy to use in the office. It is effortless for the staff to operate and is something that the technician can perform before the doctor sees the patient. It obtains rapid and consistent readings with a minimal amount of training.

The user holds the instrument in front of the patient's eye, positions the top peg on the forehead to steady it and places the instrument's probe at the correct distance from the eye. While the patient looks straight ahead, the user presses a button. The probe moves forward, touches the patient's cornea, then bounces back and retracts. An electromagnetic device records its rate of deceleration on the rebound. The iCare tonometer, developed by iCare Finland Oy, allows for repeated measuring and averages the readings.

Benefits of the iCare tonometer

I was thrilled when I saw this instrument at the 2008 AOA meeting because individuals hate to be shot in the eye with a puff of air and I have been looking for 30 years for something not so barbaric. This instrument removes the need to place a puff of air in the eye, while meeting both the quality and ease-of-use requirements of larger tonometers. The older tonometers weigh 30 to 40 pounds, sit on a table and take up a lot of office space. This tonometer is about the size of a cell phone and runs on four AA batteries.


iCare Tonometer

HEIGHT: 1.8 inches to 3.14 inches

WIDTH: .5 inches to 1.25 inches

LENGTH: 8 inches

WEIGHT: 155 grams without batteries

COST: $3,750

There is no trauma involved for the patient. It is especially useful in pediatric cases because it is innocuous in size and needs minimal patient cooperation. Patients say to me "we're so glad we're not having an air puff," and they don't flinch back in their seat.

The iCare is both accurate and requires no anesthetic or fluorescent dyes, which can stain contacts. The tentative conclusion on wearing contacts when using this instrument is that it minimally alters the accuracy of the pressure readings. You need to remember that at this point in time, the iCare tonometer is being used at a screening visit, so if you are off a millimeter or two, it is really irrelevant.

Another benefit of the iCare tonometer is that the single-use probe eliminates contamination and is perfect for sanitation issues.

I have been using the iCare tonometer for about a year now, and although for us it is not a new revenue stream, I believe this tonometer allows doctors to have a more state-of-the art practice.

I believe as the technology becomes improved, it will eventually replace Goldman applanation as the standard of care for use in glaucoma care. I would not use it for that purpose now, but certainly to replace the air puff tonometer, it is just perfect. OM


DR. THOMAS IS IN GROUP PRACTICE IN CONCORD, NC, AND SERVES AS THE OPHTHALMIC DRUG CONSULTANT FOR THE PHARMACY AND THERAPEUTICS COMMITTEE OF NORTH CAROLINA BLUE CROSS AND BLUE SHIELD. HE IS ON THE HOSPITAL STAFF AT NORTHEAST MEDICAL CENTER AND SERVES AS THE OPHTHALMIC CONSULTANT TO THE DIABETES MANAGEMENT COMMITTEE.

Optometric Management, Issue: February 2009