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U2.9.4 Tonometry (2014)

A member telephoned the other day with a query regarding home visits, particularly performing tonometry. She had concerns that she might not be allowed to carry out such work.

The situation arose when a nursing home requested a visit to a patient at the behest of the GP, wishing to have ‘pressures’ done for this patient. Our member was worried whether or not she could do this.

We have all had requests from patients whose GP has requested ‘pressures’ and it is sometimes hard to make the patient understand that this is not possible. You will all appreciate that IOP readings, in isolation, are of no use in the diagnosis of ocular hypertension or glaucoma. Most GPs fail to appreciate that a full eye examination by an optometrist or doctor is necessary to give any indication of ocular disease being present. It does take some tact and diplomacy to reassure patients that pressures will be done – but only with other checks and measurements.

Our member had the even more difficult job of explaining the situation to the care home, without appearing to be unwilling to see a vulnerable patient. A full domiciliary eye examination can be done at the request of a GP at any time within the usual intervals of eye examinations.

There was a further complication as to whether a registered DO (or CLO) may perform tonometry in such circumstances. DOs, and CLOs may perform tonometry at the request of an optometrist or doctor, as indeed may optical assistants if trained in the work. The usual instrument would be a non-contact tonometer, but this might not be so in a domiciliary situation when a Perkins tonometer is often the chosen instrument.

Such an instrument does, however, require local anaesthetic and the instillation of such drops is restricted and most DOs may only use such drops under the supervision of an optometrist. This was the case for the member asking advice.

The advice I gave was simply that a full eye examination would be necessary for the patient in question; the DO may quite legally perform contact tonometry under the supervision of the optometrist – but not otherwise.