Transpalpebral Tonometry

H.v.Below, O.Riemer

Common practice

for ambulant and stationary

ophthalmology

Grimma/Sachsen

Tonometry variants

optical

manuel palpation

Schiötz (impression dependent on weight)

applanation according to Goldmann

air pulse

digital and similar impression techniques

Why should you look for new waysto measure intraocular pressure ??

children

wounded cornea (erosio, ulcer, etc.)

pre-, intra- and postoperative

Z.n. LasikZ.n. perf. KPL e.g. cornea plana

keratoconus

Z.n. Intact

consulting bedridden patients, etc.endocrine orbitopathiedeveloping countries

This new way of measuring was invented 1997 in Russia

173,5 x 25,5 x 19,5173,5 x 25,5 x 19,5

79 gram79 gram

Methods

1) bilateral applanation andtranspalpebral tonometry, three times measurement

2) Correlation creation of tensio values for normal and glaucoma eyes

3) Gaining experiences with transpalpebral tonometry

What‘s the innovation?

F el = m (g) x a (m/s)

tonus =F el

________________________

pin surface

no anaesthesia

no bulbus contact

no risk of infection

absolute painless

mobile

low expense

simple calibration

more harmlessthen Schiötz

mm

aa

FF

The course of measuring

The angle between the patient‘s line of sightand the horizontal should approximately be 45 degrees.As orientation for the 45 degrees you may use the patient‘s finger. The horizontal distance should matchthe vertical one.

Put the tonometer‘s end with his flat side upon the front edge of the upper eyelid‘s gristle, in order that the tonometer‘s end symmetrical axis points straight through the eye‘s center.

Let‘s look at an example:The tonometer has been activated and it has been explained to the patient, in which direction she has to look at for the duration of the measuring. The patient‘s head is stabilized by the ophthalmologist‘s free hand.

Now the tonometer is put into the right position.The tonometer is softly lowered until the measuring is acoustically signaled.

The tonometer can be removed from the patient‘s eyelidand the measured value of the intra-ocular pression isdigitally displayed.

Here another example from a different angle:The angle between the patient‘s line of sight and the horizontal is 45 degrees, the tonometer is put vertically upon the upper eyelid‘s gristle.

After lowering the tonometer, the measuring will be executed and the measured value can be read from thetonometer‘s digital display.

65 patients: 42 females, 23males

normal eyes: 49 avg. value Goldm.: 13,5 +/- 2,5 avg. value. TGD: 15,0 +/- 3,3

glaucoma eyes: 16 avg. value Goldm.: 18,3 +/- 4,79 avg. value TGD: 19,1 +/- 6,02

8 POWG5 steroid secondary glaucoma1 Lasik, 3 KPL, 1 iritis2 Phtisis 1 WBG

measured in mmHg with standard deviation

Patients and results

ap

pla

nati

on

ap

pla

nati

on

TGDc-01TGDc-0150 mmHg50 mmHg25 mmHg25 mmHg

25 mmHg25 mmHg

correlation coefficient correlation coefficient

r=0.80 in glaucoma eyesr=0.80 in glaucoma eyesP< 0,001P< 0,001

r=0.88 in normal eyesr=0.88 in normal eyesP< 0,001P< 0,001

ResultsResultsResultsResults

strong neck situation while sitting

Disadvantages

unexperienced may take wrong glaucoma precaution

later a technical perfection may be possible

a little more inaccurate than applanation

measurement sometimes easier while lying

cave tarsus pathology, e.g. trachoma?

only with learning curve applicably

Svyatoslav FyodorovSvyatoslav Fyodorov

An advocator of the new method

An unique way ofTranspalpebral tonometry

Maybe the tonometer will be soon as common as the thermometer is at home

Conclusion

Applicable on children

Pre-, intra- and postoperative applicative

Realistic values for wounded cornea

For consulting purposes it replaces schiötz tonometerMore sensitive with endocrine orbitopathy

With Lasik not wrongly low

With keratoconus not wrongly low

More hygenically

More painless

More economically

Also applicable in a practice under water.

A new method to detect glaucomaA new method to detect glaucoma

contact

If this presentation should has aroused your interest in the

Tonometer TGDc-01 "PRA", and you wish yourselves closer

information, or you wish to place an order, then please use

the listed contacts below.

P.S. Art Design GmbH

Kirchstraße 2

64521 Groß-Gerau

Tel.: +049 6152/81422

Fax: +049 6152/82082

eMail: info@tonometer.de