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Contact tonometry Part 1

Clinical Practice
I n the first of two articles looking in detail at contact applanation tonometry, Dr Michael E Johnson considers the significance of intraocular pressure and the development of an accurate way of assessing it .

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Slit-lamp mounted Goldmann tonometry (GAT) has been considered the reference standard for measuring IOP for many years. It has recently become a core competency of the professional qualifying examinations and so all optometrists should be proficient in this technique.
The importance of GAT has been reinforced by the recent NICE guidance on the diagnosis and management of chronic open-angle glaucoma and ocular hypertension,1 which demand that slit lamp mounted GAT be used to assess IOP as the method of first choice in patients with glaucoma and in patients considered to have a high risk of developing the disease by clinicians involved in determining the suitability for treatment. Moreover, supplementary guidelines published jointly by the College of Optometrists and the College of Ophthalmologists for the referral of glaucoma suspects by community optometrists indicate a preference for contact tonometry over other non-contact methods,2 but in contrast to NICE do not explicitly express a preference for slit-lamp mounted GAT over Perkins tonometry.

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