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Thread: MD's rechecking IOP's: Discuss

  1. #1
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    Angry MD's rechecking IOP's: Discuss

    I've worked as an eyecare professional for ten years with some of the top glaucoma docs in practice, one of whom actually wrote "The Glaucoma Book".
    Recently I started working with a new ophthalmologist who re-checks my IOP's (many minutes later) and after every patient comes back to tell me that she finds the IOP SEVERAL points lower, every single time.
    I asked her specifically if she is putting more fluro in the eye before she checks...she says no.

    My point: She is not putting more fluro in when she re-checks IOP, and so...the mires are thinner and therefore, the IOP would SEEM lower.

    I'm confident in my abilities and do not doubt my measurements.

    I find this annoying and more. But I'd like to hear some other opinions.

    Is this happening to you? How do you deal?
    Am I over reacting?

    Ben

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    Goldman I presume?

    Trust but verify? It's her license on the line in the end, you did say you are new to the practice.

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    Thanks for the welcome.

    Yes, Goldmann tonometry.

    Yes, it's her license on the line, and I'm concerned about that too.
    If she consistently undermines my findings by performing the same measurements INCORRECTLY and finds lower readings of IOP and treats the patient based on incorrect readings...? That's a huge problem and a disservice to the patient.
    I am new to working with her, not the practice (I should have been more specific)...all of her colleagues have had zero issues with my work.

    I would never presume to tell a physician that they are doing something the wrong way, but this is really bothering me.

    Thanks for the feedback

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    How can you be so sure the doc is wrong and you are right?

    Have you had the tonometers in question calibrated?

    Although the raw numbers are somewhat important, consistencyand comparison is more important. I often treat glaucoma patients with lower pressure more aggressively than those with higher. It's not just about the numbers that you find TODAY.

    What's important to a doc is that iops are lower under treatment than they were before, regardless of where they started. I don't like monitoring the changes over time across different tonometers even if they are calibrated, let alone different operators. So maybe the doc needs to compare numbers that they took before you worked there to the numbers that stand today.

    There are so many more items to consider when treating glaucoma. Ask your doc about them. I sure there is a reason your doc is repeating the readings, and it is not just to make you look bad.
    Last edited by fjpod; 10-23-2015 at 05:04 AM.

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    What's up? drk's Avatar
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    You're right, bfd. If your mires are too fat, or hers are too thin, you're going to get discrepancies. You should arrive at a consistent protocol, i.e. one drop, wait 30 seconds, measure.

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    Doh! braheem24's Avatar
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    Find a Tonopen to use for a week.

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    All good points to consider and thanks. The reason I'm so confident that she is getting falsely low readings is because of how she is rechecking the measurement.
    She's checking the IOP more than 5 to 8 minutes after fluro is first applied and is almost completely gone from the eye, therefore she's measuring with mires SO THIN I may as well ignore the fluro completely and just use alcaine and hope I can see the whisper thin mires in the first place.
    If I find an IOP of 25mmHg and she then finds an IOP of 18mmHg...? Really? Nope, nope, nope.

    Today as a test, when I found a historically high IOP by Goldmann applanation, I used the tonopen to back my findings.... She argued that tonopens are worthless, however she did not argue with the IOP I found and the patient is now being treated as a glaucoma suspect, starting on drops and rechecking IOP in three weeks.
    (Also, the patient has a family hx of glaucoma, fyi)

    I went thru her clinic rooms and checked calibration this morning and found the devices to be wnl.

    Also, I am not the only technician in this practice to have had these exact same complaints.

    I'm just concerned and frustrated.
    Thanks for the feedback

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