[Retinography and tonometry in primary care: techniques incorporated into routine nursing practice]. / Retinografía y tonometría en atención primaria: técnicas incorporadas a la práctica habitual de enfermería.

OBJECTIVES: To determine the frequency of eye fundus examinations during the study period compared to the previous year. To find out the prevalence of diabetic retinopathy and the level of agreement between the primary care doctor and the ophthalmologist in the interpration of retinographies performed. To determine the relationship of the different variables with the prevalence of retinopathy. To describe the problems detected in the handling of the digital retinograph. And finally to determine the prevalence of increased intraocular pressure (IOP) in diabetic patients. METHODS: In the wellness area S. Gormaz Esteban (Soria, Spain) we performed a descriptive observational study on patients with diabetes. The nurse conducted a visual screening that included retinography and tonometry. RESULTS: There was moderate agreement in interpretation of retinographs. The coverage of diabetes who have undergone eye screening has increased to 50% (133). Some degree of retinopathy was seen in 38% (44) of the patients studied and the quality of images obtained in 67% (88) was good. The type of diabetes and treatment, the presence of dyslipidemia and nephropathy and years of evolution and elevated glycated haemoglobin are statistically significant variables. The mean IOP was 14.66 mmHg, and 5% (6) had levels >21 mmHg. CONCLUSIONS: The implementation of comprehensive eye screening for diabetic patients should be consolidated as an intervention in primary care and referring only patients with specialized referral criteria, doubtful cases and technical failures.

Goldmann tonometer calibration: a national survey.

INTRODUCTION: Recent studies suggest that Goldmann tonometers can rapidly develop calibration errors (CEs) in clinical use and routine checks are necessary to ensure accuracy. PURPOSE: To determine current practice regarding CE checks in the United Kingdom and assess the views of senior nursing staff in charge of running ophthalmology outpatient clinics as to whom they feel to be responsible for CE checks. METHODS: Every ophthalmology unit with training recognition in England, Northern Ireland, Scotland, and Wales was contacted. Senior nurses responded to a structured telephone questionnaire regarding local tonometer calibration practice and their views regarding who is responsible for CE checks. A total of 155 eye units were identified and contacted. The response rate was 100%. RESULTS: CEs were checked for daily in 8 units (5.2%), weekly in 20 units (12.9%), fortnightly in 1 unit (0.6%), monthly in 12 units (7.7%), trimonthly in 5 units (3.2%), biannually in 27 units (17.4%), and annually in 21 units (13.5%). CEs were either never checked or checked in a very random manner (no identifiable pattern) in 61 units (39.4%). Sixty-three (40.6%) of the respondents felt CE checks were a departmental responsibility, 48 (31.0%) felt it to be the doctor's responsibility, and 44 (28.4%) felt CE checks should be performed by the nursing staff. CONCLUSIONS: Our national survey suggests that very few units check their tonometers for CEs at intervals which ensure their accuracy. Our previous survey of doctors suggests that they believe nurses should check for CE, whereas the nursing staff believe CE checks are not their responsibility. This lack of communication between health-care professionals may lead to inaccurate tonometers being used in clinical practice. We suggest that every eye unit should have a protocol, which clearly identifies individuals responsible for checking for CEs at least on a monthly basis.

Improving the accuracy of intraocular pressure readings.

AIM: To discover whether a protocol for calibration can improve the accuracy of intraocular pressure measuerements. METHOD: A protocol for checking the calibration of equipment was implemented in an ophthalmic outpatient department. After seven months, calibration checks were compared with those done on equipment in other ophthalmic areas that were not following a protocol. RESULTS: There was a statistically significant association between errors and areas not following the protocol (p = 0.02). In comparing errors found in the area using the protocol with all other areas, a significant difference was evident at the test point of 20 mmHg (p = 0.003). CONCLUSION: Using a protocol significantly reduces calibration errors.

Tonometry.

Tonometry is the measure of intraocular pressure. There are several methods used to obtain intraocular pressure, such as Goldmann applanation tonometry, Tono-Pen tonometry, pneumotonometry, and tactile tension. All these methods have advantages and disadvantages. Measurement of intraocular pressure plays an important role in the detection and management of glaucomatous conditions. It is important that the examiner be aware of the various methods and their shortcomings to obtain the most accurate measurement. By obtaining the most accurate intraocular pressure by tonometry, the diagnosis and management of glaucoma can be enhanced.

Glaucoma screening: an important role for NPs.

Glaucoma continues to be a major cause of blindness and visual impairment in the United States today. However, with early detection through screening followed by prompt treatment, sight can be spared. This article discusses the pathophysiology of both acute open-angle and acute and chronic angle-closure glaucoma and describes the high-risk population. The rationale behind obtaining an accurate intraocular pressure reading and converting the scale reading to mm Hg is explored. A step-by-step outline of the procedure for Schiotz tonometry is presented. Nurse practitioners who are functioning within primary care settings can provide valuable early detection screening to high-risk clients and make timely referrals for further evaluation.