tonometer

RE: tonometer

Robert Lowe — Fri, 07 Dec 2018 12:20:27 GMT

I advise that on average the second eye will survive 2 years with medical management but it could be 2 weeks or 10 years. The evidence base suggests that prophylactic treatment is of no help but I still do it even if it just keeps the owner in touch and getting repeat intraocular pressure measurements it may help.

I agree that it is a rare day you can save the first eye as often they present too late to turn them around and your treatment options are completely valid. In cases that do present early enough even if they have sky high intraocular pressures it is still possible to get a good outcome surgically in the first eye.

So in the majority of cases I counsel owners that at some point in the future the second eye will go and that if we intervene early surgically, while still having evidence of an increasing intraocular pressure so that we don't operate on eyes that are likely to survive long-term anyway, we can preserve vision for well beyond the expected time frame for medical management alone.

RE: tonometer

Beats — Fri, 07 Dec 2018 10:41:43 GMT

This is interesting discussion.

Can I just clarify (I think I'm right on this) that this chat has been about the eye remaining visual rather than the dog remaining visual?

I reckon maybe 50% of dogs with a glaucoma eye (I tend to enucleate these quite early) remain visual for the rest of their lives. But I think you are talking about saving the eye with the problem.

For the bilaterally affected cases, is the surgery success with the first eye that goes glaucoma or with the second eye to stop it doing the same?

I don't *think* anyone nearby does surgery on glaucoma eyes (probably not a big enough case load to get good at this?).

I tend to enucleate the blind glaucoma eye (they often seem to have gone blind by presentation, or again that might just be me) and histopath and if cause is likely to affect bilaterally, then start some "prophylactic" trusopt and/or latanoprost in remaining eye - though I'm very unsure if this is wise or not.

Occasionally, if don't want to enucleate, and is painful, inject vitreous with gentamicin (5minute GA versus 30minute GA in say very compromised older patient) - can I check-in if that is still considered a thing to do or not.

RE: tonometer

Bob Russell — Fri, 07 Dec 2018 09:45:38 GMT

We have a JRT that is still visual after three years. On Trusopt and Latanaprost.

Our head nurse does spend quite a lot of time sourcing the medication to keep supplies coming at a reasonable cost for the owner.

RE: tonometer

Arlo Guthrie — Fri, 07 Dec 2018 07:43:11 GMT

[quote user="Robert Lowe"]***WARNING following information contains self promotion and unpublished data***[/quote]

Disgraceful

RE: tonometer

Robert Lowe — Fri, 07 Dec 2018 00:20:33 GMT

We are gradually switching over to Tonovets from Tonopens. They are much preferred by the nurses for ease of use. However the humble Schiotz is very good at what it does as long as it is kept meticulously clean.

***WARNING following information contains self promotion and unpublished data***

Also as a side note not all glaucoma ends in failure. It’s just expensive and complicated to treat . We aim to get about 50% of eyes to remain visual and normotensive at end of the dogs life if surgery is an option.

RE: tonometer

Beats — Thu, 06 Dec 2018 20:24:19 GMT

I got a schiotz tonometer 12 years ago when i graduated and it has followed me since.

Personally, I wouldn't pay for anything else.

It tells me what I need to know: is that red eye I'm unsure about glaucoma or uveitis.

Bit of a fiddle, fair enough. But given the rather seldom need (and fact that glaucoma eyes invariably go blind eventually anyway... or is that just me?) I couldn't imagine spending money on anything else.

Worked in one practice with tonopen/tonovet. it got wheeled out with similar frequency to the schiotz did in the other clinics. Ironcially, the practice that had it was also the only practice that didn't consider stocking latanoprost (Xalatan only at the time) in case of glaucoma arrival; if they had split the cost of the tonopen/tonovet into bottles of Xalatan and binned one when it expired and replaced it, this may have benefited more patients (albeit still minor benefit for small number of patients...) than the advantage of tonopen/tonovet over schiotz in my estimation at the time.

I think the Schiotz cost about £70 - if I had personally profited from the small amount of money I charged per use then it would have paid itself off in 3 years I reckon, having said that I have considered selling it on a few occasions... I put a cheat sheet together so others in the clinic could use it (and clean it again after...) also, but they rarely do.

RE: tonometer

Helen Perryman — Thu, 06 Dec 2018 19:48:50 GMT

I've used manual tonometers in the past and have found them vaguely useful (i.e. you can diagnose clear glaucoma easily with them). They are a bit of a faff to use and getting the dog to keep still in the right position can be a challenge. I find that the exact value given seems to vary quite substantially and would choose a tonopen for monitoring but it is certainly better than nothing. I'm currently working at a practice which has a tonovet tonometer and I have to say that I prefer the manual one to this, it seems really temperamental and the probe keeps falling out! I've used the tonopen vet and tonopen avia vet in the past and really like them, they've always seemed to work well and are easy to use.