Obtaining valid consent
Goldmann tonometry is a procedure for which you must obtain valid consent. The patient must understand what you intend to do, what benefit it is to them, and what potential risks are involved.
Contact tonometry is a relatively straight forward procedure, with minimal risk. The main risk is corneal abrasion. If performed correctly, the chances of a patient obtaining an abrasion are very low. It is important to stress this to the patient. To keep this risk low, Goldmann tonometry should be avoided in patients with active corneal pathology.
Obtaining valid consent for Goldmann tonometry is a potential minefield, as it is important the patient fully understands the procedure, but there is a lot to say. It is very easy to accidentally frighten a patient or put them off the procedure by saying too much! Below are some suggestions of how to speak to a patient about Goldmann tonometry.
‘With your family history of glaucoma, I think it might be a good idea we do a pressure test today. The equipment I am going to use is regarded the most accurate way of checking the pressure in your eye. Most patients prefer it to the ‘puff of air test’. I will need to pop a numbing drop into your eyes and some dye, then use this machine to come close to your eye and briefly touch the surface. Because of coming so close to the eye, there is a minimal chance of scuffing the surface. If this happens we will give you some lubricant drops to help the scuff heal. This takes 24 hours. Would it be okay if we do this test?’
‘Your eye pressure has come up a little high today with the ‘puff’ machine. I have a more accurate piece of equipment that checks the pressure, and would like to re-check it to make sure it is not too high. It is important we do this, as high pressure may indicate possible glaucoma. I will pop a numbing drop and some yellow dye into the eye, then use this blue light to come very close. The blue light will briefly touch the front surface of your eye to check the pressure, but you won’t feel it. It is unusual, but sometimes the blue light can leave a little mark on the eye which will be a bit uncomfy for a day. It is very unlikely to happen, but if it does we will give you some tear drops for this. Would it be okay if I check your eye pressure with this machine?’
Duty of Candour
As part of ‘duty of candour’, it is important to tell patients when things go wrong. This is outlined in point 19 of the General Optical Council standards of practice for optometrists and dispensing opticians.
- Be open and honest with your patients when you have identified that things have gone wrong with their treatment or care which has resulted in them suffering harm or distress or where there may be implications for future patient care. You must:
- Tell the patient or, where appropriate, the patient’s advocate, carer or family that something has gone wrong.
- Offer an apology.
- Offer appropriate remedy or support to put matters right (if possible).
- Explain fully and promptly what has happened and the likely short-term and long-term effects.
- Outline what you will do, where possible, to prevent reoccurrence and improve future patient care.
- Be open and honest with your colleagues, employers and relevant organisations, and take part in reviews and investigations when requested, and with the General Optical Council, raising concerns where appropriate. Support and encourage your colleagues to be open and honest, and not stop someone from raising concerns.
- Ensure that when things go wrong, you take account of your obligations to reflect and improve your practice as outlined in standard 5.
Supplementary guidance from the General Optical Council on the Professional Duty of Candour can also be found here.
The most likely complication of Goldmann tonometry is corneal abrasion. You can find out more about this here.
