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A common question asked during the eye exam is, “When is the puff coming?”  

Patients are referring to air-puff or non-contact tonometry. Tonometry is the procedure used to measure eye pressure, and this is important for diagnosing and monitoring glaucoma.

In non-contact tonometry, a puff of air is used to measure the pressure inside the eye.  The benefit of this test is there is no actual contact with the eye, but the air puff is sometimes very startling for patients. Some people hate that test and it isn’t the most accurate way to measure your eye pressure.

Some doctors don’t even use the air-puff test. Instead, they place a yellow drop that consists of a numbing medicine and then shine a blue light on the eye. This is done in front of the slit lamp and a small tip gently touches the eye to measure the eye pressure. This procedure is called Goldmann tonometry and is considered the gold standard for measuring eye pressure.  

Another method for checking eye pressure is the Tonopen. This is a portable, hand-held instrument that is useful when patients can’t sit in front of the slit lamp to have their eye pressure checked. The Tonopen also requires a numbing drop to be placed in the eye, and the tip gently touches the eye.

A common question related to tonometry is “what normal eye pressure?”

Normal eye pressure ranges from 10-21 mm Hg. Eye pressure doesn't have any relationship to blood pressure. Many times, people are surprised that their eye pressure is high, but they have normal blood pressure. In general, there is no diet or exercise that will significantly affect eye pressure. It is therefore important to have your eye pressure checked regularly because there are usually no symptoms of high eye pressure until it has affected your vision.

We sometimes get asked, "Why do I need an eye exam when I can see great?"

An eye exam doesn't just check your visual acuity--we are also looking for a number of treatable eye diseases that have few or no visual symptoms in their early stages. In fact, the three leading causes of legal blindness in the United States all start with almost no visual symptoms detectable by the person wit the disease. The three diseases are macular degeneration, glaucoma, and diabetic retinopathy. Each of these diseases gets more prevalent as people age. That is why regular eye exams are recommended to become more frequent as adults get older.

Macular Degeneration: The leading cause of legal blindness in the United States is a treatable--but not curable--disease. Early detection and treatment can significantly improve the long-term outcome. In the earliest stages, often when people are unaware that they have a problem, treating the disease with a very specific vitamin regimen called AREDS 2 can help. These vitamins have been shown to slow the progression of the disease and to improve long-term outcomes. When the disease becomes more advanced there is the possibility of bleeding in the retina. If left untreated, that almost always results in severe visual loss. There now are several medications that, when injected into the bleeding eye, can arrest the bleeding and potentially improve vision.

Glaucoma: The second leading cause of legal blindness in the United States is often called "the silent thief of sight." With glaucoma, there can be severe damage to the optic nerve before a person recognizes he is having a problem. Usually by the time a person notices symptoms, 70% of the optic nerve is destroyed. As of now, once that damage has occurred it cannot be reversed. This makes early diagnosis absolutely critical to saving your sight. In most cases (but not all) early detection and treatment can preserve functional vision throughout your lifetime.

Diabetic Retinopathy: This is another leading cause of legal blindness that has no visual symptoms until the disease is in its advanced stages. Every diabetic should have an annual eye exam to check for signs of retinal disease. If detected and treated in its early stages, the disease can usually be controlled and the vision preserved.

As you can see, there are very strong reasons to have your eyes examined regularly in order to keep good visual health and function throughout your lifetime.