Goldmann Applanation Tonometry without Fluorescein

Recently, there have been several suggestions that Goldmann applanation tonometry can be performed without fluorescein. In order to determine the clinical efficacy of performing Goldmann applanation tonometry without fluorescein, 100 consecutive patients had applanation tonometry performed without fluorescein (Ophthetic only) and with fluorescein (Fluress), according to a predetermined randomization schedule. It was found that the average difference between readings with fluorescein and without fluorescein was 7.01 mm Hg. Tonometry readings without fluorescein were lower than readings with fluorescein. In addition, regression analysis indicated that the differences between the readings with and without fluorescein increased as intraocular pressure increased. By not utilizing fluorescein in Goldmann applanation tonometry, the clinician will record lower readings. In addition, greater errors in measurement occur with increasing intraocular pressures. Because eyes with higher intraocular pressures are at a greater risk to develop glaucomatous optic atrophy and loss of visual field, the merits of Goldmann applanation tonometry without fluorescein are speculative.