The Finnish company, Icare Finland Oy, has donated an Icare Tonometer to the A & E department at Bowmore Hospital on the Scottish Island of Islay.
The easy-to-use Icare tonometers are revolutionising effective early glaucoma detection. Tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. Icare is transforming IOP monitoring
by making the IOP measuring routine quick, effortless and effective. It is already proving its worth in the A & E department on Islay.
Dr Kate Pickering, a GP who practices on Islay says “All the patients who present with a headache are now routinely examined with an Icare Tonometer to ensure that they do not have glaucoma so although we have had it for a short period of time it is already proving its worth. It is a real asset in the A & E department.”
Walter McLean, a resident on Islay instigated the donation of the Icare Tonometer and his experience illustrates the case for having an Icare Tonometer in all A & E departments.
“I had been seeing my GP about severe headaches”, says Walter. “My GP diagnosed “cluster headaches” a type of migraine and he tried to arrange a CT brain scan as an outpatient. Then one day I suddenly developed a really intense headache. I felt as if a brick had landed on my head and I felt nauseous. My right vision was foggy. I called my GP, who thought I had a subarachnoid haemorrhage, perhaps an aneurysm had burst. Islay is cut off from the Scottish mainland and advanced hospital facilities so we had a problem.”
Mr McLean’s GP said that he should be admitted immediately to hospital by air ambulance. When he arrived, he was rushed into casualty. The doctors and nurses quickly assessed him and agreed that he probably had a brain haemorrhage. He was then rushed to X-Ray for an emergency CT scan. Surprisingly, the result was normal. It was now impossible for Mr McLean to get home and he was still in agony so he was admitted onto a medical ward. The doctors said that sometimes a haemorrhage takes time to show up so he had a further brain scan two days later and a lumbar puncture. All the results were still normal so he was discharged and advised to take paracetamol and come back if there was any further problem. None of the doctors appeared to be concerned about his blurred vision.
“I was admitted as an emergency for a second time because of another severe headache”, explains Walter McLean, “This time, to make matters worse, the weather was really foul with a 60 knot cross wind so helicopters could not fly. A brave pilot agreed to take me by fixed wing plane performing at its ‘operational limit’. The cross wind meant that the plane had to take off sideways. This was very scary, especially as I was so unwell, with a severe headache and nausea. My GP gave me morphine to help me to cope with the flight.”
“The doctors seemed puzzled about my crashing headache and nausea” continues Mr McLean. “I now had trouble seeing out of my left eye. I saw a total of 13 doctors, including GPs and hospital physicians and A & E consultants. Then an FY1 junior doctor noticed that one of my pupils seemed large and fixed. She suggested that the ophthalmologists should review as perhaps the problem was acute glaucoma.”
The diagnosis was quickly confirmed in the eye department. Mr McLean had bilateral acute angle closure glaucoma with very high pressure in both eyes. Thirty minutes later, after the eye consultant put a drip into him, the pain vanished. The relief was unbelievable as the eye pressure came down. The original attack was on the right eye and then the left eye had followed suit ten days later. It seems that the doctors had missed the diagnostic sign of a fixed mid-dilated pupil and in any case they were unable to measure intraocular pressure.
“My ophthalmologist said I was very lucky not to be permanently blind in both eyes,” says Walter McLean. “Fortunately, he was able to make small holes in the coloured iris of each eye, using a laser to prevent the build-up of fluid and pressure in the future. Since then, I have been completely free of headaches and don’t need any on-going treatment for glaucoma now. I have learnt that most doctors find it hard to examine and diagnose eye conditions. My ophthalmologist said acute glaucoma is often misdiagnosed as migraine because the symptoms are so similar (headache, blurred vision with nausea or vomiting).”
“The equipment optometrists and ophthalmologists use to measure eye pressure is very sophisticated”, says consultant ophthalmologist Dr Robert Harvey. “But there is a device made by Icare in Finland that makes eye pressure measurement quick and simple even by non-experts. It would be a great asset in hospital A & E departments and larger GP departments. The Icare Tonometer does not require the use of anaesthetic or eye drops.”
As Walter McLean points out “I wish there had been an Icare device on my island of Islay. It could have spared me 2 emergency air ambulance flights. If the hospital that treated me had the device, it would have saved me from numerous costly investigations, including the repeated CT scans and that would have also been less cost for the NHS.
Icare Tonometers are available from Mainline Instruments Ltd, Birmingham Mainline can be contacted on 0121 458 6800 or by email at: firstname.lastname@example.org
Ends: March 2013
For further information contact Evelyn Vittery, Bloomsbury Communications 01892 518980 or 07711 706253
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