pachymetry

pachymetry

(pă-kĭm′ĕ-trē)
Measurement of the thickness of a body part, esp. the thickness of the cornea.

Pachymetry

Synonym/acronym: N/A.

Common use

To assess the thickness of the cornea prior to LASIK surgery and evaluate glaucoma risk.

Area of application

Eyes.

Contrast

N/A.

Description

Pachymetry is the measurement of the thickness of the cornea using an ultrasound device called a pachymeter. Refractive surgery procedures such as LASIK (laser-assisted in-situ keratomileusis) remove tissue from the cornea. Pachymetry is used to ensure that enough central corneal tissue remains after surgery to prevent ectasia, or abnormal bowing, of thin corneas. Also, studies point to a correlation between increased risk of glaucoma and decreased corneal thickness. This correlation has influenced some health-care providers (HCPs) to include pachymetry as a part of a regular eye health examination for patients who have a family history of glaucoma or who are part of a high-risk population. African Americans have a higher incidence of glaucoma than any other ethnic group.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the diagnosis of glaucoma (Note: the intraocular pressure in glaucoma patients with a thin cornea, 530 micron or less, may be higher than in patients whose corneal thickness is within normal limits)
  • Determine corneal thickness in potential refractive surgery candidates
  • Monitor the effects of various therapies using eye drops, laser, or filtering surgery

Potential diagnosis

Normal findings

  • Normal corneal thickness of 535 to 555 micron

Abnormal findings related to

  • Bullous keratopathy
  • Corneal rejection after penetrating keratoplasty
  • Fuchs’ endothelial dystrophy
  • Glaucoma

Critical findings

    N/A

Interfering factors

  • Factors that may impair the results of the examination

    • Inability of the patient to cooperate or remain still during the test because of age, significant pain, or mental status.
    • Improper technique during application of the probe tip to the cornea.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in measuring the thickness of the cornea in the eye.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of narrow-angle glaucoma. Obtain a history of known or suspected visual impairment, changes in visual acuity, and use of glasses or contact lenses.
  • Obtain a history of the patient’s known or suspected vision loss, including type and cause; eye conditions with treatment regimens; eye surgery; and other tests and procedures to assess and diagnose visual deficit.
  • Obtain a history of symptoms and results of previously performed laboratory tests, diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
  • Instruct the patient to remove contact lenses or glasses, as appropriate. Instruct the patient regarding the importance of keeping the eyes open for the test.
  • Review the procedure with the patient. Explain that the patient will be requested to fixate the eyes during the procedure. Address concerns about pain and explain that no pain will be experienced during the test, but there may be moments of discomfort. Explain that some discomfort may be experienced after the test when the numbness wears off from anesthetic drops administered prior to the test, or discomfort may occur if too much pressure is used during the test. Inform the patient that an HCP performs the test and that to evaluate both eyes, the test can take 3 to 5 min.
  • Sensitivity to social and cultural issues,  as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still during the procedure because movement produces unreliable results.
  • Seat the patient comfortably. Instruct the patient to look straight ahead, keeping the eyes open and unblinking.
  • Instill topical anesthetic in each eye, as ordered, and allow time for it to work. Topical anesthetic drops are placed in the eye with the patient looking up and the solution directed at the six o’clock position of the sclera (white of the eye) near the limbus (gray, semitransparent area of the eyeball where the cornea and sclera meet). Neither the dropper nor the bottle should touch the eyelashes.
  • Request that the patient look straight ahead while the probe of the pachymeter is applied directly on the cornea of the eye. Take an average of three readings for each eye. Individual readings should be within 10 microns. Results on both eyes should be similar.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Recognize anxiety related to test results. Encourage the family to recognize and be supportive of impaired activity related to vision loss, anticipated loss of driving privileges, or the possibility of requiring corrective lenses (self-image). Discuss the implications of test results on the patient’s lifestyle. Reassure the patient regarding concerns related to impending cataract surgery. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Provide contact information, if desired, for the Glaucoma Research Foundation (www.glaucoma.org).
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include fundus photography, gonioscopy, intraocular pressure, and visual field testing.
  • Refer to the Ocular System table at the end of the book for related tests by body system.
Mentioned in ?
References in periodicals archive ?
This results in corneal swelling indicated by increased pachymetry readings, which could be significantly asymmetrical in the two eyes.
No pachymetry needed (more accurate: no need to adjust for CCT or other corneal discrepancies)
Tenders are invited for Digital A Scan With Pachymeter With High Contrast Touch Screen With Atleast 5 Examination Modes With Usb Interface With Built In Thermal Printer With 20 Mhz Pachymetry Probe.
Executives linked the upsurge to the launches of Wavelight FS200 and EX500 lasers, the latter of which features a multi-dimensional 1,050 Hz tracker synchronized at 500 Hz, non contact pachymetry and a 500-Hz pulse frequency laser capable of a 1.
Evaluation of intraocular pressure obtained by two tonometers, and their correlations with corneal thickness obtained by pachymetry in raptors.
And, finally, you should undergo pachymetry, in which your eye is numbed with drops, and an ultrasonic wave instrument is used to measure the thickness of your cornea.
In addition to providing a full-thickness pachymetry map prior to laser surgery, it is the first device to image, measure and document both corneal flap thickness and residual stromal thickness immediately following the procedure -- a crucial element in ensuring optimal surgical outcomes.
Optical coherence tomography and pachymetry help track the progresslon of glaucoma.
Combining OCT pachymetry with Placido disk technology may provide the most precise information possible about the back surface of the cornea," said Jack Holladay, MD, of Holladay Lasik Institute in Houston, TX.
Captured images are mathematically analysed to generate data on elevation, curvature and pachymetry.
Manual keratometer, autorefractors / Corneal pachymetry / keratometer, Instrument for measuring aberrations, dynamic accomodates and pupil size according to specifications
Regular topographic assessment and pachymetry have become a crucial part for the continuing management of keratoconic patients so that an appropriate referral for CXL assessment can be carried out.