Goldman Applanation Mires for Glaucoma (Video)

This video shows the view you have when checking eye pressure (glaucoma check) with the goldman applanation tonometer. This device flattens the corneal surface of the eye, and by determining the amount of force required to flatten a measured area, can calculate the inner ocular pressure.

Applanation is one of the harder steps for the beginning ophthalmology student, and can be tricky in patients with sensitive eyes and aggressive blink reflex. Also, it requires that the patient be able to sit up at the slit-lamp, which can be tricky in the infirm and the very young.

Goldman applanation tonometry is based upon the Imbert-Fick principle: such that the IOP measurement can be determined by the amount of force needed to flatten a fixed area of cornea. In this case, we are pushing on the eye with the blue-light applanator, and trying to flatten a round cornea surface with a diameter of 3.06 mm (that’s the area that our variable-force scale is callibrated for).

To ensure we have the correct sized area depressed, the plastic contact point has a prism in it designed such that you know you have the correct size area when the two hemispheres touch (like in these pictures).

Download this video

To download this video, right click on a link below and choose “Save Target As…”

applanationmires.wmv (2.9meg, Windows video file)

Screencaptures

Goldmann applanation
This photo was taken at the slit-lamp microscope and shows the view you have when checking eye pressure with the Goldman applanation tonometer.
Goldman glaucoma
This photo shows the fleuroscein mires that you see when checking the pressure using the goldman tonometer. The trick is to adjust the pressure such that the two yellow circles touch (like in this photo)
Applanation mires
You can see the Fleuroscein circles (the yellow semi-circles) on either side of the horizontal devide.
SHARE
Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:

16 COMMENTS

  1. I was surprised to find that the video of applanation mires is mixed up with anterior polar cataract. On downloading appalanation mires the video is that of anterior polar cataract! Please correct. Otherwise I am quite impressed with your site!
    Dr Neelam Puthran

    Editors Comments:
    Sorry about that … I’ve fixed the download link. Thank you for pointing this out for me!

  2. thanks , i was searching for the video of applanation tonometry for a ppt , Iam very happy to have found this site

    Dr Rupa

  3. It is a very nice photos and video but i would like to ask a question please
    where should ,classically,i put the illuminating arm to the side of the eye to be measured or to the reverse or to the right side whatever which eye is measured or it does not matter?

  4. I have no idea who designed this website or took that photo but THAT IS NOT AN ACCURATE DESCRIPTION of what you should see when using the Goldman Applination Tonometer. The half circles pictured show the GREEN (as it should be) circles touching on the inner portion of each other and this is EXTREMELY INNACURATE. These half GREEN circles should just barley touch each other just on the outside of each other. If you were to use the IOP reading using this image you would have an inaccurate reading.

  5. No offense, Tech, but I think the picture and description on this page is actually pretty acurate. You want the INSIDE edges of the circles to barely touch each other for an accurate reading. That is what you see in this photo, and more importantly, what is demonstrated from the associated video.

    The prism built into the applanation tip is set so that when a perfect 3mm diameter area of cornea is flattened, the INSIDE edges of the mires touch. It doesn’t make sense to lineup the outside edges of the mires … as the outside edge of those circles vary in size depending upon how much fluoresceine is in the tear film.

    You may want to check to see if you have been checking your pressures correctly. Also, you might find it useful to run a google image search on the word “applanation” – you’ll see that everyone else is making the INSIDE edges line up as well.

  6. More info please! Can you post a video of step by step instructions on how to use the Goldmann tonometer with dial control details from start to finish?! This would be extremely helpful for an assistant getting ready to test for the COA. Thanks in advance!

  7. Yep … width looks correct.

    In general, the skinnier the mire width, the easier it is to line up and measure. This means, you should use as little fleuroscein as you can get away with. Put the drop in, have the patient dab as much out as they can, wait a little while, dab more … then applanate.

    The hardest eyes to applanate are those filled with yellow dye and who blink a lot during pressure check. The dye gets all over the applanation tip and makes the mires too thick to read properly.

  8. Thank you sooo much for taking the time of making and posting the videos, they are SOOOO VERY HELPFUL..THanK YOU THANK YOU THANK YOU

LEAVE A REPLY

Please enter your comment!
Please enter your name here