Cost and quality implications of changes in tonometry use by optometrists.

Tonometry, as a test for glaucoma, traditionally was performed routinely only on patients over age 40. In 1974 in the Helling v. Carey case the Supreme Court of Washington (state) held that an ophthalmologist was negligent in failing to administer a glaucoma test to a patient under age 40, and thus failing to diagnose primary open angle glaucoma. In a study performed at the Pennsylvania College of Optometry and the Optometric Center of Maryland an increase of utilization of tonometry on patients under the age of 40 was measured. Available literature indicates that this change occurred nationwide for optometrists in private practice. This change may result in an additional cost for eye care, without a strong indication of an improvement in quality of care.