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Fear of the glaucoma test
February 23, 2011 9:30 AM   Subscribe

How can I learn to tolerate glaucoma tests?

I've always had a very strong don't touch my eyes reflex. I'll cheerfully go to the dentist, give blood, whatever, anything but my eyes. I can't give myself eyedrops, and optometrists have told me, "yeah, don't even bother trying contacts."

Glaucoma tests are the worst by far. I've never been able to hold still for the puff, and I can't do the one with the blue ring of light either, because I know that thing is going to touch my eyes. Even the numbing eyedrops freak me out a little: they make me feel like I have holes in my eyeballs.

My last full eye exam was over ten years ago; I don't remember the details, but I recall that I panicked and the doctors tried to hold me down. (They let go and gave me a moment to breathe, and I think maybe then I actually ended up sitting through the test for once - but again, I can't recall for sure.) I've been to eye doctors a couple times since then, for minor complaints. A few months ago I went for what turned out to be a case of dry eyes, and the doctor figured he'd do the blue-light test for good measure, and my reaction was "okay, I think I can do that I'm calm NOOO AUGGHH UNCLE."

I've broken my glasses beyond repair and my prescription is years out of date, so it's time to get my eyes checked, and I want to get it over with.

Can I simply opt out of the glaucoma test when I go? How do I explain it to the optometrist? Can I put it off indefinitely, or is there a point when I'm going to have to suck it up?

More importantly, how can I overcome this fear/reflex? It's not going away on its own, and I don't want it to get worse. (I'd rather not resort to medication, but the thought has crossed my mind.)
posted by Metroid Baby to Health & Fitness (33 answers total) 2 users marked this as a favorite
 
Just suffer it for the few milliseconds. I hate them too. Although, I had my vision tested last year and the optometrist used a new machine that wasn't nearly as bad (there was still a puff, but the machine didn't seem like it was about to send a ramrod through my skull). Maybe call your optometrist and ask if they have the newer devices?

Still, don't put off getting your vision checked. You can just say no to the glaucoma test if it's that bad for you. I personally don't like dental x-rays so I tell my dentists no thanks even when he protests. It's your body.
posted by Burhanistan at 9:34 AM on February 23, 2011


Sure you can opt out. No health care provider can perform a procedure without your consent. If you decide you never want to be tested for glaucoma, that's up to you.

But it's a good idea to get screened, because early detection and compliance with treatment regimens can significantly slow down vision loss. You might want to read about it here.

As far as getting over the reflex, I'd suggest just getting yourself some eye drops and using them every day under the theory that you'll eventually get used to it. Everyone's got a "Don't touch my eye!" reflex, some stronger than others, but like any reflex, conditioning works to some extent.
posted by valkyryn at 9:36 AM on February 23, 2011


Is this a "I really don't want it" situation or a situation where you're overcome with unreasonable fear and anxiety?

The answer to the first question is will power. Take Burhanistan's advice and just endure it. Tell yourself it's for your health and that as much as you don't like to have your eyes touched, it's better to have them be touched for a few seconds then to go blind.

If it's the second situation, that sounds more like a phobia. If even the thought of it invokes a little anxiety reaction, then will power might not be your answer. Unfortunately you're looking at therapy and medication if you can't talk yourself out of the panicked reflex.
posted by royalsong at 9:39 AM on February 23, 2011


I can't give myself eyedrops, and optometrists have told me, "yeah, don't even bother trying contacts."

That's completely ridiculous. I was one of those people--the tech had to roll the solution into my eyes to dilate them. I finally decided I wanted to wear contacts, partly because of the obvious benefits over glasses, but also to overcome my ridiculous "OMG MY EYES" reflex. I'll admit, it wasn't easy. And there were quite a few (emotional) tears shed as I struggled with getting those contacts on my corneas. But within a week, I was fine, and at this point, it takes me ten minutes max to get my contacts in. I don't know how I'll do with the glaucoma test the next time I go for a checkup, but I'm fairly sure I'll do better than I did last time.

So in my case, facing my fear by trying (and succeeding with) contacts has helped a ton. At least try it--it's a relatively inexpensive (just the cost of the appointment and cheap/sample contacts) potential resolution.
posted by litnerd at 9:40 AM on February 23, 2011 [1 favorite]


Some doctors have a new glaucoma test that doesn't involve anything touching your eye. I can't remember exactly how it works but I remembered my eye doctor offering it when I told him that I can't sit still for the puff of air. Maybe look for one that has this option?
posted by joan_holloway at 9:41 AM on February 23, 2011


What's the part that actually scares you so much about it? That might help to figure out. I hate when the puff happens because I spazz out and smash my head into something. Then I realize that I'm certainly not the first person to have done that (though I always remember after the test). Seconding advice that you could always opt-out.

Good luck!
posted by raccoon409 at 9:49 AM on February 23, 2011


You can definitely opt out. The glaucoma test results in a migraine for me, every single time, and when I say migraine, I mean the kind that knocks me out of commission for the entire day. Even taking meds ahead of time doesn't stop it. So I opt out for the yearly test and only do them every three years. My opthamologist is okay with it and says she'll start doing them more frequently if things start looking iffy.

Maybe if you know you won't have to do it every year it'll be easier to deal with.
posted by cooker girl at 9:49 AM on February 23, 2011


I can't remember -- is the "blue ring of light" the one where it slowly comes closer and closer? I HUGELY prefer that one, but, again, you've said that it doesn't make much difference. (I can't even feel it.)

This definitely sounds like the kind of thing that has turned into a learned reaction, one that has little to do with the eye itself anymore. Can you talk to a counselor about it, or at least pursue some anxiety/phobia-conquering strategies with a book or something? Also, I don't know if it would get in the way of other parts of the exam, but maybe you could ask your primary care doc if Xanax or similar would be an option (in a one-time form). Hell, you're going to get dilated anyway, right?

If you can somehow get through this one exam, you'll be so much closer to feeling better about future ones.

Dental work and ophthalmology aren't the same, but people have similar phobias w/r/t visits. I hadn't been to the dentist in a good six or seven years before going back last year, and I was SO surprised at all of the great changes in technology and comfort. I imagine your doctor's office will likely be similar. If you give it the benefit of the doubt, I won't guarantee that it'll be all kittens and lollipops, but it will likely be a lot less scary than you'd expect.
posted by Madamina at 9:52 AM on February 23, 2011


What kind of glaucoma risk do you have? I have to get them every year because pretty much everyone in my family has developed severe though manageable early-onset glaucoma, but I wasn't aware that the test was recommended annually for those without a high risk.

Would you be able to ask your doctor for a mini-prescription of ativan (they can prescribe just one or two pills) to take an hour or so before the test? I might actually try that for my next exam, because I have trouble relaxing enough to complete the test myself.
posted by Frowner at 9:53 AM on February 23, 2011


Frowner, most US optometrists/opthalmologists do glaucoma screening as a routine part of the annual eye exam for patients over 40. (Can't speak to other countries' practices though.)

Metroid Baby, you need an eye exam ASAP, and you can certainly opt out of the glaucoma check for this one. When you make the appointment, ask them to note that, and then reinforce it when you check in for the appointment, and then when the doctor comes in (before the exam starts).

But you do need to have a glaucoma check sometime, so maybe start working on it between now and next year's exam. Think about using self-help techniques like those in Feel the Fear and Do It Anyway, or working with a cognitive behavioral therapist for a few sessions doing desensitizing, or a mild sedative/anti-anxiety medication.
posted by Sidhedevil at 10:07 AM on February 23, 2011


Ask for the drops instead of the puff. I had the same anxiety about the glaucoma tests, because I had to start getting them when I was a little kid. My doctor now uses applanation tonometry-- which is a couple of yellow drops in the eye, and then he uses the slit light machine to look into my eyes. No puff of air at all.
posted by headspace at 10:10 AM on February 23, 2011 [1 favorite]


Perhaps you could request a field of vision test instead (those are completely noninvasive; you look through a viewer at a screen and dots are flashes in various places.) The downside is that it can only catch glaucoma or other disorders if you've already developed some impairment. Maybe that in combination with less-frequent direct-in-the-eye testing, as cooker girl suggested?
posted by kagredon at 10:16 AM on February 23, 2011


I wish I knew how to fix it - I have unbelievably bad "don't touch my eyes" issues, too, and due to my birthmark I'm at risk in my left eye. I wish I could get GA for eye exams. Sigh.

Anyway, you can absolutely opt-out. If they don't listen, having a panic attack really reinforces the request for next time. Not that I, uh, can speak from experience or anything. (Even reading this thread is inducing some unpleasant symptoms.)
posted by SMPA at 10:17 AM on February 23, 2011


Is this a "I really don't want it" situation or a situation where you're overcome with unreasonable fear and anxiety?

It's a strong flinch reflex that I have trouble getting past or controlling. Even if I'm calm going into it, I flinch. I guess my reflex has informed my fear, so I'm not only afraid of the blue light thing, but also the possibility of me jerking my head and poking my eyeball.

I like the idea of practicing with eyedrops.
posted by Metroid Baby at 10:17 AM on February 23, 2011


Years of wearing contacts has taught me a couple of things, and one of them is that my eyes are not nearly as sensitive as I thought they were. I can touch the actual eyeball (not over a contact, but the eyeball) at the edges, in the white, without pain. I can touch the inner red edge of my eyelids, where they would usually touch the eye, without pain. In both of these, I can feel it, but it doesn't hurt.

If you are up to it, you could try teaching yourself to touch your eyes, very very slowly, by gradually expanding your comfort zone. Can you rub your eyes when they're closed? Can you do that, then crack them very slightly open, so you're still rubbing your eyelids, but you can see it?

Can you rub the outside corner of your eye, when your eyes are closed, then eventually open them just enough to touch the eyeball very gently? Extremely clean hands. If you turn your eye in to look at your nose, you won't even see it happening. If you think you might jump and press too hard, obviously this isn't something you can try. But if you're more likely to just yank the hand away, maybe you can do this.

Maybe it would even help to put your hands over your closed eyelids, and roll your eyes left and right. You can feel this happening, through the eyelids, but nothing is touching the eye, and the eye can't see anything to make you jump.
posted by galadriel at 10:25 AM on February 23, 2011


The tech is in control of the dingus-- they're not going to let your eye get poked, even if you startle.

I recommend GenTeal moderate dry-eye drops for practicing; they just wet your eye, and they have a definite feeling of solidity behind them, so you know you're getting a drop in your eye.

(Remember, don't hold your breath for the tonometer even though you want to; it'll skew the reading.)
posted by fairytale of los angeles at 10:49 AM on February 23, 2011


Switch to a doctor who does it with the laser measuring thingie. I had glaucoma tests so much that I used to take my own release form along with me after this one time when the doctor and I BOTH ended up in tears after I flinched 30 zillion times. I mean, like, you know at the end of 1984 where they put the caged rats on his chest and he confesses to anything they want? THAT'S ME AND GLAUCOMA TESTS. And having to do it over and over finally put me into hysterics, which sent the frustrated doctor over the edge too. Anyway, I just took my own release form with me after that that said, "I understand that by refusing this test blah blah blah ..."

Then I moved and ended up at a very high-tech eye place. They have a laser-measuring-test-thingie. It's over like that and nothing touches my eye and it doesn't come near enough to freak me out. So find that.

There's also an older test that uses a thing that I think of as like a tire pressure gauge? It looks like a pen and they POKE your eye with it. Your head doesn't have to be held immobile and I think they can poke the white, not the iris area, so you don't necessarily see it coming. I still kinda freaked out about that one, but since I couldn't see it coming the doctor got it on the first try and I could just freak out afterwards instead of over and over for 30 zillion attempts.

PS -- Rachel's inability to sit still for the air-puff test was the plot of an episode of Friends. I think it's pretty common.
posted by Eyebrows McGee at 10:51 AM on February 23, 2011


I've never been able to sit still for the puff, and I worked as an optometrist's assistant for 5 years, administering the puff to other people! The puff test is called "non-contact tonometry" and the one with the ring of light is called "applanation tonometry"... At present there are no alternative tests that will measure your intraocular pressure, but if you absolutely can't tolerate either test, the doctor can at least check to see if you've had any glaucoma-related vision loss by having you take a visual field test (no eye touching required!)

So, echoing what others have said about not putting off your exam any longer. You are allowed to opt out of the tonometry tests (you may have to sign a waiver stating that you understand the risks of not being tested). But definitely ask about the visual field test, because it will give you some peace of mind if your results are normal.
posted by amyms at 10:58 AM on February 23, 2011


There are a few testing options.

I've been through the optic nerve computer imaging. It's looking straight ahead, into a machine, as a laser passes by -- maybe 10 seconds per eye? I found it less annoying than the blue lights. I don't know if it requires drops, as I'd already had them before that test. It's precise in examining optic nerve damage, though it doesn't measure eye pressure. (One other thing...my insurance required a separate copay, obviously YMMV.)
posted by gnomeloaf at 11:06 AM on February 23, 2011


Just want to chime in that you need to find some way to overcome your reflexes so that you can take the test. I only say this because I had the exact same issue as you for a long time, though the blue light version was mildly less difficult for me than the air puff version. I only got over it when I discovered that I had pigment dispersion syndrome and, in short order, pigmentary glaucoma. There's nothing like a long-term fear, in this case of blindness, to help get over short-term nervousness.

Here's some perspective on glaucoma: when you have glaucoma, you often lose your sight over the course of years and since the human brain is so adept at adjusting to slow changes its possible to lose a lot of vision without even realizing that anything is wrong. This is why its important to take the test, especially since you haven't been checked in a decade.
posted by Joe Schlabotnik at 11:22 AM on February 23, 2011 [1 favorite]


I am also a person who really doesn't like anyone touching his eyes. I like glasses because they're another layer of protection between the world any my eyes!

Anyways, I just focus as absolutely hard as I can on not blinking. Gritting my teeth, yelling something loudly in my head, whatever it takes. Also, my eye doctor also has a really really bright retina photographing machine. I feel bad for the person who has to work the machine because it usually takes 5-6 times per eye for the machine to not get any of my eyelashes in the way of the picture because I blink so quickly.
posted by SirOmega at 11:57 AM on February 23, 2011


I wear contacts, I can put in eye drops, I can touch my eyeballs. I can't do the "puff" glaucoma test. I have even tried physically holding my eye open, but it didn't help.

By "full eye exam" do you mean going to an optometrist for a glasses perscription or seeing an opthamologist who dilates your pupils and does an eye exam? I see an opthamologist regularly (1-2x per year) and because of this, my optometrist and opthamologist (who share a practice) let me get away without the glaucoma test. I try to do it, though, and I get a visual field test, retina photos, and a bunch of other tests each time I am there.
posted by inertia at 12:11 PM on February 23, 2011


My doctor now uses applanation tonometry-- which is a couple of yellow drops in the eye, and then he uses the slit light machine to look into my eyes.

I had a glaucoma test done last year and it was just like this. I didn't even know there was another option, and it really felt no different than having my eyes examined normally. My optometrist makes a point of having the latest up to date of everything so you should probably ask when making an appointment, but if you can stand the bit where they stare in at your retina then you should be OK (ish at least) with this test too.

I do wear contacts quite happily though and have never had problems with eye drops etc, so you might still find it uncomfortable. But it sounds better than any kind of air puff, plus practising first with eye drops for a while sounds like a good way to make this kind of test easier for you to stand.
posted by shelleycat at 2:35 PM on February 23, 2011


Oh, also I'm only 35 so the test I had may not have been a full glacucoma screen, but she definitely was looking for vision loss and the word 'glaucoma' was mentioned (I apparently have some risk factors that make this level of screening worthwhile at my age). It might be better to get only some stuff tested rather than nothing at all if you can't currently handle whatever other testing needs to be done for a full glaucoma screen.
posted by shelleycat at 2:40 PM on February 23, 2011


The visual field test, that is the one I hate. Not because it is painful, but you have to stay extremely focused and NOT move your eyes at all for like 10 minutes.. Retinal photos were painful due to the bright light needed. The 'blue ring of light' doesn't bother me a bit.
posted by jockc at 5:11 PM on February 23, 2011


I have retinopathy of prematurity and I have had full-scale eye examinations since I was a little child. When I was little (between three and six) I HATED this. I had to be held down for the eyedrops and examination. I once was sedated so the opthalmologist could carry out the full examination.

I hate the glaucoma test too, but it's necessary. Once (with no apparent cause -- I was under 30, healthy, no diabetes) I woke up with one visual field obscured by the confetti-like shapes you see when you press on your closed eyelid. Do you know what they're called? Anyway, terrified that I was going blind, I went to the hospital and the eye doctors there diagnosed glaucoma and drilled a hole in that eye to let fluid drain. I wonder if a tear duct was blocked because I'd been exercising outdoors in the heat (long distance walking) and got dehydrated.

As for the slit-lamp examination, after the Lord of the Rings films came out, I just pretended that I was being looked at by Sauron. Maybe Peter Jackson has a childhood phobia of opthalmologists?
posted by bad grammar at 6:03 PM on February 23, 2011


I desperately wanted contacts when I was a teenager, but actually had SEIZURES when I'd go to an eye doctor to try them on. What eventually worked was finding a doctor who was very very patient and could give me some time to get them in. I've been comfortably wearing contacts ever since.

Also, I had an unexplained vision loss this past fall and had to do multiple glaucoma tests (and various other tests) over the course of 4 days, with several different doctors. The puff test doesn't seem to be used anymore, and I got used to the numbing drops and thing-that-touches-your-eye very quickly. You really can train yourself into a zen-like stance such that it just isn't an issue. In this case, I had lost my vision, so I needed to submit to whatever test they thought would figure out was going on. If you can put yourself into that kind of mindset, where it's 1.) imperative this get done and 2.) you understand it's really no big deal (it really isn't), I think you'll clear the hurdle and be able to get back to regular eye exams.
posted by FlyByDay at 7:15 PM on February 23, 2011


Valium or Xanax.
posted by tristeza at 9:26 PM on February 23, 2011


I always jerk backwards about a foot when they do the air puff tests (I am usually at ForEyes where they have you sit on a stool without a back and roll up to a machine that does it) and sometimes they have to do it twice, but they always get it. I prefer the air puff because I don't know exactly when it's coming and once I realize the air's hit me in the eye, it's already over. I've often wondered if someone just gently held my head against the machine it would mitigate the effects of my jerking backwards and they'd get the reading the first time.

Also ask your doctor about newer tests - my mom had glaucoma and had to have the pressure in her eyes checked every week before her surgery, and she insists the one she had was a blue light that only touched her eyelashes, not her eye itself.

If there is anything at all that will help you, don't feel silly, ask for it. When I'm getting blood drawn I usually ask the phlebotomist to talk to me, and I've found it works best when they ask me an open-ended question, because I'll start talking "oh yeah I went to college for OW! computers and got my degree back in..." and it makes it easier on me. I'm focused on answering the question, and it makes me just give a quick ow and get on with my answer, rather than "ow ow ow ow ow ow" and focusing on the pain. (Though to be fair the orthopedist who gave me a shot in my wrist after my car accident said "I know, it's the 'ow' that makes it better.")
posted by IndigoRain at 9:46 PM on February 23, 2011


My mom has this fear; it helps to go to a doc who's used to patients who flinch. Sometimes the doc has to try a bunch of times but they always get her in the end. I do think you should warn them first that you don't like it and tend to flinch.

Also n-thing the "you can in fact get used to contacts"-- mom wore hard lenses her whole life until recent cataract surgery. She'd tried soft before and found it unbearable (they require much more eye-touching), but this time she didn't have an option (it was soft or nothing). Finally, at 57, she figured it out, even if she did have to go into the doc a few times to get them out when she couldn't do it herself. (Go mom!) Persistence is key; but you'd have to really want them, I think.

I'm not sure there's a point contactwise though. There is a point to a glaucoma test-- and you can always tell yourself at least you don't have to do it every day! Plus glasses that fit and are in prescription are awesome.
posted by nat at 10:00 PM on February 23, 2011


Well, I've made an appointment for an eye exam at the end of the month. It's a start! I'll definitely tell the doctor ahead of time about my flinchy fear. In the meantime I'll practice relaxing, maybe try eyedrops, and think about the eye of Sauron.
posted by Metroid Baby at 7:10 AM on March 3, 2011 [1 favorite]


You guys! I did it! I am a hero of eyes!

I had my exam this morning, and I almost thought the doctor would skip the test altogether, but he just saved it for last. The test was the air puff, not the Blue Ring of Death, and I think I actually like the puff better because it happens so quickly and there's less to dread. And it wasn't the tiny invisible punch to the eyeball I remember. I did have to do each eye twice, but I did it, and it wasn't so bad. It was so not-bad that for a moment I wondered if maybe I was somehow cheating.

I deliberately skipped my morning coffee before the appointment, and I think that helped too.
posted by Metroid Baby at 8:28 AM on March 28, 2011 [1 favorite]


A WINNER IS YOU!
posted by Madamina at 12:25 PM on March 28, 2011


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