Conflicting IOP Readings

I am 27, Caucasian, male, and w/out a history of Glaucoma in my family.  Recently I went to a screening for LASIK.  The doctor found high eye pressure by using puff-air tonometry and a tono-pen (IOP in the 28, 29 range).  Concerned, he sent me to his colleague who performed a more thorough Goldman Tonometry examination (or something like that).  He recorded 21 and 22 for my IOP and also performed various tests (my Field of Vision is perfect, my retina is healthy, all my angles are right, and there’s no evidence of damage.)  He wants to see me in one month.  The next day, my original doctor tested my IOP five times at two hour intervals using the "puff" test and a Tono-Pen.  My recordings were: 28/29, 31/31, 28/23, 31/29, 26/29.  My question is: I have read that the Goldman Tonometry is more accurate than the tono-pen or the puff-tonometry.  Why is there a discrepancy between that test and the other tests?  Also, assuming I have an extremely thick cornea, would readings of 30 from the "puff" test or the Tono-Pen still be concerning?

[Ray T Oyakawa, MD]

Air puff and tonopens are NOT accurate.   The Goldman is the best.   Also, if your corneas are thick then your real pressure is less than 21.

I would recommend and an OCT of the optic nerve with a new OCT like the Cirrus or RTvue.

Dr. O.