White Coat Syndrome for Eye Pressure

I have strong evidence that I exhibit a white coat syndrome for intraocular pressure (eye pressure). First, let me provide some background on white coat syndrome.

White coat hypertension (or white coat syndrome) is defined as a situation where patients have high blood pressure in the doctor's office but normal pressure at home (or in similar situations where they are comfortable). Patients with white coat hypertension will often have occasional episodes of high blood pressure under situations other than the physician's office. However, their blood pressure is reliably high when taken in the physician's office and it is reliably low when taken at home.

I have found that my eye pressure exhibits this behavior exactly. (And it is funny that my blood pressure does not!)

I usually measure my eye pressure many times per day at home with my Reichert AT555 tonometer. Today I measured my eye pressure throughout the day, as usual, and it averaged about 12 mmHg. Just before my eye doctor appointment I measured my eye pressure again. It was 13.0 in my right eye and 12.0 in my left eye.

Then I left for my appointment and I took my tonometer from my house to my doctor’s office. At the doctor’s office, we measured my IOP six times using both a Goldman applanation tonometer and my AT555 side by side. The Goldman tonometry was done by the doctor. I did the AT555 measurements exactly like I do at home. My doctor observed all my AT555 measurements. 

In short, my eye pressure (right eye) went from 13 at home (immediately before leaving) to 20 in the doctor’s office and then back to 12 when I returned home. The entire series of measurements is shown below with times and instruments noted.

Location            Time                  Eye Pressure                           Tonometer

Home                2:18 PM            13.0 OD and 12.0 OS                  AT555

Dr. P Office        3:05 PM            20.3 OD and 18.7 OS                  AT555

Dr. P Office        3:10 PM            20 OD and 18 OS                       GAT

Dr. P Office        3:12 PM            17.3 OD and 15.3 OS                  AT555

Dr. P Office        3:14 PM            18 OD and 16 OS                       GAT

Dr. P Office        3:30 PM            18 OD and 16 OS                       GAT 

Dr. P Office        3:42 PM            20.7 OD and 18.0 OS                  AT555

Home                5:07 PM            11.7 OD and 11.3 OS                  AT555 

Note that this is one more validation that my tonometer reads almost exactly the same as Goldman applanation tonometry (GAT). I’ve done similar comparisons half a dozen times before and my tonometer has always been in agreement with GAT. Furthermore, there is published research validating the close agreement between these tonometers.

However, the more interesting result of this little experiment is the fact that my eye pressure was nearly double in the physician's office. My eye pressure is reliably low at home (around 13 mmHg) and reliably high (around 20 mmHg or more) in any doctor's office. To my knowledge, a case of white coat syndrome for intraocular pressure has never been published previously. However, I do know some other people who can measure their own eye pressure with professional quality tonometers and their own experience mirrors mine.