editor's perspective

Instrumentation for Your Practice

BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR
AUGUST 2001

Surveys show that only about 30 percent of practices that provide contact lens care have a radiuscope for measuring RGP base curves. A recent survey of Contact Lens Spectrum readers indicated that 29 percent intend to purchase a corneal topography unit in the next two years. A recent AOA News survey showed that 27 percent of ODs currently provide corneal topography services, and only nine percent offered pachometry services. A few of our readers also mention plans to buy pachometers. One can only hope that all contact lens practitioners have access to slit lamps on the premises.

Why not own a corneal topographer to assist with contact lens fitting and follow-up care and to help with corneal refractive procedures? Because it slows you down, or does it? If your technician performs the procedure, corneal topography may actually speed up your fitting and monitoring process, not to mention improve your diagnostic prowess for conditions such as keratoconus, corneal warpage, decentered apices or tight sutures. Don't have one because it costs too much, and you've gotten by without it for years? These reasons make sense. Incorporating the costs into contact lens fees in this day and age of fee reductions is a challenge. Third parties may or may not reimburse for it as an anterior segment photography procedure depending upon medical justification.

How about a pachometer to monitor corneal swelling with contact lens wear? This instrument has never become mainstream with slit lamps and good slit lamp skills, yet it could be helpful in preventing the higher myopes with too thin corneas from having LASIK. You need to end up with a 410 micron thick cornea (assuming 160 for the flap and 250 for the bed) after removing 12 microns per diopter. So a 5.00D myope needs at least a 470 micron thick cornea to start with for only a 6mm optic zone. Again, this is hard to cost justify, but it makes you a better practitioner.

The marketing value is high. These high-tech data collectors have a lot of "wow" factor and impress patients considerably. Showing the patient his corneal map is a profound experience for him, and the map may turn into an advertisement for your practice if he takes a copy home to show his friends.

In evaluating new instruments, keep these factors in mind:

• How will it help my patients?
• How will it help my practice?
• How can I efficiently integrate its utility into my office?
• How fast can I pay for it?
• Can I test drive it in my office and not just at a meeting exhibit?

Think about it.