My favorite longtime topographer, which we affectionately called “Fran,” recently went down for the count. We held a ceremony; it was a sad day. Fran was the first instrument that I purchased when I started my practice. It was something that I had used every day of practice. Together, Fran and I saw thousands of patients. We fit keratoconus patients with lenses that made them so happy that they cried; we managed myopia, slowing the progression of a devastating disease; and we observed some very colorful shapes and sizes of eyes that had experienced transplants, injuries, and weird diseases.

Yes, my topographer and I went way back. But, new and shiny things are in our future, so we have quickly moved on (sorry Fran).

Weighing the Options

We decided to look at some other alternatives this time around. Did we want to purchase a machine that just did topography, or did we want an all-in-one auto-refractor or a machine that does more? As someone who wants to manage multiple diseases with one machine, I knew that my new instrument needed to be more than just a standalone topographer this time around. I have looked at machines (and I have two of them) that perform both topography and autorefraction. These all-in-one refractive machine are awesome for primary care practices; however, when they are needed for advanced topography, I do not feel that they cut the mustard...yet.

Some machines on the market measure both axial length and topography. In my myopia management lectures and webinars, I am frequently asked about these machines. They offer some really cool additions to a practice that does a lot of myopia management or cataract surgery co-management.

Popularized several years ago was a topographer that has a dry eye suite built into it. I purchased a machine like this several years ago and have used much of the dry eye diagnostics. While it excelled in this area, in my mind, it never really measured up to Fran as a corneal topographer.

The Original Is Still the Best

When researching these replacements for my main topographer, I found that Fran had been updated with a dry eye suite of its own. Call it Fran 2.0. I decided that going with a dry eye suite built into a primary topographer would be the most ideal scenario for my practice. So many of our patients—both yours and mine—have dry eye and require advanced dry eye diagnostics for us to manage this progressive disease.

Adding this technology to a machine that I use every day not only saves space, it is good business. When I buy instruments, I want to get a return on investment (ROI); with the addition of the dry eye suite, we can bill for topography (92025), anterior segment photography (92285), and now meibography has its own code (0507T; note that this is a level III code and is rarely covered by third-party payers. In our office, pay privately for it). This not only helps get an ROI faster compared to with a topographer alone, it also helps us improve our patients’ outcomes faster.

What About You?

I’d love to learn about what you are using in terms of a combination topography unit or if one is in your future. We can share experiences at dave@optometricinsights.com. CLS