THE WORST PLACE on earth to assess the centration, segment heights, lid attachment, movement, and rotation of a contact lens is the headrest of a slit lamp. At the University of Houston College of Optometry in 1984, I witnessed faculty adviser Irv Borish, OD, demonstrate this fact by bending forward and placing his chin on the back of one hand and his forehead against the back of the other, and saying, “No one goes around like that!” You have to seat the patient in a normal head posture to assess these things.

Burton lamps, or something like them for illumination and magnification (even if it’s +20D condensing and a transilluminator) is a much better way to evaluate a lens on the eye. At Korb & Associates in Boston, Donald Korb, OD, removed the near testing lamps from the goosenecks on his examination stands and replaced them with Burton lamps. I use a handheld LED UV flashlight and a Wratten #12 filter to evaluate fluorescein patterns. One can also use the slit lamp light column even if the patient is not using the forehead support and chin rest. One can use the white and the cobalt light.

Practitioners should not look at scleral lens haptic issues with anything but a slit lamp. Further, ocular tissue evaluations should also rightly take place at the slit lamp. So, don’t light me up [pun intended]. I’m just saying that one gets significantly better data when lenses are evaluated both in and out of the slit lamp.

Second, cellphones have become a great way to collect data in the examination room. The newer versions have multiple cameras that work really well together, except when using that camera at slit lamp. However, there is a secret to using a cellphone with the slit lamp—use the “portrait” mode (Figure 1). You get great photos that even rival a $20,000 slit lamp photo. Email the photos to yourself and copy them into the patient record—just make sure to mind your HIPAA requirements.

Finally, many practitioners are using drop modulators on ophthalmic medications. The company that makes them has made colored strips for medications for patient use; they don’t make colors found on diagnostic medication caps. However, one can easily purchase 0.75” colored circle labels from the office supply and place the red, white, and green labels on the tops of the caps. These labels will help reduce drug mistakes. CLS