WITH A NEW YEAR comes a renewed excitement for setting goals, reaching targets, and making improvements. This year, consider how to better serve patients by taking more topography measurements. Topographers are commonplace in most optometric practices these days, and they provide useful, additional information for patients. Imagine how, by simply taking one extra measurement, many patients who have early keratoconus could be identified or how many potential orthokeratology candidates could be helped.
WHEN TO USE A TOPOGRAPHER
Topography is helpful in numerous clinical scenarios, from specialty contact lens fitting to mapping corneal irregularities after trauma. One of the more crucial ways to use topography is to diagnose keratoconus. When a patient exhibits an unstable refractive endpoint or displays increasingly asymmetric astigmatism, topography can be a beneficial diagnostic tool.
In the hustle and bustle of a lively clinic day, it can be easy to overlook an auto-keratometry reading of more than 47D or fail to investigate a young patient with 20/25 visual acuity. However, practitioners are doing patients a huge disservice by failing to run a topography in these instances. Keratoconus is commonly diagnosed later in the disease process, but with more awareness and increasing access to both topography and tomography, this trend can change (Kreps et al, 2021).
Another great opportunity to use a topographer is in the case of a young myope. All practitioners should educate patients and parents on their myopia management options. With one of those options being a contact lens that reshapes the cornea, it is imperative that practitioners remain equipped to gather the necessary data to fit that lens.
Having that extra data point during a comprehensive examination is powerful, especially when paired with a discussion on the potential impact of myopic progression. In addition, kids enjoy seeing their topography images change over time with orthokeratology wear, and it is a great visual reassurance to parents that their child’s contact lenses are both healthy and effective.
Patient education is at the heart of our profession, and many patients benefit from visual aids. Consider the impact of retinal photos, meibography, and optical coherence tomography images, to name a few. I argue that topography should be added to that list. How many times per day do patients ask their practitioners to explain astigmatism? Images are effective, but they are frequently underutilized resources. We can do better for our patients.
IMPLEMENTING TOPOGRAPHY IN PRACTICE
To get the most out of a topographer, practitioners must understand the functioning of their specific instrument. Learning the differences between axial, tangential, and elevation maps, as well as the added benefits of measuring tomography, is a solid start. Many topographers do much more than measure corneal shape; for instance, they may measure tear breakup time or simulate a contact lens fitting with sodium fluorescein. Certain topographers are now measuring out onto the sclera to provide a fully customized scleral contact lens fit.
There are myriad reasons to measure topography more often, and the list is growing. Our responsibilities in actualizing this resolution are to identify patients in need of a topography measurement, train our technicians to take high-quality images, and utilize the data for the good of our patients. CLS
REFERENCES
- Kreps EO, Claerhout I, Koppen C. Diagnostic Patterns in Keratoconus. Cont Lens Ant Eye. 2021 June;44:101333.
