contact lens practice pearls
Incorporate Digital Imaging
BY THOMAS G. QUINN, OD, MS, FAAO
Sometimes even the most eloquent words just don't do the trick. This is particularly true when fitting contact lenses. We can do our best to jot down detailed notes or to verbally describe a fit in great detail, but no words can quite match the impact of what an image can communicate.
It is useful to document a contact lens fit or an ocular condition with still images, which can then be referred to over time. Pictures are helpful when monitoring the effectiveness of a treatment plan for a corneal infection or inflammatory event. Images of bulbar injection and lissamine green staining of the conjunctiva (Figure 1) can assist you with monitoring patients suffering from ocular surface disease.
Figure 1. Lissamine green staining of conjunctiva.
Still images of fluorescein patterns can be quite helpful, principally when fitting specialty GP lenses (Figure 2). Don't remember the limbal region fit characteristics during a mini-scleral lens fit? Not to worry — look at the photo. Working with a consultant on an irregular cornea fit? Ease the process by e-mailing a photo.
Figure 2. Reverse geometry lens on a post-RK patient.
Documenting Lens Dynamics
Two key fitting characteristics of any contact lens type are movement and centration. Lens dynamics on the ocular surface can also impact vision, particularly with toric or multifocal designs.
While still images can capture lens centration, video is ideal for documenting lens movement. Click here to view a Video of a reverse geometry GP lens on a post-RK patient.
I'm not an expert on cameras, but I've found that the 8.1 mega pixel Sony Cyber-shot point-and-shoot camera we purchased a year or so ago works great in conjunction with a slit lamp. Cameras with even higher resolution are now available for a few hundred dollars. Also consider these additional features:
Lens Diameter I can get great images by simply holding a camera up to one of the viewing oculars of a slit lamp. The smaller the camera's lens diameter, the easier it is to line up the camera with the slit lamp.
LCD Screen It's easier to line up a shot through the slit lamp using a camera that has an LCD screen rather than a tiny view finder.
Flash Mode Use a flash when capturing external photos, but turn it off when capturing images through the slit lamp. Make sure your camera allows you to manually control the flash.
Get a Camera and Get Clicking
One of the benefits of digital imaging is the ability to easily transfer files to a computer or flash drive, then into cyberspace via social network sites or e-mail.
If an image is too large to send via e-mail, use services such as www.yousendit.com, which allow you to send files and folders of up to 100MB for free.
Digital imaging is easy to do, easy to share, relatively inexpensive, and can be a wonderful aid in monitoring conditions and fitting contact lenses. Get the picture? CLS
Dr. Quinn is in group practice in Athens, Ohio. He is a diplomate of the Cornea and Contact Lens Section of the American Academy of Optometry, an advisor to the GP Lens Institute and an area manager for Vision Source. He has served as an advisor or consultant to Coopervision, CIBA Vision and Vistakon and has received research funding from AMO, B&L, CIBA Vision, Coopervision, and Vistakon.