CONTACT LENS MANAGEMENT
Down to the Nitty Gritty
Specular microscopy can monitor corneal health to the cellular level.
BY P. DOUGLAS BECHERER, O.D., F.A.A.O.

Here's a twist on an old adage -- "If the corneal endothelium ain't happy, then nobody's happy."

But what's the best way to examine this sensitive area? This month's article will suggest a new answer to that question.

You can clinically evaluate the endothelium with Konan Medical's SP-4000 Cell Check.

A new option

Since the early 1980s, research has indicated that endothelial changes occur with long-term contact lens wear. Chronic hypoxia can disturb endothelial cellular function, resulting in polymegathism and pleomorphism and causing abnormalities in pumping functions as well.

As you know, the ramifications of an unhealthy endothelial layer are especially alarming when you're prescribing 30-day extended wear lenses, recommending refractive surgery or considering corneal remolding procedures such as orthokeratology for your patients.

We've known this information for decades, but because only trained technicians with special equipment could photograph the endothelium, the information remained merely theoretical. Today, however, we can clinically evaluate this important corneal layer effortlessly in our offices by using Konan Medical Corporation's SP-4000 Cell Check.

A deeper look

This relatively low-cost, simple-to-use, specular microscope allows for examination of the cornea to the cellular level. You can instantly view the endothelium down to the nucleus on the monitor, or print a hard copy to use for baseline information or along with therapeutic care.

Here's how it works: The patient aligns his eye in front of a hole, with or without contact lenses. The technician views the eye on the monitor, asks the patient to hold the eye open and presses the mouse button. The instrument self aligns and takes a picture that instantly appears on the monitor.

For an endothelial cell count, click the mouse on two cells, which creates a box. Then click on each nucleus in the box, and the software estimates the number of cells.

The cell count and appearance allow you to better understand the corneal health and determine whether the patient's contact lenses meet the requirements for a healthy cornea. You can also make informed decisions about whether the patient needs to undergo refractive surgery or orthokeratology and about the best treatment of traumatic injury or glaucoma.

They love it

Patient response to the SP-4000 Cell Check in my office has been even more enthusiastic than when we introduced retinal photography or corneal topography. Most patients understand our basic explanation of the appearance of their endothelium.

Before performing the procedure, we explain that we'll be examining their cornea "down to the cellular level." We quickly show them the "Cornea and Contact Lens Unit" (CCLU) chart that hangs in every exam room, illustrating endotheliums from those that are healthy (Grade I) to those with significant polymegathism (Grade IV).

Rather than trying to explain why we should refit a patient into a lens made of a better material, we can actually show that patient her own endothelial cells and explain the importance of a lens that offers her cornea more oxygen. She can also more easily see for herself the importance of scheduled, routine office visits to monitor the health of her cornea.

The bottom line

Using an SP-4000 Cell Check can also boost the financial health of your practice. Although there's no established fee, charging $10 per eye would generate a profit even if your technician examined only 10 patients per week. And because this procedure discerns whether the endothelial layer is improving, you may need multiple checks after initiating therapy to monitor the layer's progress. More importantly, you can demonstrate to the patient a concrete reason why he should upgrade to a better lens material and design, which will benefit both him and your practice.

But most important of all, the SP-400 Cell Check can increase your confidence that you've ensured proper care for your patients, and that's priceless.

DR. BECHERER IS CHAIRMAN OF THE AMERICAN OPTOMETRIC ASSOCIATION CONTACT LENS & CORNEA SECTION. HE'S ALSO A CONSULTANT FOR KONAN MEDICAL AND FOR SEVERAL CONTACT LENS COMPANIES. HE HAS COMPLETED MORE THAN 50 CLINICAL RESEARCH PROGRAMS FOR CONTACT LENS COMPANIES AND HE LECTURES AND PUBLISHES EXTENSIVELY.