Applying Aberrometry

From dispensing customized lenses to detecting eye disease, here's how these O.D.s are using aberrometry to maximize patient care.

Dr. Karpecki: We've provided an overview of wavefront lens dispensing and discussed how to select the best candidates. I'd like to know more about how you apply aberrometry in practice to perform refractions and detect disease.

Reliable data

Dr. Gindoff: In our practice, where we manage refractive surgery cases, many of our technicians perform refractions. In the past, knowing who performed the refraction was as important as understanding the data.

With the Z-View Aberrometer, I obtain standardized, repeatable data I can depend on without worrying about which technician performed the presurgical refraction. We've all had problems with instrument-induced myopia associated with some of the other autorefractors that developed over time. But this particular technology doesn't seem as susceptible to that problem.

The Z-View Aberrometer collects and processes data from the eye's higher-order aberrations for individualized prescriptions.

Dr. Campisi: I'm the technician in my office. I perform all of the Z-View scans. I like using the Z-View Aberrometer because it helps me identify cortical spokes, Fuchs' dystrophy and unusual shadows that I wouldn't normally see during refraction. On one occasion, I detected keratoconus before taking autokeratometry or topography readings — even before using the slit lamp. The cone actually cast a shadow and was picked up on the iPrint.

When the aberrometer doesn't produce a usable scan, I know to look for pathology or binocular vision disorder. It's so gratifying when patients realize that I've identified their problems within a few seconds of starting their exam.

Dr. Gindoff: In my practice, we deal with many post-op cataract cases, so it's not uncommon for technicians to tell me they think they've identified a posterior capsule opacification on the Z-View Aberrometer. I check to confirm their suspicions, and they're usually right.

Dr. Quon: My technicians use the Z-View for pretesting, allowing them to identify problems for me in advance. Cataracts, keratoconus and some corneal problems show up as irregularities on the Z-View video display. My job becomes easier when I'm told ahead of time that I may need to examine a patient more closely for ocular health issues. At the same time, the technicians become more involved with patient care and the diagnostic process.

Detecting other pathologies

Dr. Karpecki: Although the Z-View Aberrometer isn't designed or approved for detecting pathologies other than higher-order aberrations, have any of you detected other pathologies besides Fuchs' dystrophy, keratoconus and cataracts?

Dr. Campisi: Yes, I have detected epithelial basement dystrophy. We were unable to obtain a scan from a patient, who was self-referred from the izonlens.com Web site, due to his EBMD. His ophthalmologist advised me to dilate his pupils to create a larger scan area. The Z-view couldn't produce a wave scan since the dystrophy was too advanced. I could see the maps and dots in retro-illumination right on the aberrometer screen. Even though he didn't qualify for iZon lenses, we improved his vision with gas permeable contact lenses. This was another example of how we attracted a new patient by having state-of-the-art technology. Also, it's created a nice referral source with the patient's corneal specialist.

This MD saw the value in seeking an iZon consult from me before surgical interventions, such as Descemet's stripping endothelial keratoplasty.

Attracting more patients who are seeking correction for corneal irregularities and glare has changed my practice emphasis from primary care to comanagement with corneal specialists. The networking has been a tremendous asset. I've learned that what is good for the patient is good for the practice.

Dr. Karpecki: This is proof that wavefront technology actually can shift the way you practice, depending on how you apply it to patient care. OM