instrumental focus

A Master Photographer

Slit lamp camera removes hassle of photography.

David Wolf, O.D.

To capture the clarity and depth of the Merced River in autumn, the fern springs at dusk and the orchard at Portola Valley, Ansel Adams knew the precise aperture, speed and flash he needed to set on his various cameras. I can't say the same when acquiring slit lamp digital images. That's why I purchased the EC 100, from Eye Photo Systems.

Overview

The EC 100 is a dedicated, high-resolution digital single lens reflex (SLR) slit lamp camera that fits on tower-style slit lamps.

The device, invented by Jeremy Graziano, O.D., contains a movable beam splitter for unobstructed views and a touch screen computer (Microsoft Windows 7 compatible with hard drive) to acquire high-quality images and video of the anterior segment.

It accomplishes this via individual pre-set flash intensity, aperture and International Standards Organization (ISO) sensitivity. Eye Photo Systems calls this pre-set function “EasyCapture” technology because it allows the eyecare practitioner to focus on the patient rather than on achieving a high-quality photo.

I've found that this technology not only saves me time, but it also enhances my ability to diagnose and manage ocular conditions.

In addition, the device includes software that stores patient images, sorts them by date, patient age and gender, annotates images with camera settings and enables the eyecare practitioner to compare images side-by-side.

Further, the EC 100 is network friendly and contains an export function, should you choose to store patient images in your EHR system.

How it works

When a patient presents, my receptionist enters the patient's first and last name, date of birth and gender into the EC 100 system from her desk. Or, if the patient is returning, his name is entered into the existing database. Both actions take just a few seconds.

I position the patient in the slit lamp and select the desired portion of the anterior segment via the EC 100's touch-screen options: “Cornea,” “Conjunctiva,” “Iris,” etc.

The device then automatically adjusts the camera's settings to the selected option to ensure a high-quality image or video.

I step on the device's foot pedal, and the image or video is immediately displayed on the EC 100's touch screen. It takes literally seconds.

If the image isn't quite what I'm looking for, I can also manually adjust the camera's settings.

For instance, if I noted a freckle at a patient's last visit and I want to narrow in on it at this visit to ensure it doesn't have any melanoma features, I can manually adjust the camera's focus and save this reconfiguration along with the photo.

Something else to keep in mind: Photographing a different part of the anterior segment on the same patient is easy. All I have to do is select this region from the touch screen, the camera automatically adjusts the settings accordingly and once again, I'm off and running.

Once the appointment is complete, the EC 100 saves and sorts the images by exam and has them ready for comparison at the next visit.

In practice

I've been using the EC 100 to document various conditions, such as freckles, corneal abrasions and cataracts. Because the image is immediately displayed on the device's touch screen, it has greatly improved patient compliance to my recommendations.

For example, a 50-year-old male diabetic patient recently presented with complaints of a decrease of vision OD.

At his last exam, less than a year ago, the patient's vision was 20/20 OU. On this day, however, the patient's vision was 20/40 OD. The exam revealed his vision loss was due to a cataract.

I informed the patient of this, and he looked at me confused, even after I explained the developing cataract was the cause of his decreased vision.

So, I took him to the photo-slit-lamp and took photos of each lens. One revealed an image of the cataract in his right lens. Then, I showed him his healthy eye compared with his cataract eye. The patient made arrangements to have surgery that same day.

The EC 100 has also decreased appointment cancellations because patients are eager to see the progress of their condition since the previous appointment.

In addition to enabling me to provide enhanced patient care, the device has reinforced my reputation as a tech-savvy practitioner. Several patients have presented saying: “Wow. That wasn't here at my last visit. What does it do?” Both aspects have led to patient loyalty and referrals.

The EC 100 includes pre-set photo functions to capture high-quality images of the anterior segment. This lets you focus on the patient.

Return on Investment

The EC 100 costs roughly $30,000, and the CPT code is 92285. Reimbursement is bilateral with a range of $20 to $30. Doing the math, this means the device must be used roughly 1,000 times to achieve a return on your investment. Or does it?

The cataract patient mentioned will be returning to me for his postoperative care, garnering me co-management fees. In addition, the device recently led to a purchase at my dispensary.

Specifically, a long-time patient of mine with a very prominent pinguecula was in for a routine exam. I decided to document the pinguecula with the EC 100.

Upon seeing the yellow, elevated deposit, the patient asked whether he could do anything to stop or slow its growth.

I explained that some people just have the propensity to grow these, and that some clinicians believe they result from UV exposure.

The patient confessed he didn't have a good pair of sunglasses, and he purchased a pair from my dispensary immediately after the exam.

Like most of my fellow O. D.s, I possess skills in eye care, not photography. As a result, having a slit lamp camera that acts as the Ansel Adams for the anterior segment has been an enormous benefit. Add its storage software, the fact that it improves patient compliance to my recommendations and follow-up appointments and that it's reinforced my reputation as a tech-savvy practitioner, and it's been well worth the investment. OM