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INVEST IN DETECTION

A LOOK AT NEEDED EQUIPMENT, CONTRAST SENSITIVITY AND MORE

KEVIN GEE, O.D.

Q: WHAT IS THE BEST EQUIPMENT TO HAVE IN THE OFFICE, AND IN WHAT ORDER SHOULD DEVICES BE ADDED?

A: In addition to the standard phoropter, slit lamp and peripherals, such as a binocular indirect ophthalmoscope and a handheld direct ophthalmoscope/retinoscope, I would first add anterior segment photography, then an automated visual field test, a retinal camera, OCT and finally meibomian gland imaging topography.

I would start with anterior segment photography because the prevalence of anterior segment diseases, such as cataracts, is at an all-time high.

With regard to an automated visual field test, the information is valuable for differential diagnosis.

You’d want to go with a retinal camera next, as structure often correlates directly with function, and this device enables you to document changes in structure.

Next, I’d get an OCT. It enables a view beneath the superficial structures, it also aides in detection and documentation of pathology.

Finally, I’d get meibomian gland imaging topographer, as the device adds another level to anterior segment photography.

The bottom line is that all of these devices allow a practitioner to fully document and diagnose ocular pathology. In fact, they are either “standard of care” or regarded as “preferred practice patterns.” An added benefit is that they are reimbursable, which helps pay them off.

RNFL analysis can aid in early detection of glaucoma.

Q: HOW OFTEN SHOULD ONE UPGRADE DIAGNOSTIC INSTRUMENTS?

A: Unless a significant feature of one or more of your diagnostic instruments changes, I don’t think an upgrade is necessary. That said, I usually obtain cutting-edge technology and usually am an early adopter, which helps offset my rate of upgrading.

Q: DOES RETINAL NERVE FIBER LAYER (RNFL) ANALYSIS VIA OCT PROVIDE ANY REAL CLINICAL BENEFIT, GIVEN ITS HIGH COST AND LOW REIMBURSEMENT?

A: It provides real clinical benefit. For a visual field defect to show up on a visual field test, at least half of the RNFL is already lost. Early intervention with RNFL via OCT can predict glaucoma earlier, thereby preventing visual field loss and progression of the disease. Although the reimbursements have dropped, OCT can help us detect glaucoma earlier and, therefore, enhance our management decisions.

Q: WHAT INEXPENSIVE DEVICES CAN HELP ME TEST CONTRAST SENSITIVITY?

A: Make an investment in a LCD acuity system. In addition to contrast sensitivity, it includes Snellen acuities, LEA symbols, and some even have spacial frequency grating. OM

Questions are based on reader responses to an Optometric Management online survey, which closed on Dec. 20.

DR. GEE practices in Houston and is an assistant clinical professor at the University of Houston College of Optometry. He is a Fellow of the American Academy of Optometry, an ABO Diplomate and an OCRT member. Also, he’s on Allergan’s advisory board and is a consultant for Solution Reach. Email him at drgee@geeeyecare.com, or visit tinyurl.com/comment to comment.