Diagnostic Instrumentation

Are You Adopting New Diagnostic Technology Quickly Enough?

By Peter G. Shaw-McMinn, OD

Nov. 4, 2015

The technology available today to monitor eye health, and improve visual quality, is rapidly expanding. The challenge, which I was reminded of recently, is pushing ourselves as practice owners to make the investment, and implement these valuable new tools in our office.

While vacationing in Hawaii, I stumbled upon the Keck Observatory Research lab. It reminded me that astronomy has had to deal with many of the same issues we must deal with. However, they have embraced new technology–while we have been slow to use it with our patients.

Just as astronomers try to see the universe clearly, we try to see within the eye. Just as they try to focus images from outer space, we try to focus images on retinas. For astronomers, the problem was changes in the atmosphere caused by gases in space distorting the image. This issimilar to the distortions we get from imperfections in the tear film, cornea, aqueous, lens and vitreous.

Over 100 years ago, in1900, Hartmann developed a sensor to measure the aberrations, but nothing was available to correct for all of them. Over 50 years ago, in 1953, Babcock proposed that optics could be adapted to correct for the aberrations, and yield a clearer image. This gave rise to the field of adaptive optics. However 1950’s technologies were not ready to deal with the exacting requirements needed for a successful adaptive optics system. Since atmospheres changed, measurements would have to be taken 100 times a second, and a lens adapted to change just as fast to compensate. The 1990s brought advances in computers that gave us the ability to focus the images. Since 2008, we’ve gotten amazing photos of planets outside our solar system, some over 800 trillion miles away!

Our OCT uses similar technology to provide us with images of the retina we never had before. I can’t imagine practicing without an OCT today.

However, we have been very slow to prescribe vision correction for our patients using similar technology. Today we can correct higher- and lower-order aberrations using refractive surgery techniques, giving our patients better vision than they ever had before. We can correct optical aberrations on the cornea using both hard and soft contact lenses.There are soft contact lenses that can correct all the aberrations in the eye. And we have spectacle lenses that can minimize the effect of many aberrations such as Zeiss iScription and VMAX Enception lenses.

Unlike our astronomy counterparts, we have been slow to implement this fantastic technology. I urge all our colleagues to purchase an aberometer and learn about prescribing spectacle, contact lenses and refractive surgery for those with significant aberrations.

Ophthonix did studies that showed 77 percent of emmetropes have significant higher-order aberrations and 96 percent of myopes. I did a study providing patients with two pairs of glasses, one with lenses that corrected for the higher-order aberrations and one with lenses that did not. The preference for the correction of higher-order aberrations was over 75 percent!

Every practitioner should have an aberrometer to measure all aberrations on every patient. Then they should choose the most appropriate technique to correct the aberrations found.

How do you stay on top of the new technology available to help you detect threats to eye health, and keep your patients vision as sharp as possible?

Peter G. Shaw-McMinn, OD, is an assistant professor of Clinical Studies at the Southern California College of Optometry. He is the senior partner of Sun City Vision Center, a group practice including five optometrists. Dr. Shaw-McMinn has served as chairman of the AOA Practice Management Committee and the Association of Practice Management Educators. He was the appointed Benedict Professor in Practice Management & Administrationfor the University of Houston College of Optometry for 2001-2002. To contact: shawmc1@me.com.

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