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New technologies enhance your skills, improve your patient care
Clinical practice is many things — challenging, gratifying and even humbling, but never dull. While certain patient encounters are fairly straightforward, others are anything but. And when it comes to the more complex cases we often need more than clinical acumen to guide us — we need data. Accurate and detailed data. Consider, if you will, each of these everyday scenarios.
Case reports
A 30-year-old LASIK patient presents with nighttime visual symptoms including glare, multiple images and halos. Your examination reveals uncorrected visual acuities of 20/20-, no significant refractive error, normal corneal topographies and 6.5-mm pupils. Perplexed by these symptoms — and lack of objective findings — you order a wavefront analysis. The results? Increased coma and spherical aberration.
A 55-year-old male complains of difficulty reading. His systemic history is negative, though his familial history includes a father with glaucoma. Goldmann tonometry is 23 mm Hg in each eye. The remainder of his examination is normal, including screening visual fields and a cup:disc of 0.3 v x 0.3 h OU. In pondering your findings and risk factors, you quickly perform corneal pachymetry. The results? Corneal thickness of OD 610 µm and OS 617 µm.
A 47-year-old hyperopic presbyope complains of blurred near vision with her bifocal contact lenses. Her VAs are 20/25- and J2 OU, the lenses fit well and there is no significant over-refraction. An alternate lens design is prescribed and, although the VA is just about the same, she reports much improved vision. Attempting to better understand this disparity, you check low-contrast log MAR acuity. The results? Increased low contrast acuity with the preferred multifocal lens design.
A 62-year-old male presents for an annual diabetic eye examination. Corrected VAs are 20/20 OU, intraocular pressures are 20 mm Hg OU, and his cup:disc are ~ 0.65 v x 0.5 h with inferior neuroretinal rim notching OS > OD. Perimetry reveals a few spurious relative defects, but nothing diagnostic of chronic open-angle glaucoma. In an effort to better qualify this patient you image the optic nerve. The results? A retinal nerve fiber layer analysis outside normative data base guidelines.
Instruments clarify diagnosis
The common thread among all of these cases is obvious: a clinical presentation of modest complexity without a clear-cut diagnosis. The proverbial puzzle with a missing piece. However, with an additional piece of data the entire case’s complexion changes. Furthermore, what’s particularly interesting is that the critical data is derived from procedures not routinely performed. These are procedures that have evolved out of technologic advancements.
Undoubtedly, technologic advances drive expansion of services and elevate quality eye care to the next level. And while patient care time constraints and third-party payer resistance can slow their implementation, new technologies are certainly worth pursuing. In the final analysis, embracing new technologies provides more information, enhances our diagnostic skills and results in better patient care.