With the advent of advanced digital diagnostics comes a wonderful opportunity for patient education. My mentor Dan Durrie taught me the value of an advanced eye exam with his advanced ocular analysis. At the Magill Vision Center, we use advanced diagnostic technology not only for clinical assessment but also to educate patients. Marketed as an advanced eye analysis, this exam takes patients on a digital tour of their eyes to create a truly visual experience.
Within minutes of checking in, patients are escorted to our advanced eye analysis center, where they are essentially put on a digital diagnostic track while our technicians explain what each machine does. This is important, as patients appreciate the high-tech, high-touch experience. Furthermore, they associate the advanced eye analysis with state-of-the-art technology. All digital images are then imported into our EMR while patients are being escorted to the exam lane. While they are dilating, patients review educational material on digital tablets, explaining the benefits of laser-assisted lens surgery and advanced lens implant options.
At the outset of the exam, I explain that we will evaluate the patients’ overall ocular health with an advanced eye analysis that assesses their lids, lashes, lenses, nerves, vessels, and nutritional status. Once the biomicroscopic exam is completed, patients are taken on a digital tour of their eye (using a camera as analogy), paying particular attention to their two lenses and the film of the camera. I begin with a discussion of their outer lens and show them their astigmatism with topographic and tomographic images, including the ectasia risk screening maps for LASIK evaluations. This is followed by OCT images of the cornea.
Patients are then educated on the health of their internal focusing lens with a dilated Scheimpflug image of the lens correlated with the densitometry (both with the Pentacam; Oculus). This step is important in that patients can easily see the aging changes associated with lens opacity and the correlating light scatter. Patients are then shown “how they are seeing” with a double-pass wavefront (HD Analyzer; Visiometrics), which “measures not only the amount but also the pattern of blur” (point spread function), as we explain. Although patients are generally thrilled postoperatively, images can be repeated and compared after lens replacement to demonstrate their new clear lens with no light scatter or blur. The exam is augmented with slit-lamp video and photography as needed, as well as with macular OCTs or fundus images.
Additional diagnostics and imaging are performed for other conditions and procedures. For example, in patients with narrow angles, particularly hyperopes, we will image and measure their angles with anterior segment OCT and Scheimpflug imaging before and after lens replacement, and we can often correlate a drop in IOP with widening of the angle after lens replacement. Patients appreciate the procedure more when they can visualize why they have improved. We will preform similar images for patients implanted with the Visian ICL (Staar Surgical) to measure their angles and vaults.
Our advanced internal lens analysis is paramount to properly educate patients with dysfunctional lens syndrome. This exam is often the first time patients have the opportunity to see why they stopped driving at night and why their glasses no longer work despite multiple attempts. We discuss the nonsurgical and surgical treatment options for these patients, including dysfunctional lens replacement (DLR). It is worth mentioning that DLR is different from a clear and refractive lens exchange in many ways. Most important, these lenses are not clear, as demonstrated by objective diagnostics described above. Even though these patients may not qualify for an insurance-based lens procedure, they came to our clinic looking for surgical options to reduce their dependence on glasses. Once we show them the sources of their blur, it is easier for patients to understand that they may be better served with a lens-based refractive procedure than with a cornea-based procedure. This is particularly true for patients older than 60 years. Like all surgical consultations, we outline all risks, benefits, and alternatives, including the relative risks associated with lens- and cornea-based procedures. However, patients like that DLR is a permanent, all-in-one solution that addresses both congenital and age-related causes of ametropia.
Advanced eye exams should be a part of advanced eye clinics and a premium patient experience. Things have changed since Herman Snellen first described the gold standard visual acuity measurement in 1862. We now have the technology to objectively measure and show patients their quality of vision with advanced diagnostics such as the HD Analyzer. These advancements have enabled us to not only serve our patients with better options and outcomes but to better educate them as well.