There are many different devices and tools that would be useful to clinicians practising in private practice. However, in a hospital setting things can be a little different due to the nature of the patients we see.
However, in a hospital setting things can be a little different due to the nature of the patients we see. For me, there are two things in practice that I could not live without. While they both function differently, the Oculus Pentacam and the Optos Daytona provide data that is very useful for us as optometrists.
The topographer that we use in our department is called the Oculus Pentacam. Optometrists would mainly use this tool to measure corneal curvature (Ks). This can estimate the amount of astigmatism (in most cases over 3.50DC) that the patient has, which guides us for refraction.
For me, the Pentacam is most useful in contact lens fittings, where I can use it as an estimate to predict the contact lens for the patient. Numerous patients that present to me in the hospital clinic have irregular astigmatism and require complex contact lenses, and in these cases the topographer can show me a ‘map’ of where the irregularity is, guiding me on how the fit of the contact lens will look.
Although corneal curvature is beneficial for contact lens patients, it is also useful for those patients who have been referred in for cataract surgery.
At the pre-operation assessment, biometry can sometimes be difficult, depending on the clinical nature of the patient’s cataract and even because of the physical state of the patient. In this case, the Pentacam can be used to enable the optometrist to make the clinical decision for cataract surgery or not.
A key use of the Pentacam is also for keratoconic patients. For those patients who are referred into the hospital setting from outside practice, there is a specific setting on the tool called Belin/Ambrósio. This highlights any corneal ectasia and informs the optometrist of the likeliness of the patient having keratoconus. It is therefore useful for optometrists who work alongside a corneal consultant in diagnosing the patient.
Corneal thickness is also a key measurement as it highlights to doctors those patients who are under consideration for corneal cross-linking.
"I would be lost without the Oculus Pentacam and the Optos Daytona. They might not be the first choice for most practitioners, but for me, as a hospital optometrists, they are key"
The Optos Daytona
The Optos Daytona device is fundamentally a fundus camera, although it is not just any fundus camera. This machine has an ultra-widefield lens, alongside a red-free filter, which means that more of the peripheral part of the fundus can be seen.
The Optos Daytona is used as a screening tool for the early detection, documentation and monitoring of disease or abnormalities in the posterior segment of the eye.
The image that is produced by the Optos Daytona, which is known as an Optomap, is used on most of the children that we see in our department. It can prove particularly useful for those who have poor cooperation during ophthalmoscopy, or if an abnormality is detected, and can be used as a reference to refer back to.
Although the Optos Daytona may not seem any different to similar devices that are often found in private practice, because of the widefield photograph that it takes it, has the ability to spot a retinal tear far out in the periphery, which would be difficult to spot with a Volk lens.
To conclude, I would be lost without the Oculus Pentacam and the Optos Daytona. They might not be the first choice for most practitioners, but for me, as a hospital optometrist, they are key.