Top 5 Reasons You Need A Corneal Topographer

Top 5 Reasons You Need A Corneal Topographer


– Hi, I’m Dr. Brill, and today, I want to go over a piece of
equipment that is probably the least purchased piece
of equipment in optometry, and what I’m talking about
is corneal topography. I have a wonderful
piece of equipment here, it’s very slim, very streamlined. It’s the Medmont E300 corneal topographer. Now, I’ve had it for quite a few years, in fact, I have a brand new one that I’m going to be
installing and next year, they have an update
even further than that. But corneal topography, think about it, our main refractive surface
is from the interface from air to our tear film in the cornea. All right, I’m going
to go over five reasons that you should have a
topographer in your office if you don’t already have one. Number one: as we all know,
from optometry optics 101, the main refracting surface
of the eye is the cornea, so actually looking at the tear film, but the interface between
the air and the cornea gives us our main refracting surface. So yes, we do use autorefractors, we use keratometers, but
we need to really see what’s going on with the corneal surface so reason number one, let’s find out what’s going on refractively
with the cornea. Reason number two: disease processes. Honestly, all the corneal diseases are going to affect the topography of our cornea in one way or another. So think about keratoconus. Now, we used to think that keratoconus had a incidence of about 1 in 12,000. I think some respects
is not, maybe 1 in 200, depending on how you analyze the cornea. We now have technologies
like corneal cross-linking that if we could pick up and
detect topography changes that are indicative of
keratoconus in youngsters, we could do corneal cross-linking and perhaps prevent further
changes like keratoconus. So, I know it’s important
to check eye pressure, but how many children do you
get eye pressure problems with when they’re five or six years old? And although there is a standard, we need to make the standard
for topography much younger. Let’s pick up these conditions earlier and prevent further change. Number three: general
contact lens fitting. Now with soft lenses, we
have different base curves but honestly, a lot of companies just come one base curve. But if somebody has a very flat cornea versus a very steep cornea,
we should really know that, and your corneal curvature
readings on your keratoscope, on your keratometry readings, that just is essential
two to three millimeters. So we really need to know, and maybe you’ll decide to put that 8.4 base curve on instead of an 8.6 So for regular contact lens fitting, regular gas perm fitting,
regular toric lens fitting, we really need to know what’s going on. For example, when we have a toric cornea, is it just axially or
is it limbus to limbus? That’s going to help us decide what type of contact lens to put on. Number four: dry eye. Our dry eye surfaces really are impacted by the tear film, and now, with non-invasive
tear film detection, we could do a non-invasive
tear breakup time and at least it’d be standardized. We all know in our own
practices how we count down for how long the tear film will be stable, but we’re getting more
and more capabilities of analyzing the tear film
with our topographers. And number five, finally,
specialty contact lens fitting. So I’m an ortho-k guy, we fit sclerals and I think there you really,
really need the topographer to tell you what is going on. So in ortho-k, anybody could
fit orthokeratology lenses, we call it overnight corneal reshaping, but how do you tell
what happened overnight? So just this morning,
this is a patient who, I detected keratoconus on. Now it’s very obvious from
the topographical map, this is an axial curvature
map, that this patient has a problem, and it’s very
easy to demonstrate to them why they’re not seeing
well out of their glasses, and this patient varied from about 8 diopters of cylinder to 6, and from the sphere from -1.00 to -5.00. So, they understand it
when you show them this, and then this is going to be
the basis for your fitting. So how do I know if
they need a scleral lens or for a regular one? Well there’s a formula
for the elevation map, so we can generally check different maps, the axial map, the tangential
map, the elevation map. This is not a course in topography, see Randy Kojima or Pat Caroline for that but this gives us so much information and so many indices, that
we know what’s going on. And for sclerals and for ortho-k, I mean it’s crucial to have a topographer that you can trust. Here’s Perry’s, my son’s topography from when he was doing
overnight corneal reshaping. This is from 2005. (camera shutter noises) Or a current one from April of 2018. So here I have potential
difference in over all those years, what’s happened to the cornea? So this means we have ample reasons for doing corneal topography. Now if you don’t have one
and you’re thinking more with your business hat
than your clinical hat, there’s a code for this. All right, so I’ve just gone
over five clinical reasons, let’s talk about the business reasons. There’s actually a code
for corneal topography. I’m not going to get
into the money part of it but every time I do a
topography for a medical reason, for an important reason,
maybe the patient pays, maybe I do file it as a
code for reimbursement. So for example, let’s
say you just charge $50. Corneal topographers are not expensive; they’re somewhere between 12 and $15,000, depending on what you
get, what program it is, if you buy it at a show. So if it’s $12,000, you charge $50, you get 240 topographies and you have the basics of it paid for. (gentle music) This is the standard of care and we need to really address our needs to do a good job for the patient. Now there’s different
types of topgraphers, I prefer the Medmont, it’s the standard, every time you see articles, generally speaking they’re
showing the Medmont topographer. OCULUS has one, you can get one that’s attached to your
Topcon autorefractor. So know what you’re going to need it for, if you just want a general idea or are you going to use it
to design contact lenses? Are you going to use it to
simulate your contact lens fitting on the monitor before
you even try lenses on? So there’s a lot of science, there’s a lot of things you need to know but let’s get on board, let’s
do topography in our offices and you’re going to provide better care and it’s also another
profit center for you.

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