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September 16, 2024
By Aaron Wolf, OD, FAAO, FSLS, FIAOMC
The topographer can be a valuable revenue generator for the practice when considered for more than just OrthoK. Maximizing the use of your corneal topographer can lead to enhanced patient outcomes and open new revenue streams for your practice.
The Medmont Meridia Pro Advanced Topographer can meet several different needs in your practice. Photo Credit: Euclid
In many eye care practices, the corneal topographer is one of those instruments that is employed primarily for fitting and follow-up of orthokeratology. Unfortunately, this device might sit idle between patients and fail to generate a strong financial return for the practice. However, the modern topographer is not limited to OrthoK alone and can be used as a screening tool as part of routine patient workups as well. Here is the wide range of functions that a corneal topographer can perform while generating income for the practice at the same time.
In dioptric strength, the cornea contributes approximately 66% of the eye’s refractive power. Thus, understanding eye shape can lead to a more accurate diagnosis of visual potential and guide dispensing decisions to correct the patient appropriately.
One of the topographer’s unique analysis display options is the Axial map interpretation, which aids practitioners in understanding whether the patient has regular or irregular astigmatism. This analysis is helpful when attempting to determine why a patient may have reduced visual acuity. The corneal topography CPT procedure code 92025 can be billed in cases where poor visual acuity may be related to irregular corneal shape.
Figure 1: In this Axial power map display of a patient with regular corneal astigmatism, note the symmetry of power when comparing hemispheres. Based on the anterior surface shape, this patient should achieve a high level of visual acuity with most vision correction modalities.
In assessing the early signs of keratoconus, the topographer can be critical to diagnosing the condition and ensuring the patient is sent for corneal cross-linking when appropriate to protect corneal health and visual function. Additionally, the topographer plays an important role in choosing the correct contact lens path for a patient and increasing the first-fit success and profitability of the practice.
In OrthoK, the corneal topographer is a necessary and invaluable instrument. For instance, corneal topography determines patient candidacy and whether OrthoK is a good option for that individual versus other refractive, therapeutic, or myopia management modalities. Topography also plays a critical role in defining the initial parameters of lenses. Then, following overnight wear, the subtractive, or difference, maps in Axial and Tangential interpretation analyze the success of treatment and guide whether changes are necessary and what modifications should be made.
Figure 2: In this Axial power map display of a patient with presumed keratoconus and irregular astigmatism, note the asymmetry between inferior and superior hemispheres. This patient will have reduced visual quality due to the irregular distribution of power across the central cornea and is likely to require rigid gas-permeable (GP) contact lens optics to neutralize the anterior shape of the eye and properly refract light to the retina.
When good-quality maps are taken, OrthoK can achieve as high as 95% first-fit success.1 This is important for the practice as each necessary refit can result in two or three extra office visits. The better the quality of the initial maps taken, the higher the first-fit and overall success of treatment will be.
Corneal topographers perform a wide range of analyses in the practice, including:
- Corneal analysis
- Visual potential
- Eye shape
- Contact lens molding
- Disease detection
- Diagnosis
- Classification
- Disease monitoring
- Contact lens selection
- Custom soft lens diameter and sagittal height selection
- Corneal GP parameters
- OrthoK lens parameters
- Scleral lens estimated sagittal height and base curve
- Mapping over contact lenses
- Determining GP/OrthoK/Scleral lens warpage or flexure
- Multifocal optics in relationship to the visual axis
- Position of prism ballast or optical prism
- OrthoK and refractive surgery assessment
- Candidacy
- Post-treatment response
This long list favors all the benefits the topographer has related to eye shape analysis and, primarily, contact lens fitting. Additionally, images taken can be digitally shared with your specialty lens consultant to assist with the initial lens orders and fit optimization. This improves the accuracy and efficiency of your contact lens practice.
Utilizing your topographer to its fullest potential can be beneficial for patient outcomes and practice revenue. Photo Credit: Euclid
Corneal topographers can also be a valuable tool for dry eye in your practice. This has increasing importance as myopia was recently shown to be associated with the presence of diagnosed dry eye disease and short tear break-up time.2 The latest topography models include tools that can perform non-invasive tear film break-up time testing.3 By reflecting off the tear film layer, this instrument can objectively assess the quality and percentage of surface area in break-up. Additionally, using white light, cobalt blue, and infrared light sources, the corneal topographer becomes a multimodal dry eye tool that can image and categorize a wide range of dry eye disease signs as follows:
- Meibography
- Non-invasive tear break-up time
- Tear film surface quality
- Tear meniscus height
- Fluorescein stain grading
- Cornea
- Conjunctiva
- Lissamine Green stain grading
- Cornea
- Conjunctiva
- Lid Wiper Epitheliopathy
- Blepharitis
The corneal topographer is more than just a contact lens tool; modern devices can also be wonderful anterior segment imaging and dry eye assessment tools. If your practice is set up to treat dry eye disease, the corneal topographer can drive treatment revenue while relieving signs and symptoms.
Your staff can perform most functions discussed. A trained technician can easily learn to capture these images and then provide the diagnostic information to the eye care providers in the practice.
The topographer can be a valuable revenue generator for the practice when considered for more than just OrthoK. Maximizing the use of your corneal topographer can lead to enhanced patient outcomes and open new revenue streams for your practice.
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Dr. Aaron Wolf received his Doctor of Optometry degree from the University of Houston in 2009. He is the owner of Austin Optometry Group, a private practice in Austin, Texas, focusing on ocular surface disease and specialty contact lenses, including scleral lenses and orthokeratology. Dr. Wolf provides topography-guided and tomography-guided corneal, scleral, and orthokeratology lenses, ocular impression-based lenses, and custom HOA correcting lenses. He has fitted more than 1,500 scleral lens cases and more than 500 orthokeratology cases. Dr. Wolf is the first doctor in Texas to earn all of the following clinical fellowships: Fellow of the American Academy of Optometry, Fellow of the Scleral Lens Society, and Fellow of the International Academy of Orthokeratology and Myopia Control. He has served as a product development consultant, IRB research participant, and is a Key Opinion Leader for numerous anterior surface imaging manufacturers and specialty contact lens manufacturers.
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References
- Tan Q, Ng AL, Cheng GP, Woo VC & Cho P. Combined atropine with orthokeratology for myopia control: study design and preliminary results. Curr Eye Res 2019.
- Hirayama OI, Ayaki M, Yotsukura E, Torii H, Negishi K. Dry eye disease and high myopia in teenagers; a reciprocal relationship. Investigative Ophthalmology & Visual Science. 2022;63(7):1442-F0400.
- Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology Report. Ocul Surf 2017;15:539–74.
