As a doctor, there is a constant daily balancing act between using technical devices and personal attention to the patient.
Which patient wants to be put in front of apparatus after apparatus without being able to tell his view of things to the doctor?
On the other hand, which patient wants a doctor who talks a lot but cannot do important examinations?
We’re working very hard daily to find our middle ground between these extremes – keeping in mind that ophthalmology is one of the areas of medicine heavily relying on technical devices.
So we like to introduce our medical devices to you on this page, each with a short explanation what examinations we’re doing with it, and what for.
Auto Refractometer (Nidek AR-1s)
Nidek is a huge Japanese producer of ophthalmological devices. The company is rather conservative – or put less politely, their products often manage to look quite old right out of the box. But we don’t care about design, only about preformance.
The Auto Refractometer is used to measure the eye and make an assessment of the lens’ dioptric power. What you get is something that almost looks like a regular prescrition for glasses – but isn’t. The values determined by the machine is first and foremost an indication if there have been important changes to the eyesight (when the patient has been measured before) or simply give an idea of how much the patient actually can see.
To properly do a prescription for glasses, it needs quite a bit of fine-tuning by an optician or an ophthalmologist, a machine cannot do that.
If you suffer from blepharitis or similar lid problems, then you know the situation: It itches a lot. Sometimes you feel as if only you were able to give it a good scrub, things would be better, but then it never works. So it keeps itching and often the lids are swollen, too. With quite a bit of expectation (as well as apprehension) we therefore took a good look at a new device that was introduced at the American Academy of Ophthalmology in Chicago 2016. The device is intended to address the «good scrub» problem mentioned above and it addresses this quite logically. Something that looks like a Dremel, a little sponge mounted to it and with that thing the lid rims get scrubbed cleam. Of course this is a registered and approved medical device (so no, we don’t recommend doing this at home with your Dremel), but the principle seems understandable enough. We tried it out (with Mr Heitzmann as a guinea pig, he knows the itching problem) and bought the device then and there. The recommendation is to treat every 4–6 months – this seems a bit exaggerated, we see it similar to your annual dental hygiene appointment, just at the eye. There are surely cases where doing this in 4–6 months intervals is justified, but for the time being we recommend having it done annually. If you want to take a look, go to the company’s website, they have a few videos to illustrate the problem as well as the treatment.
Health insurance doesn’t cover it unfortunately, we’re charging CHF 150.00, which includes a 15-minute heat mask treatment as well as the BlephEx procedure of upper and lower lid on both eyes.
Digital slit lamp
In principle, a slit lamp is a microscope mounted horizontally which the ophthalmologist uses to take a look at your eyes. The name slit lamp is related to a narrow beam of light (the slit) the lamp can produce, and which is used to examine the optical boundary layers in the anterior segment of the eye.
And as nowadays the slit lamps are linked to the computer, it’s possible to take pictures of a certain finding, or to document the process of a disease.
«Dry Eye Disease» is a complex topic, you’ll learn that when reading through our website or simply by realizing that the therapeutic options are overall limited. For blepharitis (which can be an aspect of dry eye) there is the new BlephEx device (see above) – but stimulation of the meibomian glands is another scientific goal. French ESW-Vision has developed a device that is intended to stimulate the meibomian glands by stimulating their nerves through a strong infrared flash of light. This is one of the few options to directly influence the glands and their sescretion. Usually 3 sessions are necessary (sometimes 4) to see the effect of a better secretion, and up to 86% of patients do experience an improvement. This is a promising therapy, however, one should keep in mind that this is no miracle therapy and the entire treatment of the dry eye is important.
Similar to BlephEx, E-Eye is not being covered by health insurance. Cost per session is CHF 150.00, so with 3 sessions it’ll amount to CHF 450.00 (note that as mentioned above a fourth session can be necessary). How long the effect will last seems to be very individual, the range is from 6 months to 3 years.
Retinal Camera (Topcon NW-200)
Next to our Auto Lensometer our Retinal Camera is the second real veteran amongst our devices. But as the Auto Lensometer is still used daily, the Retinal Camera is rarely used nowadays.
Initially used to photographically document diseases of the retina and the posterior eye segment, the Camera has been sidelined by the appearance of the OCT (see below). Advances in technology…
Keratograph (Oculus Keratograph 5)
The Keratograph is used to three-dimensionally measure the cornea’s surface. This is helpful when assessing progress of some diseases (like the keratoconus), but is mainly used to properly fit contact lenses.
But the keratoconus is rare and we prefer to leave fitting contact lenses to specialised opticians – why do we need the Keratograph? Well, modern devices have added abilities whch are very helpful when diagnosing and assessing “Dry Eye Disease” – and with Dr. Eberle being specialised on “Dry Eye”, it’s clear that our Keratograph is mainly used in that field.
Non-Contact-Tonometer (Nidek NT-530P)
This devices measures the eye pressure as well as the thickness of the cornea, both important parameters in glaucoma. As usual we don’t take anything for granted, and if in doubt we re-measure eye pressure manually.
OCT (Heidelberg Spectralis)
30 years ago we would have called this the “Mercedes among OCTs”. However, 30 years ago there were no OCTs and (without wanting to offend Mercedes) the accentuated position of Mercedes cars is not as obvious anymore today.
Be that as it may, in our view the Heidelberg Spectralis is the Rolls-Royce among OCTs. OCT stands for “optical coherence tomography” – simply put it is a technique that creates something resembling an ultrasound picture of your eye with which we can see structures behind the retina which cannot be see otherwise.
The little difference is that for technical reasons the picture is not made with ultrasound, but with laser light – not an important difference for you as patient. More important is the fact that using this harmless examination a number of severe eye diseases can be detected a lot earlier than it was possible in the past.
Perimeter (Oculus Twinfield)
Nobody likes this one. The examination isn’t painful, it doesn’t take too long – and yet most patients roll their eyes when it’s perimetry time again. And they’re right.
The device is used to determine how well your retina works by measuring sensitivity to light in many different areas (mainly used in glaucoma). The patient has to intensely watch a white half-dome and occasionally press a button. That’s good fun for about a minute, but after 5 minutes it’s quite annoying.
But it has to be, there is no replacement for this.
Auto Lensometer (Nidek LM-990A)
So this is our oldest device. We could replace it with a new one, but most new ones are simply that: New. But not really better, so we’re simply waiting it out.
The Lensometer is used to measure patient’s glasses so we can see whether they still fit the eye optically.
A device to measure osmolarity of the tear film. This is a pretty specific diagnostical tool in “Dry Eye Disease”. In “Dry Eye”, the composition of the tear film is changed, this change can be quatified and categorised with the Tearlab.