Recent research shows that 68% of ophthalmologists own a computerized corneal topography system – more than double the amount who reported owning one 6 years ago. According to the 1999 Practice Styles and Preferences study by Dr. David Leaming, 98% of high-volume surgeons have computerized units.

This finding is no surprise to me. Several years ago, as I was repositioning my surgical practice and moving into refractive surgery, I came to appreciate the benefits of computerized topography, some of which I hadn’t even fully utilized.

Here’s how this emerging technology is enhancing my practice – and how you can experience similar success in your own practice, either by using the advanced equipment for the first time or by tapping into the full potential of a unit that you already own.

As you know, clinical applications for corneal topography range from monitoring of astigmatism after corneal transplant surgery to assisting in the fitting of contact lenses for keratoconus.

In our practice, we use three computerized corneal units that can exchange images by e-mail. Like most refractive surgeons, I wouldn’t think of doing a procedure without such an advanced corneal mapping system.

I can remember when I started doing radial keratotomy, using standard keratometry readings. Too often, I was at risk for missing problems, such as keratoconus.

Here’s how the newer technology helps in our refractive surgery practice, which manages about 50 cases per month:

• Screens out poor candidates for surgery.
The computer provides us with results in a matter of seconds, revealing surgical risk factors. Besides keratoconus, the corneal topographer helps us identify corneal ectasia and even pre-keratoconus conditions.
• Helps solve postoperative problems.
With the topographer, I can identify and address central islands, depressions and irregular astigmatism. Our corneal topographers also tell me if my laser beam is homogenous. As you know, this is a critical factor in successful outcomes. If the postoperative patient’s whole refractive map is "blue" in the 6-mm optical zone, that’s a good early indication that we’re maintaining optimal surgical standards.
• Maximizes postoperative healing.
As I’m sure you’re aware, using corneal topography to monitor post-refractive surgery patients is a standard of care. Certain programs are now available that let you follow healing trends over time. You can learn how corneas change and stabilize, comparing pre- and postoperative maps. The maps also quickly let you know if you’ve achieved your targeted level of correction.
• Helps with Intacs implantation.
When implanting intracorneal rings, you can pick up the possible positive asphericity effect postoperatively with corneal topography.
• Prepares the surgeon for future developments in laser technology.
I can foresee a day when computerized corneal topography will help us create laser patterns for a custom ablation for each cornea on which we perform refractive surgery.

When we get to the next level, benefiting from customized ablation, we’ll be able to fix irregular astigmatism and treat asymmetric regular astigmatism, such as the bow tie patterns commonly seen. Customized discs and/or software will guide the laser to accomplish this goal.

Today’s corneal topographers also assist with disease management. Some of the more signification applications are listed below.

• Corneal transplants.
Naturally, I turn to a topographer to monitor patient response after performing a corneal transplant. I titrate corneal sutures, adjusting them as needed, based on maps. As a result, I know exactly when to remove sutures or adjust running sutures, plus how to approach surgically induced astigmatism.

• Keratoconus patients.
I can determine the exact steepness of a patient’s cornea, plus monitor the progress of the cone. In conjunction with my clinical findings, especially in a patient with a steep cone, the corneal topographer helps me fit these patients in custom contact lenses. (Some topography systems have programs to help fit all types of contact lenses.)

• Epithelial dystrophy.
This condition may show up initially as irregular astigmatism, necessitating a phototherapeutic keratectomy (PTK).

Unfortunately, too many surgeons buy today’s sophisticated corneal topographers without fully understanding all of the available features, such as how you can integrate computerized records and send e-mail with these units.

The ideal situation – if you’re looking to buy – is to have a system that is compatible with Windows. This will let you transfer images from one unit to another or to your own computerized medical record system, if you have one. This is a boost to practices that consist of more than one office because it lets you and your colleagues get instant access to images – no matter where you might be located. I’m currently in the process of linking and integrating my three offices with current Windows-based software.

In this era of maximizing cost and efficiency everywhere – including how you manage low-price consumables in the operating room – Windows will also prevent you from wasting color ink on many images that you generate.

Using my topographers, I can access my computer system from a variety of rooms in my practice. Unless you have a corneal topographer in every exam room, the alternative is producing map printouts and having them with you when you want to analyze a certain patient’s history.

Therefore, I’m able to track all data, including the exam performed with our automated refracting system. And I can show patients in the exam room what’s going on via display – instead of having to rely on ink-intensive and time-consuming print-outs.

Going high-tech is a lot less costly these days. Besides giving you more options, the newer computerized corneal topography units are portable and are available in the $15,000 range – down from the $35,000 you might have spent for a less effective unit 4 or 5 years ago.

Our corneal topographers play a critical role in working with our co-managing ophthalmologists and optometrists. Because many of our co-managing doctors have bought the same corneal topography systems that I own, our staffs can exchange e-mailed images. As a result, we only need to fax exam findings back and forth.

Computerized corneal topography also helps with refractive surgery courses that I teach. This increases co-managing opportunities for me and other doctors. It also helps them become certified to use our center.

Besides expanding our practice, these courses improve standards of excellence and minimize miscommunication, unrealistic expectations, malpractice liability and other problems that can hamper co-management.

At this point, I can’t imagine maintaining our standards, let alone moving ahead, without computerized corneal topographers. I didn’t realize how indispensable they would become to our practice growth when I bought them.

Currently, I have a 2,500-square-foot laser center in Lake Villa, and 45 miles away in Chicago, I have a new, 2,700-square-foot center. I’ll be looking at new ways of integrating information systems and this type of diagnostic equipment as we forge ahead in search of even more opportunities to provide quality care to patients.