THE DIGITAL PRACTICE

Finding a new use for an old friend

A slit-lamp retrofitted with a digital camera to capture images will show patients’ eye conditions.

By Peter J. Polack, MD, FACS

Most of what ophthalmologists see in the clinic can best be documented with a photograph, despite how skillful we think we can describe something with words alone.

I inherited a slit-lamp with a built-in film camera and flash from my father, who also was a cornea specialist. Then, it was more of an art than a science to get the lighting just right. This usually required bracketing several different exposures to be on the safe side. Anxiety set in waiting for the slides to be developed and returned from the photo lab. Reviewing and indexing slides with the appropriate patient name was also a hassle, as they had to be inserted into archival sleeves and stuck into the patient’s chart.

An iPhone with a slit-lamp adapter can be a convenient replacement for a typical slit-lamp camera.

A MARRIAGE OF OLD AND NEW TECH

With an EMR we can store digital images in a patient’s electronic chart — but how do we get the image in the first place?

The same slit-lamp camera we once used is still useful. It is married to a digital SLR camera instead of a film camera. The camera is connected to a computer that houses the images. Those images are then filed into the appropriate patient record. The downsides: expense and lack of portability. If you work in the office with the camera, that’s fine for patients who need pictures. But we have five locations, so it isn’t practical to purchase more of these or send patients to the office with the camera for pictures when necessary.

We overcame the downsides with an old iPhone and a slit-lamp adapter. Several types of adapters are on the market; they vary in price. The cheaper ones use a clip to hang the iPhone onto the eyepiece of the slit-lamp. I chose a higher-quality device with built-in optics (http://www.zarfenterprises.com) that replaces the eyepiece when taking the picture. This manufacturer has adapters for several slit-lamp makers.

Pictures of the lids and adnexa look great using a transilluminator as the light source while we use the slit-lamp beam for pictures of the eye. The images are then securely emailed to a tech who places the images into the corresponding patient’s EMR chart. It also makes for a quick and easy patient education tool: Patients rarely see what we see, and it helps explains their condition more easily. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multi-subspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice resource for physicians and administrators. His e-mail is ppolack@ocalaeye.com.