Pearls

Tools and techniques I have found useful in practice.  Email us with your ideas to share.

SLIT LAMP PHOTOGRAPHY ON A BUDGET

The Nikon CoolPix 4300 with attached Martin Microscope MMCOOL-E4 adapter slides into one ocular of slit lamp, allowing instant and portable digital photography.  Make sure to set camera on infinity focus to prevent auto focus feature from obscuring the picture.   Many of the pics in the photo section of this site were taken with this setup.  The Univ. of Iowa site also has additional info.  TTI Medical also sells adapters for slit lamp oculars.

DIGITAL DICTATION WITH EMAIL TRANSFER

Forget dictating with recorders that use tape.  We found that digital voice recorders, which are now inexpensive and quite sophisticated, are the way to go.  These devices are rugged, easy to use, and have plenty of memory. The biggest advantage is being able to email the dictations to our off-site transcriptionist.  She has software on her home computer that allows her to listen to and transcribe the dictations, very similar to the way she used to do with tapes--this makes for a short learning curve.  She then can email the typed documents back, fax them to the recipients, or print them out for the paper chart.  In short, this is a very efficient and versatile system. Mind your HIPAA laws though.  Hint:  some of the digital recorders come with music (mp3) play capability, so they are useful after work as as well!

ALTERNATE COUPLING GEL FOR LASER PROCEDURES

Compared to Goniosol, Genteal Gel is a bubble-free and less-messy/goopy coupling gel for use with laser lenses.  It also may be more hygienic since the quantity in the tube forces the opening of a fresh tube more often than a bottle of Goniosol.  Free samples from your drug rep may make it more economical as well.

BASKETBALL HALF AS ASTIGMATISM MODEL

To demonstrate astigmatism to patients, we use a miniature basketball cut in half.  This allows stretching the ball, "turning a basketball into a football". 

BELT CLIP CASE FOR RETINAL EXAM LENSES

I used to stock retinal lenses in every room since I did not like wearing a white coat with large pockets.  This lens case from Gulden, which clips to my belt or scrub pants,  allows me to have ready access to my 20D, 78D, or 90D lenses on the go.  Very handy. 

CYLINDER AXIS KNOB ADAPTER

Sometimes letting the patient dial their own cylinder axis, at least for starters, can be more efficient than using the cross cylinder.  Gulden makes a ring ("Twist Assist") that slips over the axis knob that makes it easier for patients to find and turn the knob, esp. older folks.  I just leave it on the phoropter full-time.  The pic on the left shows the knob on the right side and off on the left side for comparison.  Another simple but great idea.

TRACKING TEMPERATURE & HUMIDITY IN LASIK SUITE

Keeping the temperature and humidity within a narrow range is important for consistent results with Excimer laser surgery.  We found that Omega (model OM-PLTH) makes an inexpensive, reliable, and user-friendly "data logger" that can automatically store temperature and humidity data.  It can run for months on a small battery, and the Windows software allows you to choose the logger's sampling frequency, as well as download and graph the data.  It is only attached to a computer to download the data or change its parameters.

SYNCHRONIZING MULTIPLE ASC CLOCKS

In our surgery center, we have multiple clocks and many staff logging times on the same chart.  We found it difficult to keep all the clocks accurate and synchronized.  A perfect solution was to replace all our clocks with "Atomic Clocks" that receive a radio signal to maintain perfect (satellite) time.  Now all our clocks are accurate (to the second!) and synchronized as well.  These clocks come in a variety of styles, so they don't have to look any different than conventional clocks.  They're not expensive either.  Wrist watches with this technology are available too!

LIGHT-BLOCKING HOOD FOR DIAGNOSTIC TESTING

We found that adding an "Ophthalmic Hood," available from Gulden, to our aberrometer serves to block extraneous light and allow maximum pupil dilation and quality images.  This can be used on other diagnostic instruments as well. The left pic shows the hood open before testing, while the right pic shows the patient "zipped up" in the hood, ready for testing. The hood attaches with adhesive Velcro.

CONVERT AN OLD COMPUTER INTO A MUSIC (MP3) JUKEBOX

Retired Pentium (or Mac) computers that may be too slow for modern office networks make great dedicated music juke boxes.  These can be used in the operating room or wired into an office speaker system.  A hard drive can hold enough music so that you never have to hear the same song twice in day of continuous play!

LIDOCAINE JELLY FOR ANESTHESIA

Applying unpreserved 2% Lidocaine Jelly (AstraZeneca), which is usually used for GU procedures, greatly decreases the discomfort associated with topical anesthesia ophthalmic procedures.   After initial anesthesia with drops, we apply it to both the upper and lower conjunctiva (by having the patient look up and down) just before the patient is brought back into the operating room.  Excess jelly is then washed out with the pre-surgical preparation.

Recently, TetraVisc (Cynacon/OcuSoft) was commercially introduced for the same purpose.

INSTANT ALCOHOL LAMP

Alcohol Prep Pads make a great fuel source to create an ash-free flame to sterilize spatulas prior to corneal scrapings or other procedures.  Create an "X" opening using a needle or other sharp tool, peel back the flaps, and light with a lighter.  Just don't burn down your clinic.