Instruments

I use the Nidek 5100 phoropter, which measures the refraction to 0.12 of a dioptre, as oppose to the more traditional 0.25, so it’s more accurate than most systems.

It also has a very useful contrast sensitivity function that helps diagnose non-refractive issues, such as cataracts or degenerative macular problems.

Slit lamps are used to see the exterior of the eye in great detail. It’s used extensively in Dry Eye work and aids measuring tear function and quality.

The lids and lashes are seen up to 40x magnification to check for conditions such as blepharitis and conjunctivitis as well as checking corneal health.

The ZEISS iProfiler maps the focus of the eye across 1500 points to build a topographical map and a 3D profile of your eye’s focus.

The eye’s focus is rarely consistent across the whole cornea and the focus map reveals the variation of sight across the cornea, which is considerably more accurate and revealing than traditional methods of eyesight measurement.

For example, if the focus is substantially different towards the outer edges of your cornea, you’re likely to have different sight depending on your pupil size. This can mean that you would be better off with a separate pair of glasses for day (small pupils) and night (large pupils).

The topographer is used in advanced contact lens fitting to ensure perfect fitting, particularly for more advanced and complex contact lenses, such as for keratoconus. 

The iProfiler also aids with analysis of the tear film, which is essential for quantifying tear function and dryness.

The OCT scanner images the tissues of the retina, similar to an MRI or an X-ray. This can reveal any early signs of macular degeneration and glaucoma, both of which rely on early detection for best treatment. For flashes and floaters, it provides a differential diagnosis between a retinal detachment (serious) and a vitreous detachment (usually harmless) without a five-hour wait at Moorfields.

It also scans the optic nerve head and can reveal cranial swelling (or hopefully the lack of) and neural changes from glaucoma. There is ongoing research into changes in the retinal nerve fibre thickness over time that may aid prediction of the onset of Alzheimers.

This is used to measure the precise location of the pupils within the frame so that the lenses can be positioned optimally, accurate to 0.25mm. Where necessary, we will measure reading distance, computer distance and height, dashboard distance and neck angle.

Inaccurate pupil centre measurements are the most common cause of dissatisfaction with varifocal lenses.

Tests show that the Zeiss iProfiler is the most accurate of all current digital centration devices.

I’ve recently bought the MeiboVue VMC-100, a lovely piece of kit that uses infra-red technology to image the meibomian glands, which has become an essential tool in Dry Eye management. It means that the level of meibomain gland dysfunction can be objectively measured by seeing how many glands are broken or missing.

We use the latest Cerium Intuitive Colorimeter, which has been designed to present the colours in 360 degrees of colour space, allowing a patient to swiftly identify the precision colour that will alleviate their symptoms.

The instrument is unique in offering tens of thousands of colour combinations as precision is crucial. 

The test lasts approximately 15 minutes and is easy to follow. It is entirely subjective and therefore there are no incorrect answers. Reading speed both with adn without the filter can be checked.

Once the appropriate colour tint has been prescribed, lenses are then tinted and checked spectrally. A certificate of authenticity will be issued so patients can be assured they are receiving genuine Cerium precision tinted lenses.

Intense Pulsed Light (IPL) is a non-invasive, completely painless treatment whereby flashes of light are converted into energy within the cells of the meibomian glands photo-rejuvenating them to open up and express the oil more effectively.

IPL stimulates the nerves supplying the meibomian glands by creating a temperature gradient, which causes the secretion and contraction of the glands to produce the all-important oil.

IPL has been shown to improve tear quality, minimise dry eye symptoms and slow the progression of chronic dry eye. In addition, it can help to improve patient outcomes of  procedures such as laser and cataract eye surgeries.

Four sessions separated by two to three weeks are required and benefits are usually seen after the second session, but often immediately. The positive effects last well over a year – usually two to three.

The protocol is to perform both IPL and Low-Level LED Light Therapy (LLLT) during the same session. For best results, I use Blephex to open the pores on alternate visits.

The eyes are covered with goggles and gel is applied to the face whilst five flashes of light pulses are applied below each eye.

Developed and patented for medical use the technology originally employed by NASA biological level, generating endogenous heat through powerful LEDs stimulating ATP production in cells.

The mask is worn for fifteen minutes and is very pleasant for the user. The lids are warmed and the results are usually felt immediately. The mask contains medical-grade LEDs that are considerably more effective than the home-use LED masks that have become popular of late. Best to bring along some earphones to keep yourself occupied.

LLLT works by triggering endogenous heating of both eyelids, which means that the heat is created within the cells themselves rather than externally. This improves cell metabolism due to increased ATP (adenosine triphosphate) production within the mitochondria, the engine of the cells within the meibomian glands.

It’s recommended that you bring AirPods or headphones to keep occupied during the fifteen minute session, unless you’re good at meditation!

This machine allows us to cut lenses in-store. We have a stock of single-focus lenses that means that we can provide finished glasses within 30 minutes or so.