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PubMed2004

[Comparison of optic nerve head measurements obtained with the slit lamp and with CSLO].

PURPOSE: To evaluate the accuracy of disk size and cup/disk ratio (C/D) estimation by measuring the vertical diameter and cup/disk ratio at the slit lamp. METHODS: Two hundred and thirty eight eyes of 185 people, 82 glaucomas and 156 normal subjects were included. All underwent slit lamp examination, tonometry, optic nerve photographs, scanning laser tomography (HRT) and standard perimetry (Humphrey). Correlation between slit lamp measurements (vertical diameter and C/D ratio) and HRT parameters was evaluated. RESULTS: There is a significant correlation between the disk diameter measured at the slit lamp and the disk area measured with HRT (Pearson Test, r: 0.52, p<0.001). Additionally, there is significant correlation between the semi-quantitative estimation of C/D ratio at the slit lamp and the C/D area ratio from the HRT (r: 0.83, p<0.001). CONCLUSION: Measuring the vertical diameter and the C/D ratio at the slit lamp is a useful method for estimating the real disk area and C/D ratio. It is highly recommended that disk size be estimated when attempting to interpret clinical findings in the optic nerve head.

Anthropometry↗
PubMedDate not supplied

On focusing the slit-lamp: Part I. An inaccurate ocular setting--what is there to lose?

Adjustments of the diopter rings on the slit-lamp oculars compensate for three independent factors: the observer's refractive error, the observer's state of accommodation, and any instrument misalignment. An inaccurate setting of these rings will significantly affect the slit-lamp image quality, as well as the precision and accuracy of slit-lamp mounted lasers, such as are used for retinal photocoagulation, YAG capsulotomy, and laser trabeculoplasty. For each slit-lamp and microscope-related examination technique, photographic technique, and laser procedure, the consequences of an incorrect ocular setting are discussed. Data are presented on the preferred ocular settings of several random observers, highlighting both interobserver and intraobserver variability. Finally, photographs demonstrate the image deterioration that occurs when an incorrect ocular setting is used. It is shown that for younger observers, one's distance refraction is only seldom the correct setting of the slit-lamp oculars, and that on different instruments, one should not be surprised to find somewhat different settings. Examiners are urged to check the accuracy of their habitual setting, if only to find out whether the improvement in image quality is worth the extra bother.

Calibration↗
PubMed1986

Device for eliminating corneal light reflections during recording of lateral images with a slit lamp.

Corneal reflections produce defects in photographic sections of the lens taken with a slit-lamp biomicroscope for computerized densitometric analysis of cataract opacity. A simple and workable, adjustable antireflection device was built that can be easily adapted to photographic slit lamps, a common instrument in ophthalmology equipment. The slit lamp is a versatile tool for photographing structures in the anterior segment of the eye, particularly the lens. Corneal reflections are eliminated for angles between the light band and a photograph plane ranging from 20 degrees to 90 degrees, with the light band no greater than 0.5 mm and the corneal curvature about 7.6 to 7.9 mm. The device acts by blocking aberrant light rays from the light source that would otherwise be reflected by the mirrorlike surface of the cornea and enter the objective lens. Here we present a prototype designed for the Zeiss slit lamp.

Cornea↗
PubMed1985

Photometric oculometry: a slit-lamp technique for determination of intraocular distances.

The optics of slit-lamp fluorophotometry were analyzed. This analysis forms the basis of the formulation of a slit-lamp technique called photometric oculometry, which makes it possible to measure intraocular distances. A comparison between ultrasonography and photometric oculometry in the determination of the ocular axial length was carried out. Measurements in 11 eyes showed statistical agreement, with a mean of 22.90 mm, SD +/- 1.815 (ultrasound), and a mean of 23.17 mm, SD +/- 1.667 (photometry). The principle involved in photometric oculometry is of special importance for the calculation of the blood-retinal barrier permeability to fluorescein by vitreous fluorophotometry, since the method allows the volume of the vitreous body to be estimated directly from the slit-lamp fluorophotometer recording.

Eye↗
PubMed2000

Light-induced damage of the retina through slit-lamp photography.

BACKGROUND: I report on two patients who suffered severe loss of visual acuity after slit-lamp photography of the anterior eye segment. METHODS: Both patients were pseudophakic and pictures were taken to document the degree of posterior capsule opacification via retroillumination with dilated pupils. Both patients had excellent visual acuity at the time of photography was taken and experienced reduction of to hand movement afterwards. A Zeiss 75 SL device was used for the slit-lamp photography. In cooperation with Carl Zeiss Jena the slit lamp was investigated. RESULTS: Ophthalmoscopy and angiography after photography discovered a central macular defect, similar to a photocoagulation. The visual acuity did not recover. CONCLUSION: Under certain circumstances slit-lamp photography of the anterior eye segment can lead to severe light-induced damage of the retina.

Aged↗
PubMedDate not supplied

Repositioning the laser in situ keratomileusis flap at the slit lamp.

PURPOSE: To describe the indications and technique for repositioning the laser in situ keratomileusis (LASIK) flap at the slit lamp. METHODS: We present a description of patients with striae or slippage of the flap who had repositioning of the flap at the slit lamp. RESULTS: Indications for repositioning at the slit lamp are mostly flap striae. However, it can also be done for a displaced flap and small amounts of debridement. This procedure is not recommended for taking cultures, irrigation of diffuse lamellar keratitis, suturing the flap, or epithelial ingrowth. Repositioning the flap is done by finding the edge of the flap with the cannula, lifting the flap, sweeping the cannula to release the entire wound, and infusing balanced salt solution under the entire flap. We did not encounter infection or recurrent epithelial erosion in these patients. CONCLUSIONS: Repositioning the LASIK flap at the slit lamp was effective and safe in the treatment of striae or flap slippage. It saved time, money, and, anxiety for the patient.

Adult↗
PubMed1984

Photometric oculometry. II. Measurement of axial ocular distances with slit-lamp microscopy. Clinical evaluation, and comparison with ultrasonography.

Photometric oculometry is a slit-lamp technique, which makes possible an estimation of intraocular axial distances and axial length. The technique is based on a transformation of a sagittal slit-lamp movement into intraocular axial distances when the slit-lamp focal plane is moved in the optical axis from retina to cornea. Determination of the axial length in 50 eyes (refractive range +4.75 to -5.25 D) showed that the axial length varied from 21.9 mm in hypermetropic eyes to 26.0 mm in myopic eyes, with the emmetropic eyes being approximately 24 mm. A comparison of intraocular axial distances determined by photometric oculometry and by ultrasonography on a small series of eyes showed no significant differences between the axial length, the length of the vitreous body, and the lens thickness, whereas a significant difference between the anterior chamber depth was observed (photometry giving slightly larger values than ultrasound).

Adult↗
PubMed2000

Slit-lamp-adapted optical coherence tomography of the anterior segment.

PURPOSE: To evaluate the diagnostic potential of a slit-lamp-adapted optical coherence tomography (OCT) system as an in vivo imaging device for routine clinical examination of the anterior segment of the eye. PATIENTS AND METHODS: In a pilot study, healthy volunteers and patients with different pathologies of the anterior segment were examined with a slit-lamp-adapted OCT system using 100-200 axial scans with 100-Hz line-scan frequency. The scan length is variable up to 7 mm, and the axial depth is 1.5 mm in tissue. RESULTS: The slit-lamp-adapted OCT system allowed direct biomicroscopic imaging of the measured area. Anatomic structures and morphological changes anterior to the attenuating iris pigment epithelium could be visualized with high accuracy. Biometric analyses of the cornea, the chamber angle, the iris and secondary cataract were possible. Complete demonstration of the chamber angle was difficult due to the backscattering properties of the anterior part of the sclera and the consequent shadowing of the most peripheral part of the iris. CONCLUSIONS: Slit-lamp-adapted OCT is a useful diagnostic tool which allows in vivo microscopic cross-sectional imaging of the anterior segment and precise measurement of ocular structures.

Anterior Eye Segment↗
PubMed2004

Vitreoretinal surgery with slit-lamp illumination combined with a wide-angle-viewing contact lens.

PURPOSE: To evaluate the feasibility of illuminating the fundus by combining a wide-angle-viewing contact lens and slit lamp attached to a surgical microscope during retinal reattachment surgery and vitrectomy. DESIGN: An interventional study. METHODS: We combined slit-lamp illumination and a wide-angle-viewing contact lens to visualize the fundus during retinal reattachment surgery and vitrectomy. RESULTS: We clearly observed the fundus using this combination approach during conventional retinal reattachment surgery, which we completed without using an indirect ophthalmoscope. With slit-lamp illumination, the wide-angle-viewing contact lens provided a wider area of illumination than a planoconcave contact lens during vitrectomy in addition to an area of illumination as wide as that obtained using a light pipe. CONCLUSIONS: Combining slit-lamp illumination and a wide-angle-viewing contact lens seems to provide a useful alternative method for viewing the fundus during vitreoretinal surgery.

Contact Lenses↗
PubMed2006

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement.

PURPOSE: To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs). METHODS: Twenty-five ocular hypertensive subjects and 56 patients with primary open-angle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cup-to-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference. RESULTS: The mean VCDR and HCDR was significantly higher (P<0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher (P<0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland-Altman method, as the cupping increased, the agreement also increased. CONCLUSIONS: There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.

Early Diagnosis↗
PubMed1992

Suitability of slit lamp retroillumination photographs for classifying cataracts according to 'Lens Opacities Classification System II (LOCS II)'.

The Lens Opacities Classification System II (LOCS II) utilizes photographic standards (two retroilluminated Neitz-CTR and one standard slit lamp Zeiss photographs) for the classification of cortical and posterior subcapsular cataracts, nuclear color and nuclear opalescence. However, dedicated photographic devices, particularly retroillumination cameras, are not always available and this study was aimed at evaluating the suitability of a retroillumination photographic technique with a standard slit lamp camera for cortical and posterior subcapsular cataract classification according to LOCS II. Two observers examined 273 eyes. Kappa statistics demonstrated that agreement between the standard slit lamp, clinical grading (according to published LOCS II methodology) and photographic grading (according to our photographic technique), as well as inter- and intraobserver reproducibility, were excellent (Kappa > 0.74) for the classification of all lenticular regions. The results indicate that a standard slit lamp camera can be as useful as a dedicated retroillumination camera when LOCS II standards are used for cataract classification.

Adult↗
PubMed2006

Shooting a film photo slit lamp into the digital age.

PURPOSE: The purpose of this study is to describe a method of taking a slit lamp initially designed for film photography and updating it to provide digital photographs. METHODS: A "how-to" guide is provided. RESULTS: Updating a Nikon FS-2 slit lamp is more economic than many practitioners may realize. By using what is already available on the market, a few steps can make a would-be dated instrument useful for many years to come. CONCLUSIONS: The upgrade to the Nikon FS-2 slit lamp is not only possible, but is able to functional well in the clinical setting and capture high-resolution photographs.

Diagnostic Techniques, Ophthalmological↗
PubMed1989

A modified slit lamp for examination of wheelchair-bound patients.

A standard slit lamp can be modified with readily available components to examine wheelchair-bound patients. This modification minimizes discomfort in transferring patients to an examination chair and may provide better patient positioning in some cases. In addition to saving staff time, this technique minimizes the disconnecting of intravenous tubing, drainage catheters, and similar appliances. The addition of a swivel extension to the base of the slit lamp allows the entire unit to slide between the arms of the wheelchair at a height that is comfortable for the patient.

Humans↗
PubMed1979

Comparison of photo slit lamp and fundus camera photography of the optic disc.

The photo slit lamp has characteristics that may be important in optic disc photography for measuring glaucomatous cupping. This finding led to the question of whether disc photographs with the slit lamp showed less detail than fundus camera photographs. Tests were conducted on in-air resolution and of each instrument's ability to record fine vessel detail in normal human optic discs. The results showed that the instruments performed comparably in each test.

Fluorescein Angiography↗
PubMed2000

[Slit-lamp laser photocoagulation with a quadraspheric contact lens for the treatment of retinopathy of prematurity].

PURPOSE: To present our experience of slit-lamp laser photocoagulation with a pediatric quadraspheric contact lens for the treatment of retinopathy of prematurity (ROP). MATERIAL AND METHODS: 8 eyes of 4 premature babies with threshold ROP were consecutively treated under general anesthesia by means of blue-green argon laser photocoagulation delivered through a table mounted slit-lamp and a wide field contact lens specially designed for infants. Three of the treated eyes had a zone I disease, 2 a posterior zone II disease and 3 a zone II disease. Mean follow-up was 13 months. RESULTS: Early complete regression of the neovascular proliferations and plus disease was observed in all the treated eyes (100%) without apparent sequela. In only one eye that had zone I disease a mild and small peripheral vitreous hemorrhage was observed. Neither cataract nor posterior synechia was observed. A discrete and transient badly hypothermia occurred only in one case. COMMENTS AND CONCLUSIONS: This study shows the efficacy and precision of slit-lamp argon laser photocoagulation through a quadraspheric contact lens in ROP, with a very low rate of complications, and with a magnificent and comfortable visualization of all the structures to be treated. Each retinal burn was easily and very precisely placed from the ridge to the ora serrata in 360 with only a slight to moderate tilting of the wide field lens and without the need of scleral depression.

Gestational Age↗
PubMed1983

Video-photo slit lamp.

A combination video and photographic slit lamp manufactured by Rodenstock with a special light source by Storz has been described. Primarily a research instrument because of the expense of the light source, the video system, when properly adjusted, provides useful records of certain procedures and pathology and is an excellent teaching tool. The photographic attachment provides excellent quality, high resolution 35 mm documentation of anterior segment disease and pathology.

Ophthalmoscopes↗
PubMed1981

A system for slit-lamp polaroid photography.

A system is described in which a SX-70, Alpha Model II, Polaroid, single lens reflex camera, and photoflash unit can be quickly and sturdily mounted to a slit lamp. Such a system can take sharp anterior segment prints of the eye at all slit-lamp magnifications, with white light and in the flourescein mode. The heart of the unit is the modification of an assembly initially designed to attach the camera to a light microscope. The small flash unit and power supply were designed specifically for slit lamp usage. Examples of "instant" photos of the anterior segment at different magnifications are presented.

Contact Lenses↗