Ryan Alfonso, M.P.H.
Managing Editor
Space saving handheld pachymeters and A-Scans not only simplify your lane layout, but they can facilitate the examination of children, the elderly, and wheelchair-bound patients. Additionally, these devices help free-up room for other diagnostic equipment that occupies more space such as visual field analyzers and digital retinal imaging systems. With each iteration of new handheld technologies, greater levels of accuracy and functionality become available. Handheld ultrasound biometers now are capable of being precise pachymeters and A-Scans.
When purchasing a new handheld pachymeter/A-Scan there are several considerations of importance: the accuracy of the device, whether it can be readily upgraded with the latest IOL calculation software algorithms, whether the data collected can be easily migrated into your electronic medical records system, and of course, associated cost.
The fact is that many handheld ultrasound biometers are just as accurate as their stationary cousins. Accuracy is dependant upon several factors. Probe frequency is typically 10-20MHz for these devices. In the case of the PalmScan Systems by Micro Medical Devices Inc. (MMD) the sampling rate is 264 MHz. This makes the PalmScan Pachymeter the fastest digital Pachymeter in the market today. This sampling speed equates to a device accuracy of ±3.1 microns.
PalmScan’s optional LRI Nomogram Software and 50MHz probe facilitates the planning of LRIs (limbal relaxing incisions) to remedy the residual astigmatism in postoperative cataract patients. The LRI option allows fast and accurate peripheral corneal measurement and the software needed to calculate the size, location and the depth of LRI/AK incisions based on the NAPA (Nichamin Age & Pach-Adjusted) Nomogram. The results are displayed on the hi-res color touch-screen display in the form of a graphical and textual “surgical plan” that can be printed, stored electronically and archived.
Another unique feature of this family of pachymeters is that they also display corneal waveforms on the device itself. Several new software innovations provide users the additional ability to display, store and recall of corneal waveforms on a per patient basis. You can also confirm the calibration of your femtosecond laser microkeratome by measuring the depth of flap and bed prior to lifting the flap. This ensures accurate direct flap measurements without the need for subtraction pachymetry. In A-Scan mode, the PalmScan actually slows its sampling rate by half. This equates to an accuracy of ±5.75 microns. This degree of accuracy and reproducibility gives you results that will allow you to more confidently prescribe the right IOL. PalmScan’s immersion capability along with its ultrasonic alignment detection software ensures accurate results.
A typical pitfall in purchasing any new technology is that two months after you purchase it, the release of the next version renders it obsolete. Nowhere is this more evident than in home electronics, as you are no doubt personally aware. To avoid these issues, medical device manufacturers like MMD are designing instruments that can be “field-upgradeable" to the latest software. This means that new releases of the system software can be loaded to systems that are already in clinical use. This ensures that users have access to the latest software releases available. Hardware upgrades are another problem for which MMD has a good solution. The PalmScan A2000 (A-Scan) and PalmScan P2000 (Pachymeter) are upgradeable to the PalmScan AP2000 (A-Scan/Pachymeter combination device).
Sparked by a presidential mandate stating that all Americans will have an electronic medical record by 2014, many device manufacturers and software companies have endeavored to become pioneers in this field. The ability to easily transfer captured data from a medical device to a network PC has a myriad of benefits: facilitating patient care, office administration and billing, enabling clinical research, and easing the reimbursement process. The PalmScan devices utilize widely available wireless networking technology (Bluetooth, 802.11b,g,n, etc.) in order to bring connectivity and efficiency to the ophthalmology practice.
Portability brings convenience and efficiency. In today's competitive medical environment most physicians are discovering that their practice requires multiple lanes, multiple office locations or even visiting patients outside of the office setting. The PalmScan product line provides a solution to reduce costs associated with purchasing equipment for these multiple settings while increasing the convenience and overall efficiency of any practice. The secret is mobility.
Innovation has brought about handheld versions of many of the mainstay technologies in ophthalmology. The price-points of these new handheld devices, and their stationary cousins are quite comparable. You then have a choice as to how you want to arrange your practice; one handheld pachymeter/A-Scan that can be used in all of your exam lanes, or a station for each system that would potentially create a patient back-up and scheduling hassle. Having a mobile system is simply faster. This is just one of the many ways handheld devices can help generate revenue and save time. Collectively, medical device companies have brought to market an impressive quiver of diagnostic devices that give today's healthcare providers better means to detect disease and treat patients. While conveniently packaged in small forms, these innovative handheld medical devices can actually improve therapies and reduce costs, while enhancing the quality and economics of healthcare delivery.