Dispensing in domiciliary practice

Providing the patient with all the facilities they could have in a high street practice has always been the aim in domiciliary work. Often patients will lament the fact that they are unable to see how they appear with different frames. Relying on friends and helpers is not always possible, so this simple technique has been developed. If you already keep a digital camera as part of your kit for photographs of external eye problems, contact lens complications etc, then this is zero cost procedure.

Method
Having selected a short list of possible frames, the patient puts them on and a photograph is taken of each. (It is good practice to confirm that they are happy to have a photograph taken, though usually the only problem is that they may ask for a copy).
The photos are then played back through the laptop PC using 'picture manager' or equivalent (usually a quick and automatic process). The displayed photographs can then be shown to the patient, who, now wearing reading glasses (or trial frame if need be) will be able to see themselves wearing the selected frames, in much the same way as using the TV magic mirror systems found in many high street practices these days. In addition, if you keep a frame glazed with MAR coated lenses; the appearance benefits of these can easily be demonstrated. The process does not take long, with the added advantage as follows.

PDs, PCPs and Seg Heights
Accurate measurement of PDs are obviously needed to make up a pair of spectacles; however, in a domiciliary setting this essential task can sometimes be difficult if the patient has severe postural problems or Parkinson's disease.
Having chosen a frame, set up and adjust in the usual way. Take a photograph from about 2m away, taking care to be directly in line with your patient. Instruct them to look directly at the camera. Now, or later at the end of the day, play back the image using Microsoft picture manager, resize the picture until the frame is exactly the size of its image on the screen (this can be done in 1 per cent increments so accurate sizing is possible). The patient's PD, bifocal height and PCPs in the case of varifocals, can now be measured directly from the screen, with the advantage of a stationary target. If the camera's 'red-eye' feature is cancelled, the pupils may also be highlighted in red, making measurement even easier.
The error in PD measurement when converging to 1.5 m instead of looking to infinity is less than 0.5 mm.
The procedure also works well in the high-street practice, and can be useful for children who often enjoy having a photograph taken with their new frames (again permission needs to be asked regarding photographs and reassurance given that the images are deleted after use).

Graham O'Regan is an
optometrist working in private practice and specialising in domiciliary visits