In this episode of the Eye Views podcast from Eye News, host Lorcan Butler speaks with Lucia Pelosini, a consultant ophthalmologist at King's College Hospital, London, about the crucial and expanding role of the Oculus Pentacam in ophthalmology and anterior segment imaging. The discussion highlights how the Pentacam has evolved from a dedicated diagnostic device for cornea anterior topography to a tool used for a full examination of the anterior segment.The Oculus Pentacam is used daily in a busy practice, and its versatility is a key focus of Dr Pelosini's episode. The discussion covers several critical applications such as the Pentacam's vital screening capabilities and significant educational value for patients. Clinicians can show pictures to patients to explain pathology and clinical decisions, which saves time and is engaging for patients, who often say they finally understand their problem.The Oculus Pentacam is central to the diagnostic platform for patients with corneal diseases like keratoconus or corneal dystrophy. It helps detect early-stage keratoconus, which is important for planning interventions like collagen cross-linking or corneal rings to slow disease progression. It also assesses the densitometry of the cornea. This is critical for patients with dystrophies, such as Fuch's disease, to understand how much visual function is impacted by corneal abnormalities versus lens cloudiness. It also performs pachymetry measurements, assessing the central, paracentric, and peripheral cornea. It also provides a correcting factor to apply to IOP measurements for glaucoma patients.The Oculus Pentacam offers a 3D reconstruction and objective measurements of the anterior chamber depth and angle depth from 25 different directions. This is used for glaucoma patients, assessing drainage tubes, and pre-operative planning for phakic IOLs. The device examines the crystalline lens and its densitometry. It has a grading system for nuclear sclerosis, which is useful for risk assessment and assigning cases to surgeons of different levels in a tertiary hospital setting.The Oculus Pentacam is a 'critical examination' for calculating the IOL power for patients with a history of LASIK or radial keratotomy. By measuring the posterior corneal surface, it significantly increases the reliability and precision of the lens implant prediction. It also helps examine the cornea for complications like a flap fold or epithelial ingrowth.For premium IOLs (multifocal IOLs or toric IOLs), the Oculus Pentacam provides the total corneal refractive power, aberrometry, and refraction. It measures pupil size (in dim and bright light) and detects higher-order aberrations, helping clinicians select the correct lens for the patient.Retroillumination is vital for assessing the position of a toric IOL post-surgery. The Oculus Pentacam features software to identify the precise IOL axis and guide the clinician on how many degrees and in which direction the lens needs to be realigned.The discussion emphasises the logistical advantage of having one diagnostic platform that can quickly perform five different assessments (tomography, topography, biometry, refraction, aberrometry, and retroillumination). Eye News is the longest-running print and digital magazine dedicated to ophthalmology in the UK, with an international and domestic readership of healthcare professionals, both within the NHS and private healthcare practices. Season 2 of Eye Views is proudly sponsored by Mainline Instruments. Visit their website here: https://eu1.hubs.ly/H0rc4Th0 To reach their team, email: sales@main-line.co.uk

In this episode of the Eye Views Podcast from Eye News magazine, host Lorcan Butler welcomes Consultant Ophthalmologist Professor Philip Bloom from Western Eye Hospital to discuss the exciting new advances in lens technology and design.Professor Bloom details the shift in cataract surgery goals to, if possible, achieving complete spectacle independence, especially for distance. He explains that this is now achievable in the NHS with the addition of Toric intraocular lenses, enabling many patients to drive without glasses after cataract surgery.The discussion covers the progression in intraocular lens (IOL) options, from monofocal lenses to enhanced monofocal lenses, extended depth of focus (EDOF) lenses, multifocal/trifocal lenses, and the newest continuous range of vision lenses. Professor Bloom shares that while most advanced lenses are in the private sector, enhanced monofocal lenses are increasingly available in many NHS units through the procurement process. He notes that with techniques like mini-monovision, he can confidently offer patients independence from driving and computer glasses, and a lot of independence from reading tasks.A significant portion of the conversation focuses on the challenges and differences between private and NHS practice regarding IOLs. Professor Bloom acknowledges that managed healthcare, even in the private sector, often restricts coverage for the most expensive lenses, leading to patient 'top-ups'. He advocates for allowing top-ups in the NHS to give patients a greater selection of lenses, despite concerns about increased chair time and the management of complications like Toric lens rotation. He stresses the importance of clinicians advocating for their patients.The conversation then pivots to other advancements in the field, including the rise of immediate sequential bilateral cataract surgery (ISBCS), which became more widely adopted post-lockdown as an efficient use of resources to tackle huge backlogs. Professor Bloom also discusses the light adjustable lens (LAL) technology, calling it "extremely interesting", and the ongoing debate between laser and lens-based spectacle independence for pre-presbyopic and presbyopic patients.Finally, Professor Bloom shares his expertise in glaucoma management, focusing on MicroPulse Transcleral Laser Therapy (MP-TLT) and Minimally Invasive Glaucoma Surgery (MIGS). He is a lead investigator for a national registry study on MicroPulse, set up to generate efficacy evidence after a 2021 NICE ruling. He emphasises that the goal of glaucoma surgery, like cataract surgery, is to achieve independence – in this case, from daily eye drops, which can cause significant side effects and inconvenience. He concludes that MIGS has been a "great addition" to patient care.Eye News is the longest-running print and digital magazine dedicated to ophthalmology in the UK, with an international and domestic readership of healthcare professionals, both within the NHS and private healthcare practices. Season 2 of Eye Views is proudly sponsored by Mainline Instruments. Visit their website here: https://eu1.hubs.ly/H0rc4Th0 To reach their team, email: sales@main-line.co.uk

In this episode of the #EyeViews podcast from Eye News, host Loren Butler is joined by Consultant Ophthalmologist Dr Iain Livingstone to discuss the transformative role of mobile technology and artificial intelligence (AI) in eyecare, specifically within patient pathways for ophthalmology and optometry. The discussion begins with how a smartphone can assist an eye specialist and their patient. Dr Livingstone recounts his early innovation as a registrar, developing an app called Eyesight Test (one of the first to be CE marked) by scaling Kay's Picture Tests on his phone. This initial project affirmed his interest in mobile technology and led to the founding of Peak Vision, a technology which allows the extraction of a beautiful picture of the optic disc with zero experience, mobilising the eye clinic and enabling transatlantic retinal exams.The conversation moves to the impact of the COVID-19 pandemic, where their work in peer-to-peer video conferencing and decision support rapidly mobilised a decision-support service across optometry in Scotland, particularly Central Scotland. This placed them unexpectedly in the public health space. By leveraging systems like NHS Near Me (re-labeled Attend Anywhere) and equipping optometrists with tools like the video slit lamp, the eye casualty was spread across the community.Dr Livingstone emphasises the continued focus on consolidating and maximising the link between community optometry and secondary/tertiary care. Strategies for maintaining this relationship include increasing independent prescribing and utilising simulation for training, shifting from "see one, do one, teach one" to "do one virtually a hundred times" before the first real case. The role of safety netting and understanding the attitude to risk and comfort with uncertainty are crucial in this blended care model.Discussing the origins of his involvement in digital tech, Dr Livingstone calls it his "burnout prevention part of the week" and explains it originated from the need for remote support as a first-on consultant with no juniors. The segment on patient-centered care explores the impact of mobile technology for the patient, citing a case where a patient with a cavernous sinus fistula was directed straight to neurosurgeons, bypassing the ophthalmology department, after a video consultation. However, Dr Livingstone cautions that the technology is not a panacea, noting a case where relying solely on the video call missed the crucial detail of dangerously high intraocular pressure in a young patient with a hyphaema.Regarding uptake, he notes that technology is a "totally polarizing prospect" among colleagues. While some embrace it, others see it as a distraction from an already saturated service. The lack of change in job plans to accommodate the time needed for unscheduled care and the subsequent drop in usage since the pandemic are significant challenges. He shares an example of successful video-first services at Moorfields Eye Hospital, where a 999 call can lead to a video consultation with an eye health specialist. Dr Livingstone's dream is to have a team of video-first ophthalmologists working across boards in Scotland to protect time for unscheduled care, especially in remote areas.Finally, Dr Livingstone addresses the use of AI in daily practice, emphasising the need for transparency, being the "biggest critic," and taking full responsibility. He quotes a colleague: "AI won't replace a doctor, but it will make you a more competitive doctor than your colleagues," arguing that not using it is a disadvantage. For those interested in AI, Dr Livingstone encourages them to start, noting the rise of "vibe coding" (describing what you want and letting AI create it) allows for rapid prototyping without a computing degree, making it a great time to be interested in digital tech in healthcare.