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There are two realms of information when assessing ocular health: the structure of the various components of the eye and the functioning of the visual system. Like many things in life, there are many variations on what a normal eye can look like – sometimes healthy eyes can appear entirely unhealthy. On the other hand, ocular pathology can sometimes be subtle and difficult to detect. At times only the best in analytic instrumentation can make the distinction between normal and diseased eyes. Because technology matters, Beartooth Vision Center offers the best to our patients in both structural and functional testing.

This is an important distinction between primary care private optometric practices such as ours and the abundance of retail and store – based optometry offices in Billings. Square footage matters: Retail optometry exists so the chain store can sell eyeglasses. Because of this, commercial stores do not dedicate valuable floor space to primary care diagnostic instrumentation that is deemed by them to be unnecessary. At Beartooth Vision Center, we consider leading edge technology vital to the quality of care we provide our patients.

Optos Daytona

Optos Daytona LogoThe Optos Daytona gives a large digital view of most all of the inside of the eye, like a satellite view of the earth; able to look at several layers of the retina highlighting areas of the retina that are not functioning properly; generally avoids the for dilating drops; highly recommended for yearly eye exams so that changes the eye can be seen by comparing picture to picture over the years; the “big picture”.

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Photo of Optos MachineThere is no other instrument like the Daytona scanning retinal laser. We have used it as an important part of our annual eye examinations in our practice since 1998. The Daytona retinal exam is an option our patients can choose as part of their yearly eye exam to evaluate the health of the inside of their eyes. It gives a sweeping digital “bird’s eye view” of the internal eye, including the retina, the optic nerve, the blood vessels, and the macula (the part of the retina that provides your sharp central vision). The Daytona has revealed diabetes, cancer, high blood pressure, blockage of the blood vessels to the eye, glaucoma, macular degeneration, retinal detachments, tears, and holes, as well as other retinal conditions in our patient’s eyes.

We recommend the Daytona as part of our annual eye examinations. We also use it to trouble shoot when our patients have symptoms of vitreous or retinal problems. Based on what we see with the Daytona, we are able to “zoom in” on the problem with other scanning diagnostic laser technology if needed. (See Heidelberg OCT below). – Dr. Currence

Following is a quote from the Optos web site about the Daytona instrument:

“From the 200 degree view of the retina in one image, captured in less than one second to the multiple imaging modalities available, the Daytona brings the benefits of ultra-widefield Optomap images to your practice, inside a compact design … Daytona is capable of on-the-fly, ultra-widefield imaging in color, red- free, and auto fluorescence, providing views of deeper structures of the retina … Daytona was engineered with patient comfort in mind. Our ergonomic design encourages a neutral body posture and simple positioning of the eye.” Learn More >>>

Heidelberg Spectralis Ocular Coherence Tomographer (OCT) with Multicolor

Heidelberg Engineering LogoThe OCT is like a high resolution CATSCAN, able to give a very magnified, detailed 3D sliced view of different parts of the eye; the Multicolor scanning laser image creates a very detailed picture of the retina and other structures composed of 3 different light wavelengths; like “boots on the ground” as compared with the satellite perspective of the Daytona; extraordinarily precise measurements and analysis of eye structures so that small but sometimes important changes can be detected early; generally targets a specific area inside the eye.

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Heidelberg OCT Optometric MachineWe acquired our Heidelberg Spectralis Ocular Coherence Tomographer (OCT) in October, 2010. An OCT is essentially a high resolution CATSCAN of the retina, the cornea (the clear tissue on the front of the eye) and other internal ocular features. The OCT uses a series of very detailed and highly magnified visual slices through the tissue in question that allows us to closely evaluate problem areas we discover inside the eye using the Optomap instrument (see above).

We decided on a Heidelberg Spectralis OCT because it is a combination of 2 diagnostic confocal scanning lasers which work together to provide unparalleled clarity, precision, and ease of use for both the patient and the operator of the instrument, as well as the ability to scan exactly the same place in the eye when monitoring for small and microscopic changes over time. This is essential for the diagnosis and monitoring of conditions such as glaucoma and macular degeneration. The Multicolor scanning laser image is a very detailed picture of the retina that can be broken down into 3 retinal layers. Our OCT has excellent analytical software for clinical decision making and we also benefit from software updates that further expand the capabilities of this remarkable instrument. – Dr. Currence

Following is a quote from the Heidelberg web site:

Multi-modality imaging with SPECTRALIS® is helping drive the development of novel therapeutics and changing the course of patient management in eye care. Using an upgradeable platform approach, SPECTRALIS has enhanced the role of spectral domain OCT by integrating it with confocal scanning laser ophthalmoscopy (cSLO). The combination of these two technologies has enabled new imaging capabilities, such as TruTrack™ active eye tracking, and BluePeak™ blue laser autofluorescence, providing clinicians with unique views of the structure and function of the eye.

Enhanced anatomical details, 1 micron measurable change1 and automatic rescan at follow-up are the direct benefits of TruTrack™ active eye tracking and simultaneous dual-beam imaging. These two technologies are at the core of the SPECTRALIS product platform. Enhanced image detail comes from Heidelberg Noise Reduction™, which improves images like Dolby® noise reduction improves recorded sound. Measuring change with 1 micron reproducibility is possible with AutoRescan™, which automatically places follow-up scans in precisely the same location, bypassing operator variability. This precision is the product of 20 years of proven HRT technology, which paved the way for the dual-beam approach to imaging. Learn More>>>

Heidelberg Spectralis Ocular Coherence Tomographer Angiography (OCTA)

Heidelberg Engineering LogoIn December 2018 we became the first office in Montana to add the Angiography capability to our Heidelberg Spectralis OCT. Called OCTA, this technology uses extremely precise imaging to track the flow of blood cells through the thousands of retinal blood vessels inside the eye. The Spectralis OCTA allows us to check the health of the ocular blood vessels, including for Diabetic Retinopathy and Wet Macular Degeneration without the use of injections or other invasive techniques. We look forward to the development of even more applications for this amazing technology.

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The below left image shows the different blood vessels that nourish the 10 layers of the retina. The middle OCTA image shows what healthy blood vessels look like with OCTA. The right OCTA image shows abnormal capillaries that can grow inside the eye with conditions like Diabetic Retinopathy, Wet Macular Degeneration, and the blockage of blood flow through the normal retinal blood vessels.

Diagram of OCTA Cell Layers
Close-up Photo of Healthy OCTA Blood Vessel
Close-up Photo of Unhealthy OCTA Blood Vessel

Humphrey Visual Field Analyser

Zeiss LogoWith our Humphrey Field Analyser we have the longstanding industry leader in this area of eyecare. This instrument is used to help determine the extent of vision loss due to strokes, retinal conditions, optic nerve conditions, brain tumors and medicine toxicities.

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Humphrey Optometric Machine

Our Humphrey visual field analyser is the gold standard for measuring the peripheral visual field. In healthy eyes, the peripheral vision (also known as “side vision”) remains the same in size throughout life. There are medical conditions such as glaucoma, stroke, and space – occupying lesions inside the brain which can cause complete or partial loss of sensitivity of the peripheral vision called an absolute (complete) or relative (partial) scotomas. We have used both of these instruments to detect significant medical problems and both will continue to be valuable diagnostic tools at Beartooth Vision Center. – Dr. Currence


Following is a quote from the Humphrey web site:

Validated by more than 25 years of research, design and clinical experience, the Humphrey Field Analysers are the accepted standard of care in glaucoma diagnosis and management. With over 65,000 installed units worldwide, the Humphrey Field Analysers are the premier automated visual field perimeter.

Reichert Ocular Response Analyzer G3

Reichert Technologies logoTraditional glaucoma instruments measure either the structure or the performance of the optic nerve and visual system. Despite the amazing variety of information that these instruments provide, the accurate diagnosis of glaucoma can be very challenging. Healthy eyes can seem to have glaucoma but don’t. A person with high pressures in their eyes may not have glaucoma, and people who have glaucoma may never have a high measured pressure. The Reichert Ocular Response Analyzer G3 helps us to understand our patient’s eyes better in that it is the first instrument that measures the dynamic biomechanical properties of the eye.

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The addition of the Reichert Ocular Response Analyzer G3 provides our office the ability to understand even better the nuances and dynamics of glaucoma. Corneal hysteresis is a measure of the behavior of the eye in that it measures how a cornea responds to an outside pressure. It is essentially a measure of the elasticity of an eye. Some eyes are very elastic (like a balloon) and can absorb a higher internal pressure with no damage. Other eyes are far more rigid (like a glass bottle) and are much more likely to have damage with a higher pressure inside. The Reichert Ocular Response Analyzer G3 is a very good predictor of who is at risk of developing glaucoma and also how well our glaucoma patients are responding to their medications. – Dr. Currence

Ocular Response Analyzer Machine

The Ocular Response Analyzer® is uniquely positioned as the only tonometer that can measure corneal hysteresis, a superior predictor of glaucoma progression. Corneal hysteresis is an indication of the biomechanical properties of the cornea differing from thickness or topography, which are geometrical attributes. “Corneal hysteresis measurements were significantly associated with risk of glaucoma progression. Eyes with lower corneal hysteresis had faster rates of visual field loss than those with higher hysteresis. Reichert’s automatic, non-linear pressure ramp customizes the air pulse, in real time, for each eye being measured. This patented feature enables the softest possible air pulse, ensuring maximum patient comfort. – as quoted on the Reichert website.

Marco / Nidek OPD-Scan III

OPD Scan LogoThe OPD-Scan III is a state of the art autorefractor, corneal topographer, and it measures higher order aberrations of the eye which can cause major visual problems for some people. These imperfections in the focus of light are not corrected by traditional glasses or contact lenses. We are the first office in Eastern Montana to use the OPD Scan III to fit leading edge technology waveform soft contact lenses for many of our patients who have severe visual distortion from degenerative corneal problems such as keratoconus.

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Nidek OPD Optometric MachineThe Marco / Nidek OPD-Scan III instrument has brought waveform technology to Beartooth Vision Center. This instrument measures a wealth of information about the patient’s refractive status, including corneal topography (contour mapping of the clear tissue on the front of the eye), a person’s glare and blur simulations, and an aberrometer which measures the higher order aberrations (HOA’s) of the eye. For the first time in the United States, we have added the fitting software from the Waveform contact lens company to our OPD-Scan III to create a powerful problem-solving device for many of our patients who have special visual needs. The Waveform company manufactures highly precise custom wavefront guided soft contact lenses and multifocal contact lenses. With the fitting of Waveform contact lenses, Beartooth Vision Center has entered the cutting edge area of correction of higher order aberrations (HOA’s). There are about 80 different types of HOA’s. These are imperfections of light that occur as light goes through the pupil and different interfaces of the eye on the way to the retina in the back of the eye. Traditional glasses and contact lenses do not correct this blur that everyone has to one extent or the other.

The amount and impact of HOA’s vary widely from person to person. Some people have fewer HOA’s, with little effect on their vision. Other people have significant HOA – related visual problems, including glare and reduced clarity in low light and at night. People with degenerative corneal conditions (such as Keratoconus and Pellucid Marginal Degeneration) can experience significant distortion and blur of their vision under any lighting conditions – even with traditional glasses or contact lenses – due to an extreme amount of HOA’s from the corneal irregularities. With the incorporation of a precise “HOA fingerprint” custom soft contact lens correction compensated to align perfectly with the position and fit of the contact on the cornea, Waveform custom soft contacts can be life changing. These contact lenses are truly unique and custom made for our patients. Waveform contact lenses can provide far better visual clarity for these people, as well offering an alternative vision correction for people with very high prescriptions that create significant visual distortion with conventional lens technology. – Dr. Currence

Following is a quote from the Waveform web site:

OPD Optometric MachineOver the past 15 years, new high-tolerance objective measuring technology called “wavefront aberrometry” has been developed. Conventional eye exams measure low order (2nd order) optical aberration—sphere, cylinder and axis and, in the case of a presbyope, the addition power. Through advancements in LASIK surgery, wavefront aberrometry was developed to optimize the visual outcome. Wavefront aberrometry is an advanced 21st century optical measuring technology that measures 28 levels of aberrations within the human eye, called Zernike coefficients. Only one of these levels—2nd order aberrations—are measured in conventional subjective refractions today. An aberrometer is capable of taking advanced, objective and complex optical measurements of the human eye in seconds, compared to the typical 15 minute subjective eye exam.

Optical aberrations are defined as anything that causes light to bend and can change significantly as the pupil dilates under low light conditions, such as at night. This is why many people are happy with their vision during daylight hours and then are uncomfortable and complain about their vision at night. The important optical aberrations that affect vision are:

  • 2nd Order optical aberrations – currently measured in all eye exams providing sphere, cylinder and axis corrections
  • 3rd and 4th Order optical aberrations – high order aberrations currently not measured in today’s eye exams but can account for up to 20% of the eye’s refractive error.
  • 5th and 6th Order optical aberrations –also high order aberrations not currently measured in today’s eye exam. These aberrations are of less significance clinically, however they manifest in reduced vision for a small percentage of eyes.

Uncorrected high order aberrations (HOA’s) can lead to poor nighttime vision, a reduction in depth of focus for reading, glare around lights at night and reduced color perception. All of these HOA’s manifest in varying degrees for each individual patient. Pupil size is a significant contributor to the manifestation of high order aberrations. As the pupil increases in size, more peripheral light enters the eye. As a result, a blur circle is created instead of a point focus on the retina. As the blur circle increases in size and shape, visual clarity is diminished. This is why even some patients with 20/20 vision can complain of visual discomfort.

Wavefront aberrometry has been commercially available for over 10 years. Its primary use, when originally introduced into the optical industry, was to provide optical measurements that could aid the refractive surgeon improve the vision outcome for LASIK. The aberrometer shines a perfectly shaped wave of light into the eye and captures reflections distorted based on the eye’s surface contours. Thus, it generates a map of the optical system of the eye, which can be used to prescribe a solution, correcting the patient’s specific vision problem.

Over the past four or five years, this technology has greatly improved optometrists and ophthalmologists’ ability to develop more precise and specific prescriptions. By using the wavefront aberrometer, they have helped many patients achieve a much higher standard of vision.

WaveForm has developed two technologies that utilize advanced wavefront aberrometry measurements to improve the eye exam experience called “Optimized WaveFont Refraction,” the patient and eye doctor can provide a customized correction of each individual’s low and high order optical aberrations through the manufacture of wavefront-guided soft contact lenses.

WaveForm’s wavefront-guided contact lens technology and optimized wavefront refraction for eyeglass lenses address the problem of uncorrected high order aberrations in different ways.

  • For WaveForm’s wavefront-based objective eye exams, the optimized wavefront refraction incorporates all low and high order aberrations to produce an optimal low order prescription in seconds. Since the eye moves behind the eyeglass lens, it is virtually impossible to correct for the optical fingerprint on the surface of eyeglass lenses.
  • In the case of WaveForm’s wavefront-guided contact lens technology, the individual optical fingerprint is generated on the surface of the soft contact lenses and placed directly on the eye’s surface, thereby fully correcting this unique optical fingerprint.

Summit Optical

Beartooth Vision Center glasses lenses are made in Helena, Montana. Summit Optical is a small privately owned lab that makes glasses lenses for private optometric practices located primarily in Montana. Summit Lab has consistently done superior quality work in a prompt fashion and has an in house state – of – the art antireflective lens coating facility that applies the top rated glare reduction coating in the industry. Their work is superior.