the P.A.L.M.P.I. Technique

I think I may have developed my own technique for identifying the laser mark positioning of toric contact lenses. I have come up with a quick acronym for it:


or "PALMPI" Technique (pronounced "PALM-pie") for short.

Here's how it came about: I have multiple toric contact lens wearing patients who for whatever reason cannot put their head easily into a slit lamp biomicroscope. Either they're too obese or wheelchair-bound or have a head tilt or whatever. So how does one assess the position of the laser marks on the toric lens? Well if they see well out of the torics its easy...its probably close to being positioned correctly. But if they don't see well, then what? Is the lens twisted 10 degrees left? Or 10 degrees right? Or TWENTY degrees?

The ambitious OD would say "do a spherocylindrical over-refraction". Yes, that works. Its also a monumental pain in the rear hahah. the PALMPI Technique is more fast & dirty than that.

Here's now it works. Its easy:

1) with the lenses on, dim the lights & have the patient looking in primary gaze (straight ahead)
2) shine a light (transilluminator, direct ophthalmoscope, MIO, etc) at the pupil as if you were performing pupillary testing
3) look carefully for the shadow of the laser mark projected onto the iris
4) estimate rotation (LARS rule, etc) accordingly

Well it may not be all that big of a revelation to some people, and maybe some OD's already use this previously-unnamed technique. But now it HAS a name! :D Since figuring this out a few weeks ago I've already used it 3-4 times in clinic and it has worked well! Its not as accurate as using a slit lamp, but its not as annoying as a spherocylindrical over-refraction & associated calculations, either.


  1. Hi. I hope you dont mind but i have a question about eye-crossing. I was searching for your e-mail but i didnt find any, so i decided to ask the question on your newes post.

    Everyone saying that its not bad to cross your eyes, like you do to see 3D images without glasses, but is it bad to cross them up to the maximum point? where you feel you cant cross them any further?

    To make story short, is it bad to cross your eyes as far as you can?

    Thank you, i hope you dont mind me asking!


  2. a common question. no, it is not bad for you to cross your eyes, even to the maximum point. uncomfortable, maybe, but certainly not dangerous for your eyes in the short term or the long run. no harm.

  3. Thank you :) !


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