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:

the
Prince
Astigmatism
Laser
Mark
Position
Identifier
Technique

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.