Meghan Berkenstock, M.D., had a problem. An assistant professor of ophthalmology at Wilmer, Berkenstock had a patient whose optic nerve she needed to see more clearly to determine if his glaucoma was progressing. The obstacle? He had a very long (myopic) eye. The machine used to image his optic nerve, called an optical coherence tomography (OCT) machine, employs light waves to take cross section pictures of the retina and optic nerve. But the light has to travel farther in a myopic eye, making the signal weaker and the scan less reliable.
Berkenstock expressed her frustration to Melissa Collins, a certified ophthalmic technician and photographer who performs imaging in Wilmer’s Bel Air clinic. Berkenstock suggested that they place a lens in front of the patient’s eye to boost the signal strength of the OCT scan. “Why not use a contact lens?” suggested Collins. All eye clinics have plenty of trial contact lenses. “It was brilliant!” says Berkenstock. “I did the scan without the contact lens and repeated it with the contact lens, and the signal strength improved.”
Because this is Wilmer, the story does not end there. Berkenstock scoured the academic literature to see if there were previous publications on this technique and found there were none.
With the help of Collins and Denise Ricard, another ophthalmic technician at the Bel Air clinic, Berkenstock set out to change that. They designed and executed a study to see if using a contact lens did consistently boost the signal strength of the OCT machine, resulting in better images of the optic nerve in patients with high myopia.
Berkenstock says it was a Bel Air-specific process, from conception to recruiting the patients. The location of the study is important, she says, because it “showcases that our clinics outside of East Baltimore are places where a lot of great things can happen.” She, Collins and Ricard found that patients were excited to enroll in a study that could help others and were glad they did not have to drive downtown to do so.
The close collaboration between Berkenstock, Collins and Ricard is unique. While Berkenstock is accustomed to publishing academic studies, Collins and Ricard are not as familiar with this aspect of medicine.
“It’s not something I ever thought I’d be part of,” says Ricard, referring to the study. “It’s exciting to be a part of something that’s going to possibly help people in the future.” Collins too is surprised, yet pleased to be an author on the research paper based on the study.
“I stumbled upon this idea because we were going back and forth about the patient. It was pretty neat just to hear Dr. Berkenstock say, ‘Wow. Why hasn’t anybody thought of this before? Let’s get this moving,’” says Collins. “She wanted to be the first to have it published.” And they will be — in the prestigious journal Ophthalmology Glaucoma.
“Based on our data, the use of a contact lens statistically improved the signal strength and average nerve fiber layer thickness of the spectral domain OCT scan,” says Berkenstock. Because the signal strength and quality of the OCT scans improved, they were able to see a thicker nerve fiber layer than previously noted, which has broad implications for patient treatment—from adjusting the number of drops prescribed to determining the need for surgical interventions.