Adjusting the slit-lamp oculars: an unnecessary burden or a must?

Adjusting the slit-lamp eyepiece rings is perceived by some to be insignificant for achieving adequate focus. Others assume that these rings should be set only to compensate for one's refractive error. Observations are presented concerning the eyepiece scale setting during routine examinations, slit-lamp mounted YAG and Argon laser procedures and during opthalmic surgery. Diagrams illustrate the optical basis of these observations. Factors influencing optimal eyepiece ring setting, besides ametropia, include slit-lamp misalignment (variations in calibration) as well as unconscious accommodation. An inaccurate setting cannot be fully compensated by adjusting the slit-lamp joy-stick. When an incorrect setting is used, while using oblique illumination, it becomes impossible to focus on details placed at the center of the viewfinder. In addition, irrespective of joy-stick position, it is impossible to view an oblique slit transecting the cornea in perfect focus. An accurate setting, as a whole, results in sharper images throughout the slit-lamp examination. Differences between individual instruments make it necessary to reset the eyepieces for each eye and for each individual instrument. Methods are described for evaluating the need for readjustment, as well as a simple technique for calibration in the absence of a focusing rod.