Lately I’m toggling between an Eaglet ESP and AS-OCT to set initial vault and confirm 200–250 microns central clearance after settling, aiming to reduce compression rings and keep the limbus happy. If you’ve used Medmont or sMap3D alongside OCT, which setup gives you the most repeatable numbers, and do you tint the bowl with a fluorescein strip to spot early edge impingement?
I’ve had the most repeatable numbers using sMap3D paired with AS‑OCT, and I average three sMap captures, then start 50–80 µm under the suggested SAG so I still land at “200–250 microns” after a 20–30 minute settle. I do tint the bowl with a lightly wetted strip — just a quick dip — because it flags early edge impingement well, but too much dye can make mild blanching look worse; have you seen ESP overcall SAG on small HVIDs?
With ESP I get repeatable starts, but I always apply a 100–120 µm settling offset for 16.5–18.0 mm and verify with AS‑OCT at 30 min; that lands me right at 200–250 without mid‑day compression, and I only streak one fluorescein strip in the bowl so I don’t overcall edge bite. @ethan_holt23 have you noticed ESP overshooting SAG inferiorly on asymmetric scleras?
ESP for capture, but I trust AS‑OCT at 45–60 min rather than 30 to judge true post‑settle vault and catch early limbal squeeze. I do “tint the bowl” — a pinhead of NaFl in the fill — and view with a yellow/Wratten filter; edge impingement shows as a thin dark ring before staining tracks. Medmont’s fine for cornea, but for scleral SAG I get tighter repeatability with sMap3D + OCT on toric sclera — @ethan_holt23 do you average three maps or more on irregulars?
Quick tip: before you trust AS‑OCT calipers, set the material index to tear fluid (n=1.336) instead of cornea — on my unit that trimmed measured vault by about 50–70 µm and stopped me overshooting; @mcneil34 have you checked your OCT’s index setting?
I get the most repeatable numbers pairing sMap3D for haptics with AS‑OCT for the reservoir; the single best tweak was to “standardize the fill” — [redacted] via a [redacted] syringe and the same large plunger — cut my starting variance by about 60 µm. For 15.8–16.2 mm lenses I apply a 70–80 µm settling offset and check horizontal/vertical OCT line scans at 60–90 min to catch early limbal issues; @csanders10, have you tried locking fill volume like that?
I get better repeatability by watching the ‘vault-loss slope’ on AS-OCT from 15–60 min; if it’s >1 µm/min I loosen the landing rather than chasing initial vault — think slow leak, not snapshot. I also budget a bit for inferotemporal drift so the 200–250 µm target lands where it should after decentration. @grace_elliot92 have you sanity-checked your OCT with a #1.5 cover slip (about 170 µm) in saline to verify the caliper scale?