Fitting Devices (ipads and the like)

[ThatOneGuy]

Are you using them?

I've been taking POW measurements and selling exclusively premium lens products for years. My patients have returned regularly due to great quality of vision. In the last two years, as the rest of the market has begun catching up on product technology, I began getting patients who would complain about the reading area width, or intermediate, or just generally feeling like it wasn't as amazing as what was once experienced.

Now that I'm using a fitting device for POW measurements, I'm getting the wow again. What's more, I've realized that I was measuring wrap too shallow in most cases, which seems to be the biggest differentiating factor between the devices measurements and my own. Finally, seeing where a patient looks specifically out of their frame (instead of guessing), I can make much better lens selections with much better feedback.

If you have wondered if there is value to a fitting device, I would say most definitely yes. I would like to think I know what I'm doing some of the time, and here I had potentially misfit a large percentage of my patients, potentially shooting myself in the foot if they go somewhere else.

Has anyone else had a good/bad experience with using fitting devices?

[Slim]

Were started using the Walman Spec tech iPad to see how it goes before we were to spend 15k for something... This thing surprises the hell outta me. 99% of the time its right on with what I would have guessed it to be.

I dont have any back to back like you do, at least not yet... but it was well worth the 2100 including the iPad hands down.

[Robert_S]

The towers are much better than the hand-held versions in my opinion.

[rbaker]

Hey, how about the good old Grollman. You don't have to recharge it and it never needs an upgrade.

[ThatOneGuy]

The towers are much better than the hand-held versions in my opinion.

Better results, easier to use, or both?

[Slim]

We were going to do the Visioffce, but realistically we do not have the room till we put up the new building, frame room is really small so the iPad deal is good for now. Id like to go to a tower once we move.

[iD]

we used ipads for otto. measurements were off. granted it was the initial release so they could have fixed the bugs\glitches. but we couldn't get it to work for us.

[Tallboy]

My bosses are cheap and I use a all the old school ways of POW. It works well, I never have people complain about lack of Wow factor. I would love to have a device to fiddle with, but it still seems like a way to get my coworkers to be able to do the same POW measurements as me without learning how to just take them more than something that really helps reduce remakes. I'm glad its working and one day I know I"ll have one, I just see it as a dog and pony show... for now.

Good to hear I might be wrong from your descriptions, do you really think your device has increased the width of your patient's intermediate and reading ThatOneGuy?

[MakeOptics]

I have been using a self made device, for POW measurements on an android device with a total cost of $99 minus the programming time and effort. The big benefits are:

1) Patients are impressed and confident.
2) Consistent measurements.

[CCGREEN]

Has much as your time spent fitting the pt increased? If you are in a busy location how has it affected business?
Are you really using it as a baby sitter to pacify the pt till you can get to them.
How many of you are in a MD's office which primarily has older pts that tend not to be wowed by gadgetry and tomfoolery?
How many of you are in OD offices which tend to have younger people who are really into the new techno stuff and are really really WOWED! Or are just mehhhh....whatever you say sir. (but i'm not really seeing it)
How many of you are in younger collage age towns vs large retirement communities and towns?

I do not have any of the fitting devices at my location and these are questions that run through my mind that have yet to be answered.

[Tallboy]

I have been using a self made device, for POW measurements on an android device with a total cost of $99 minus the programming time and effort. The big benefits are:

1) Patients are impressed and confident.
2) Consistent measurements.

Would you be willing to sell this app?

[Randal Cheek]

Very cool and interesting! I looked far and wide for an android solution...it would have been preferable to the ipad... But I broke down and bought the Shamir Spark for half price till the end of the month (event special) I think....Works pretty well, and doesn't need a clip or anything!

[idispense]

1) tower displays can be difficult to read and washed out depending on room lighting

2) any device is still a tool subject to interpretation and to be used by a skilled person

3) compensated power Rx's in theory are nice, but require their own unique troubleshooting.

4) the initial "wow" factor in aging people may be more obvious with the first pair when transitioning from a conventional fitting and non-compensated Rx.

5) the continuing "wow" with subsequent pairs may be diminished as the patient retains older compensated power glasses and compares new compensated power glasses to older compensated power glasses vs the first pair of compensated power glasses being compared to non-compensated.

6) the continuing "wow" is reduced in aging people as they advance to cataracts, macular issues etc.

7) it's important to record the compensated powers in the patient file for future reference and troubleshooting.

[Chris Ryser]

1)


6) the continuing "wow" is reduced in aging people as they advance to cataracts, macular issues etc.

"idispense"' .............You also forgot to mention that the older people have a higher add which results in a smaller reading and close up area. For older people the "wow" factor becomes the "POO" factor.

That is why I am a lot happier with my ST 35, have all the wide close up area and I can say "POO" to the "wow" factor

[ThatOneGuy]

My bosses are cheap and I use a all the old school ways of POW. It works well, I never have people complain about lack of Wow factor. I would love to have a device to fiddle with, but it still seems like a way to get my coworkers to be able to do the same POW measurements as me without learning how to just take them more than something that really helps reduce remakes. I'm glad its working and one day I know I"ll have one, I just see it as a dog and pony show... for now.

Good to hear I might be wrong from your descriptions, do you really think your device has increased the width of your patient's intermediate and reading ThatOneGuy?

I really do! And more to the point, is you can make better judgment calls about lens design when you know exactly what people are doing with their eyes, instead of making educated assumptions. I have been super impressed, even still, with a few months under my belt.

[Tallboy]

I really do! And more to the point, is you can make better judgment calls about lens design when you know exactly what people are doing with their eyes, instead of making educated assumptions. I have been super impressed, even still, with a few months under my belt.

What handheld fitting system are you using?

[sharpstick777]

I have deep suspicions of any hand held device. I never trusted the PDs from an Autorefractor even with the patients head and chin are in a brace of sorts. none of these devices requires a physical reference point. there is no way they can be as accurate as an autorefractor. I still prefer manual measurements with a Pupilometer and Vertometer.

[sharpstick777]

An improvement on near and intermediate zones will depend on 2 things, were you using Mono near PDs previously? And were you using lenses that actually used the REAL patient near PD? There are only 4 lenses in the US that use Near PDs, but I consider it the most important POW measurement over them all. not only can I calculate where to perfectly put the reading for each patient, I can actually use a combination of Distance RX and near PD to estimate the axial length for better distance Ray Tracing. In the end it improves near zone immensely, but distance zones some.

I am thrilled with your success, but it may be due more to the lens and less to the measuring device. Right now the only lenses that use a real Near PD are the Zeiss Individual 2, the Seiko Surmount, Superior and Supernal (lesser degree on the Supernal). The Rodenstock Impression does as well but its not easily available in the US. In every other lens the corridor is not truly aligned for the patient.

I began getting patients who would complain about the reading area width, or intermediate, or just generally feeling like it wasn't as amazing as what was once experienced. Now that I'm using a fitting device for POW measurements, I'm getting the wow again.

[ThatOneGuy]

An improvement on near and intermediate zones will depend on 2 things, were you using Mono near PDs previously? And were you using lenses that actually used the REAL patient near PD? There are only 4 lenses in the US that use Near PDs, but I consider it the most important POW measurement over them all. not only can I calculate where to perfectly put the reading for each patient, I can actually use a combination of Distance RX and near PD to estimate the axial length for better distance Ray Tracing. In the end it improves near zone immensely, but distance zones some.

I am thrilled with your success, but it may be due more to the lens and less to the measuring device. Right now the only lenses that use a real Near PD are the Zeiss Individual 2, the Seiko Surmount, Superior and Supernal (lesser degree on the Supernal). The Rodenstock Impression does as well but its not easily available in the US. In every other lens the corridor is not truly aligned for the patient.

Spot on!

For the inquiring minds amongst us, I am using the Walman app.

I have used Individual 2 almost exclusively since its release, but nearly every time I used mono near PDs, it blew up in my face, leading me to suspect I was outwitting myself and needed to trust the lens default calculations.

Since using the app, I have opted to accept the results it gives me, and it has been a good decision. Also, I've been taught to more or less use default near distance PD measurements if taking near PD, and the app has given me the confidence to trust that people are rarely average.

As to the comment by someone earlier about no physical reference point, that is the purpose of the devices that clip to the frames. They provide the physical reference point.

I used software in the mid 90s that used similar calculations so that I could build 3D environments based off of 2D photos and import them in to 3D video game environments. It DOES work.

[sharpstick777]

Spot on!

I have used Individual 2 almost exclusively since its release, but nearly every time I used mono near PDs, it blew up in my face, leading me to suspect I was outwitting myself and needed to trust the lens default calculations..

I would suspect the difference is due that Europeans may use a different working distance than Americans, you may have to get adjust your pupilometers distance point to match what Zeiss prefers for best results. Pupilometers should be calibrated every 6 months as well, which also may contribute.