Introducing automated refraction ...............................

Optometric Management

INTRODUCING AUTOMATED REFRACTION

THE “RIGHT” WORDS CANMAKE PATIENTS BOTH VALUE AND GET EXCITED ABOUT ANNUAL EYE EXAMS

By April Jasper, O.D., F.A.A.O., West Palm Beach,

Fla. September 1, 2018


When I look at the patient confusion

regarding optometry, I find much of it is due

to our (the doctor’s) lack of effective

communication about our technology and

“why” it is so important to see us annually.

The good news: Using automated refraction

and the “right”words can make patients

both understand the importance of and

become excited about an annual eye exam.

(See “Automated Refraction Benefits,”

right.)



At mypractice, we start the conversation

about automated refraction on our website.

Specifically, we have information from the

company on our website in both digital

formats for those who prefer a video, as

well as written information.



When Patients enter the office, they hear

from our technicians and from doctors

exactly what makes the technology special

in words that matter to them. Here’sa look

at what the technicians and the doctors say

about automated refraction at the patient

touchpoints:




Automated Refraction Benefits

Here is a list of some of the benefits of automated refraction:

• All the tests available on a
• manual refractor are
• available.

• Increased accuracy: 1/8 D
• Sphere and 1° Axis.
• Increased efficiency (of
• patient flow and refraction
• itself): Refraction time is
• typically less than a minute,
• allowing greater time to
• communicate prescription
• needs with patients.

• Can assess acuity to 20/10
• (or smaller) with LCD charts.
• Can refract in light or dark
• conditions with LCD charts as
• opposed to the projector with
• the light bulb set up
• projecting on a screen.

• Coordinates chart selection
• with test performed
• automatically with LCD
• charts.
• Allows patients to quickly
• compare their old
• prescriptions to their new
• prescriptions, so they can be
• assured of the value of
• buying new glasses
• regardless of the degree of
• change.
• Provides for rapid, error-free
• transfer of data into EHR,
• which saves an average 50
• mouse clicks.

• Provides for digital
• integration of data from
• multiple
• instruments/autorefractors/
• topographers.

• Can be programmed, so each
• refraction is done the same
• way.

• Programs can be customized
• for practitioners to allow for
• their specific preference of
• test type and order or patient
• type, such as children and
• adults.

• Accurate and demonstrable to
• be patient instantaneously.
• Remakes are much less likely
• when a patient is confident in
• the results they have seen.

See all of it:

https://www.optometricmanagemen

t.com/issues/2018/september-

2018/introducing-automated-

refraction

That reads like a list of things that benefits a McOptical trying to crank through patients and get to the sales pitch. Where exactly is the patient benefit Dr. Jasper?

Quote:

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Originally Posted by Tallboy

That reads like a list of things that benefits a McOptical trying to crank through patients and get to the sales pitch. Where exactly is the patient benefit Dr. Jasper?

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That is exactly what you wrote. Automatization saves time, and time is also money.

......................this is from a publication geared to optometrists without pushing any make or pricing, and in the concept of speed , quality and records storing, and more time to spend on selling contact lenses and eyeglasses.

https://www.optometricmanagement.com...er_om_0918.jpg

Hmmm.

Methinks the initial premise—making people interested, excited and motivated to see their eye doctor—based on the latest technology in refraction, is flawed and misdirected.

What should be done is explaing why eye health is so important to be comprehensively checked regularly, along with a comprehensive BV assessment.

The rest can and will be accessed a lá carte, eventually.

B

Quote:

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Originally Posted by Barry Santini

Hmmm.

Methinks the initial premise—making people interested, excited and motivated to see their eye doctor—based on the latest technology in refraction, is flawed and misdirected.

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................lets not forget that this is a professional publication directed at the optometrist and not the consumer.

Quote:

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Originally Posted by Chris Ryser

................lets not forget that this is a professional publication directed at the optometrist and not the consumer.

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Even more so

That's not "automated refraction" but an automated phoroptor.

Quote:

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Originally Posted by Barry Santini

Hmmm.

Methinks the initial premise—making people interested, excited and motivated to see their eye doctor—based on the latest technology in refraction, is flawed and misdirected.

What should be done is explaing why eye health is so important to be comprehensively checked regularly, along with a comprehensive BV assessment.

The rest can and will be accessed a lá carte, eventually.

B

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I get your perplexity.

The "warm and fuzzy" aspect to the practice here, that goes on the website, is that:
1. you buy expensive equipment for God knows what reason (how many exam rooms can you put that monster in, anyway?) (ODs like toys)
2. you justify it by making it some practice management PR-thingy: "Hi Tech R Us".
3. Maybe, maybe (if pesky state boards allow, and some do) you feel more comfortable delegating refraction to a technician so you can have mega-throughput.

Don't forget that April's a familiar industry spokesperson. She gets her refractor special. Or, she paid for it, and she gets reimbursed by sharing the fun news to the world.


Hey, it reminds me of those "Visio" stand up gaze and pupil measurer thingys that make the simple, complex. Who wants one of those?

Quote:

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Originally Posted by drk

That's not "automated refraction" but an automated phoroptor.

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2018.10.08
SILMO D’OR AWARDS FOR ESSILOR INSTRUMENTS AND BBGR AT PARIS INTERNATIONAL TRADE SHOW


Two Essilor Group innovations were honored at Silmo international optics trade show: Essilor Instruments’ Vision-R™800, in the Material/Equipment category and BBQR’s BLUV® XPERT, in the Vision category. Congratulations to both teams.

With Vision-R™800 phoropter,eye exams will never be the same again!

Vision R™800 is a breakthrough phoropter, the instrument used by eye carepractitioners to measure patients’ correction needs and prescribe visioncorrection solutions

see all of it:
See all of it:
https://www.essilor.com/en/medias/ne...onal-tradeshow

Ironically, Dr. Jasper chose the wrong words in the opening statement of this article ("THE “RIGHT” WORDS") by describing a digital phoropter as "automated (dictionary.com def.:convert (a process or facility) to largely automatic operation."
The instruments she is describing do not actually perform the "objective refraction" automatically. They still require the "operator" (whether a licensed refractionist or ancillary technician, is irrelevant) to make the necessary changes based on patient response to the age old question, "better one or two?"
Digital phoropters greatly enhance the efficiency and accuracy of an otherwise unnecessarily lengthy process.
Shouldn't we all embrace improvements in technology especially when it affords better patient care?
How many Opticians do you know still using Lemay Robots to edge lenses?
I don't remember hearing anyone refer to a fancy new edger as a toy.
Did we have the same attitude when LEAP blocking was introduced?
This is no different.
If we should want to debate removing the objective response from the refraction process and prescribing based on fully automated subjective measurements, my position changes considerably.
There is a fine line between the "science of refraction" and the "art of prescribing" that will always require the ECP to interpret the data, whether gathered manually or automatically.
RJW

Thanks for your additional comments and corrections.

Ain't no way in America that an automated phoroptor is going to speed up refraction.

It will slow it down, dollars to donuts.

However, some docs have short arms, bad backs, etc. and it may be more ergonomic.

But that ain't sexy enough to sell a $40,000 phoroptor, so instead it transports you to the 23rd century to have an eye exam with Dr. Leonard McCoy.

"Ain't no way in America that an automated phoroptor is going to speed up refraction.
It will slow it down, dollars to donuts." If you are still practicing, I welcome the opportunity to prove you wrong

"However, some docs have short arms, bad backs, etc. and it may be more ergonomic." Very true, in fact a peer reviewed article reveals 56% of your colleagues are plagued with these problems. Some of whom are forced to discontinue practicing because of.

"But that ain't sexy enough to sell a $40,000 phoroptor, so instead it transports you to the 23rd century to have an eye exam with Dr. Leonard McCoy." OMG, LOL, and all of that good stuff! This reminds me of a comment my employer made to a lab sales rep in early 1980's. The sales rep offered a "free fax machine," if we would send $x of business to that lab. My employer replied "A fax machine?, ah, thats a thing of the future, we would never use it but thank you." I scratched my head and tried to make sense of that comment. Never was I able to. P.s., that independent retail optical establishment closed its doors in the early 90's. Is there a lesson to be learned? (I think so, and I am happy to have learned it when I was a novice early 20 something y.o. Optician)

..

Quote:

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Originally Posted by rwallner

"ain't no way in america that an automated phoroptor is going to speed up refraction.
It will slow it down, dollars to donuts." if you are still practicing, i welcome the opportunity to prove you wrong. i can't say they've made my life easier

"however, some docs have short arms, bad backs, etc. And it may be more ergonomic." very true, in fact a peer reviewed article reveals 56% of your colleagues are plagued with these problems. Some of whom are forced to discontinue practicing because of. very true, i could see shoulder injuries be more problematic than back, but i get it. Poor sitting posture is also a source of bad backs.

"but that ain't sexy enough to sell a $40,000 phoroptor, so instead it transports you to the 23rd century to have an eye exam with dr. Leonard mccoy." omg, lol, and all of that good stuff! This reminds me of a comment my employer made to a lab sales rep in early 1980's. The sales rep offered a "free fax machine," if we would send $x of business to that lab. My employer replied "a fax machine?, ah, thats a thing of the future, we would never use it but thank you." i scratched my head and tried to make sense of that comment. Never was i able to. P.s., that independent retail optical establishment closed its doors in the early 90's. Is there a lesson to be learned? (i think so, and i am happy to have learned it when i was a novice early 20 something y.o. Optician)
from my side of the phoropter, digital refractor::phoropter is not equal to calculator::abacus. I would say, digital refractor::phoropter as digital clock::analog clock. It doesn't measure time any more accurate, but is an updated technology.,,

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Amen! Thank you for your valuable input in this discussion.

I think it would be cool to get my opinion on how an automated phoroptor is designed.

I'm the refracto-king!

Just not as cute as April.

Please share your opinion. I am anxious to learn from you. I will ask that you please consider the fact that not all automated refractors are created (designed) equally. There is a very wide discrepancy among the players in the market. Premium, full featured auto-phoropters (specifically Nidek TRS5100, Topcon CV5000s, and Reichert VRx) typically include very similar, competitive features. Then there are the others which are targeting specific markets, generally more price target oriented.

Another much less important point, but one I would be remiss not to mention, is the distinction between "Phoropter" and "Phoroptor." The later being a trade mark of Reichert.

Ah.

First principle: Programmable.
a. user programmable
b. pre-programmed (this is where I could help)

Second: Projector-linked
a. What's the point of a programmable phoroptEr without the correct slide in place?
b. Does yours have a "virtual screen" or "internal screen" instead?

Third: Variable sensitivity
a. Jackson flip cross should have +/- 0.25 AND THIS IS THE BIG ONE: +/-0.50
b. Sphere increments should be available to be programmed at +/- 0.25, 0.50, 1.00

More later.

Quote:

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Originally Posted by drk

Ah. Thank you for your insight. Interestingly enough, you touched on all of the most important features found on the "premium, full featured autophoropters" I previously specified. Some of these features are also common to the very basic instruments.

First principle: Programmable.Since you mention it, a stepchild of programming is preferences, where the device can be set up to specific preferences (something as insignificant ;-) as plus or minus cylinder, VA nomenclature, etc.)
a. user programmable Very common feature
b. pre-programmed (this is where I could help) Any "good" organization with a qualified Application Specialist installing the instrument and training the practitioner will try to understand the specific requirements of THAT practitioner. I have installed hundreds of digital autophoroptOrs :-), and rarely found two practitioners who practice identically. The diversity is even more apparent from one coast to the other. I was pretty proficient at identifying the source of the training once I asked the practitioner to "walk me through, step by step, a typical refraction." I will have to maintain my opinion that pre-programming adds little value to the conversation as everyone wants to do it their own way.

Second: Projector-linked I am not aware of any that are not. If they do exist, I would agree with your comment "a".
a. What's the point of a programmable phoroptEr (lol, thank you) without the correct slide in place?
b. Does yours have a "virtual screen" or "internal screen" instead? I have no affiliation with a particular manufacturer, so I cannot speak to "yours." But all (there are many) of the digital auto-phoropters I have intimate familiarity with have bidirectional communication capability to control the digital acuity system and then display to the practitioner exactly what is currently on the chart. Very different and much more efficient than the projector/screen I learned on.

Third: Variable sensitivity
a. Jackson flip cross should have +/- 0.25 AND THIS IS THE BIG ONE: +/-0.50 Again, those I am familiar with all have this feature. In fact, at least one also offers a 1D JCC for your low vision patients.
b. Sphere increments should be available to be programmed at +/- 0.25, 0.50, 1.00b You got me on this one! I know a few that have two options (Control Knob in up position changes the value by 0.25D or 1 deg., in the pressed down position, changes by 1D or 10 deg.

More later.

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Now that you have engaged me in a very interesting and meaningful conversation, I am learning a lot from you, specifically the "end users" perception of these instruments and would like to learn more if you are willing to share.
Robert