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Thread: It's 2006, why is the antique phoropter still being used?

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    Question It's 2006, why is the antique phoropter still being used?

    Heh, first off, I'm a consumer. Second, I'm irritated consumer.

    As a kid I wore an eye patch to help deal with dominant-eye syndrome, but even now at age 33 I still notice the effects of this condition. I can see with my left eye reasonably well but it is hard to focus clearly on details or read text easily, since the right eye is still so dominant.

    This makes eye exams especially aggravating because for my left eye the optometrist says "Is 1 or 2 better?" Um, well. I am not exactly sure what I am seeing here doc, so uh, why don't YOU tell me which is better?


    And really, it seems highly odd to me that in this age of computerization and cheap, incredibly powerful digital imaging systems, that no one has come up with a way to digitize and map the shape of the retina, and determine my exact prescription without any input on my part.

    The astigmatism testing done with a phoropter seems to be rather crude anyway. Instead, scan the retina for a precise astigmatism map. Go beyond mere cylinder to imaging an actual 3D contour map of the eyeball shape, with matching contoured optics for more a pefect correction, then do some in-out focus limit/range tests to find the focusing abilities of the lens muscles, to find the optimal prescription.

    Probably this could be all done in about five minutes with a digital laser scanning/measurement system. "Here's your prescription, sir. This scan is far more accurate than what you would be able to tell us, due to your dominant eye condition."

    How soon can I expect this at the local mall? Next year? :)

    -Javik

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    refractionists are, and continue to be *constipated*. They resist new approaches in instrumentation and overall technique.

    I too, want to throw out the phoropter!

    Barry

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    Master OptiBoarder LENNY's Avatar
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    Good luck in filing this prescription!

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    OptiBoard Professional Excel-Lentes's Avatar
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    Javik,

    I am sure this is being worked on as we speak. Out of curiosity, how much would you be willing to pay to have a prescription developed this way? $100, $200, $300?

    I'll bet that even with a system as accurate as that; subjectively people will still have trouble with their Rx's occasionally due to vision taking place in the brain (fusion, habitual glasses, etc..).

    Interesting to watch for in the future though.

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    Don't know about the various autorefractors accuracy but I do know that I certianly don't trust the auto-keratometers out there. Or the readings from referring practioners for that matter. I always personally take my on corneal measurments ( and Yes, I do read the scans intently) and based on what I know and trust, and the way contact lenses fit when based on each, use your own old B&L keratometer (properly positioned and calibrated of course) whenever the eye is within it's range.

    I also get the feeling from many of the older or more concienious refractionists that thier hand, eye and trial frame is far more trustworthy than automated machines.

    Of course in both cases it could just be some of us like to feel the results are wrought by our own hand.

    Chip

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    Manuf. Lens Surface Treatments
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    Thumbs up Phoroptors...................

    Quote Originally Posted by chip anderson View Post

    I also get the feeling from many of the older or more concienious refractionists that thier hand, eye and trial frame is far more trustworthy than automated machines.
    Chip
    In addition the auto refractors do not ask questions and evaluate answers by the patient, like a seasoned refractionist does.

    The eye is a living, moving thing while the optical system of an automatic device is made with rigid optics and computer circuits.

    The patient has the knowdlegde of feeling the final touch of the correction and can say so.

    Just keep the phoroptors and trial frames going they will never be replaced by automation which can at the best be......................close
    Chris Ryser
    ________________________________________
    DLO. NA.IC.I.T.PO

    http://optochemicals.com............................. http://arcoatings.com

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    Ophthalmic Optician OptiBoard Gold Supporter
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    Quote Originally Posted by Javik View Post
    Heh, first off, I'm a consumer. Second, I'm irritated consumer.
    -Javik
    No need to be redundant. Just the fact that you are a consumer posting here tells us that you're probably irritated.

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    Underemployed Genius Jacqui's Avatar
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    Rising Star loncoa's Avatar
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    I must say as well, that what you ask is already being done. Your eyes are objectively refracted, meaning the raw finding is based on the physiological shape of the eye. Then the eyes are refracted subjectively, meaning that they refine the prescription based on your input. It kind of sounds like you don't want to have to take any responsibility for the prescription, and if so, you are in a large group of people who would like the doctor to decide what you are seeing. The doctor cannot. You must tell the doctor what you are seeing. From an objective refraction the doctor can get fairly close. Only with your help can the rx be refined to make your perception of clarity a reality. With that comes a certain degree of responsibility to honestly answer the doctor's questions as to what lenses appear clearer TO YOU. It is easy to sabotage this process if you go into it with a malicious attitude. The doctor wants the rx to be perfect just as much as you do.
    Last edited by loncoa; 08-17-2006 at 01:08 PM.

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    Rising Star loncoa's Avatar
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    P.S. almost all astigmatism is in the corneae rather than the retinae. Just so's you know.

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    Optiwizard making films Audiyoda's Avatar
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    Quote Originally Posted by Javik View Post
    And really, it seems highly odd to me that in this age of computerization and cheap, incredibly powerful digital imaging systems, that no one has come up with a way to digitize and map the shape of the retina, and determine my exact prescription without any input on my part.
    Actually what you are asking for exists in a few levels. The EyeLogic system is one that is fairly affordable - but still many times more expensive than a traditional phoropter.

    Another and more acurate system is the system used for wavefront corneal mapping in conjuntion with lasik. It is precise to the point of evaluating higher order abberitions that we currently cannot correct for - even with lasik.

    But all of this is dependant on economics of scale - how much are you the consumer willing to pay for a service like this? The cost of equipment like this - even spread out over an entire practice full of patients - is very, very high. And in our current economy where everyone seems to expect everything for free or even cheaper, it's just not cost effective for most private practices to invest in this type of equipment.

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    OptiBoardaholic
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    If the doc is flipping between lens 1, and lens 2 and you can't tell the difference, the correct response is "I can't tell the difference."

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    OptiBoard Professional Ory's Avatar
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    Quote Originally Posted by cjcarlen View Post
    Actually what you are asking for exists in a few levels. The EyeLogic system is one that is fairly affordable - but still many times more expensive than a traditional phoropter.

    Another and more acurate system is the system used for wavefront corneal mapping in conjuntion with lasik. It is precise to the point of evaluating higher order abberitions that we currently cannot correct for - even with lasik.

    But all of this is dependant on economics of scale - how much are you the consumer willing to pay for a service like this? The cost of equipment like this - even spread out over an entire practice full of patients - is very, very high. And in our current economy where everyone seems to expect everything for free or even cheaper, it's just not cost effective for most private practices to invest in this type of equipment.
    Actually the eyelogic system is just an automated version of the good old "which is better, one or two"

    A retinoscope is a pretty good way of getting an objective refraction if you know what you're doing but is far from precise.

    Wavefront mapping is the closest to what is being asked. I know iZon/Ophthonix is all over this but their lenses are ultra expensive. I really don't know how their patients fare. Custom Lasik using wavefront does correct many higher order abberations.

    Ask any cataract surgeon if vision looking in is the same as vision looking out. They will all tell you some people with horrible looking cataracts can see just fine while those with minimal changes may have rotten vision.

    I really doubt there will ever be a great system for assessing refraction that is independent of patient responses.

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    opti-tipster harry a saake's Avatar
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    exams

    i will also throw in from years of doing exams with doctors, that people lie about what they see to the doc, and you will find as you get into the poorer and poorer and less educated segment of the poulation, there is a propensity to say yes to everything,,is that better, yes, better now ,yes

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    Master OptiBoarder mike.elmes's Avatar
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    Are you saying you had Strabismus as kid.?.. I find no such condition "Dominant Eye Syndrome". If at 33 you have a non functioning eye as a result of strabismus (one eye turns in or out) at childhood...there will be no corrective lenses that will improve the sight in that eye. The doctor will try to improve the sight(with your help) but the lack of sight is from lack of developement of the eye system that connects to the brain.
    Quote Originally Posted by Javik View Post
    Heh, first off, I'm a consumer. Second, I'm irritated consumer.

    As a kid I wore an eye patch to help deal with dominant-eye syndrome, but even now at age 33 I still notice the effects of this condition. I can see with my left eye reasonably well but it is hard to focus clearly on details or read text easily, since the right eye is still so dominant.

    This makes eye exams especially aggravating because for my left eye the optometrist says "Is 1 or 2 better?" Um, well. I am not exactly sure what I am seeing here doc, so uh, why don't YOU tell me which is better?


    And really, it seems highly odd to me that in this age of computerization and cheap, incredibly powerful digital imaging systems, that no one has come up with a way to digitize and map the shape of the retina, and determine my exact prescription without any input on my part.

    The astigmatism testing done with a phoropter seems to be rather crude anyway. Instead, scan the retina for a precise astigmatism map. Go beyond mere cylinder to imaging an actual 3D contour map of the eyeball shape, with matching contoured optics for more a pefect correction, then do some in-out focus limit/range tests to find the focusing abilities of the lens muscles, to find the optimal prescription.

    Probably this could be all done in about five minutes with a digital laser scanning/measurement system. "Here's your prescription, sir. This scan is far more accurate than what you would be able to tell us, due to your dominant eye condition."

    How soon can I expect this at the local mall? Next year? :)

    -Javik

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    Master OptiBoarder snowmonster's Avatar
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    My autorefractor/autokeratometer (Topcon KR-8800) is extremely good, but there is always an element of subjectivity to most people's prescriptions.

    Likewise, I'm usually very close with retinoscopy, but there are a few patients where both of these objective tests will require refinement as they seem to be under-minused or over-plused by about 1.00 to 1.50 diopters, even after I've accounted for my working distance with retinoscopy.

    -Steve

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    1. Yes, as a consumer I would be willing to pay much more for an automated scan that is far more accurate than what can be obtained through the usual question/answer routine. $200-300 certainly sounds reasonable.

    This is because I don't trust the results I'm already getting, and it seems like I'd have to redo the exam and prescription about five times before it is correct. Due to the costs involved, it's hard to do a one-off test lens, then toss it after a week, try another, re-exam, try another etc.

    If I were to fully go through with this to get my prescription fully correct to a point where I am satisfied that is is correct, it would probably end up costing as much or more than a single $300+ five minute laser-guided precision scan.


    2. I would be willing to pay much more for a custom-formed 3D-mapped contact lens prescription that fully corrects for weird night-time nonlinear astigmatic smearing that isn't cleared up by the usual generalized cylinder corrections.


    3. Sorry, wrong terminology in the initial post. It's not "dominant eye".. it's "lazy eye". That website mentioned has another page that says amblyopia is not the same as strabismus, and has more info:

    http://www.strabismus.org/amblyopia_lazy_eye.html

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    Master OptiBoarder snowmonster's Avatar
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    Maybe you should just see a different doctor then if it always takes that many attempts to get it right?

    Or if you see a different doctor every time, maybe you should just stick with one so somebody can get the chance to figure it out and know what not to do in the future.

    -Steve

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    Z View Abberometer

    Try going here,
    www.ophthonix.com

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    Rising Star loncoa's Avatar
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    As was mentioned before, you may never get a lens which corrects your amblyopic eye to your satisfaction...because it may not be the prescription or the eye that's the problem. The whole idea of an amblyopic eye is that the vision is unsatisfactory. This is due to the way the eye developed at a young age. Are you sure this isn't the root of the problem?
    Some things have to be accepted because it doesn't matter how much money you throw at them.
    However, maybe by pursuing it this way, you will discover new ways of helping people with your condition...and that really WOULD be worth doing.

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