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Thread: Zeiss i.Scription - Innovation or Nonsense?

  1. #1
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    Zeiss i.Scription - Innovation or Nonsense?

    My boss is looking into offering Zeiss i.Scription. I've read up on it, and on the surface, it sounds rather innovative. However, since it's introduction, they are, to the best of my research, still the only ones offering this kind of technology (there was i.Zon, which was similar, but that was a deadend, and the company that made it ended up folding). I have to believe if this technology offered any real innovation, it would be offered or supported by many other brands, and it's not. This makes me think it's a bunch of marketing nonsense and hoopla.

    So, I thought I would ask here for opinions, as I have no doubt Optiboarders are likely to know the truth; is this something innovative, or if not innovative, at least reasonable to offer patients, or is it truly just a bunch of nonsense?
    Last edited by Lelarep; 03-20-2019 at 10:33 PM.

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    I have not used the Zeiss I.scription but if it’s similar to the Essilor Visio-office position of wear measuring machine, then in the right hands it’s a solid money maker. If you understand the optics and physics of lenses then this measuring device is a no brainer. You need the right way to explain and pitch it.

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    The i.Scription, from what I understand, is an "ocular wavefront aberrometer, autorefractometer, ATLAS corneal topographer and keratometer", and spits out some kind of compensated Rx, so it's dissimilar to Essilux's Visioffice. The Visioffice is more like Zeiss's i.Terminal 2 system that grabs "Frame data (A, B, DBL), Interpupillary distance, Monocular pupillary distance, Fitting height, Segment height, Back vertex distance, Pantoscopic angle, Wrap angle, Head rotation".

    The "compensated Rx" it produces is what I'm interested in understanding, and it's benefit, if any, to patients. To me, after more than a decade of it being around, if it has any major benefit, I'd think Shamir, Hoya, and especially Essilux, would be doing this as well. The lack of adoption of this technology by other major lens manufacturers is what makes me so skeptical.

    It really makes me wish Darryl Meister was still with us. His input was invaluable in so many situations.
    Last edited by Lelarep; 03-21-2019 at 09:18 AM.

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    doesn't this involve an entire system starting from refracting which outputs a script to the hundredth of a diopter. i've only worked at 1 practice that had the entire system... otherwise i've only seen 1 other place use the tower measuring device consistently. most of the new lenses are tuned to these measuring devices, so when used properly it does provide better results.

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    Quote Originally Posted by Lelarep View Post
    The i.Scription, from what I understand, is an "ocular wavefront aberrometer, autorefractometer, ATLAS corneal topographer and keratometer", and spits out some kind of compensated Rx, so it's dissimilar to Essilux's Visioffice. The Visioffice is more like Zeiss's i.Terminal 2 system that grabs "Frame data (A, B, DBL), Interpupillary distance, Monocular pupillary distance, Fitting height, Segment height, Back vertex distance, Pantoscopic angle, Wrap angle, Head rotation".

    The "compensated Rx" it produces is what I'm interested in understanding, and it's benefit, if any, to patients. The lack of adoption of this technology by other major lens manufacturers is what makes me so skeptical.
    i think it hasn't made wide spread adoption because of patents and $$$

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    Quote Originally Posted by Oscar View Post
    i think it hasn't made wide spread adoption because of patents and $$$
    I was strongly wondering about that. Had they built a patent wall around it that strong? I didn't think that was likely based on the fact that the basic technology is well established by many manufacturers of equipment.

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    I know a Doctor in California that has one. He seems to like it. I personally don't know much about it. I with Oscar in the belief that it is just helping get more "accurate" RX. I think it was designed to be use with Zeiss lens in mind, Individual 2 or Individual SV. I think they is a way to sent the information to Zeiss labs, I could be wrong though

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    - what’s the cost ?
    - whether you produce a compensated Rx based on Essilor’s or Zeis’s system, in the right hands, with the right approach, it’s a tool to grow your practise. [
    - find someone who is using either system daily and shadow them for a week
    - the Essilor system is a solid money maker

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    Just to clarify what I'm looking for, I'm interested in whether the i.Scription objectively produces a better visual outcome for patients using something like a FFSV Zeiss lens over a comparable FFSV lens (Shamir, Essilux, IOT, etc...) that is not used with this device. Monetization, etc. is of no interest to me. I'm purely interested in the objective optical performance of lenses produced with the information generated by this device. If there is no objective information to be had, I'd be happy with direct, subjective experience with the device and how patients felt about the outcome they got from it compared to previous lenses of a similar type they had before, or compared to other patients with the same lenses, but not using this device.
    Last edited by Lelarep; 03-21-2019 at 01:11 PM.

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    The process begins with i.ProfilerPlus, a combination wavefront aberrometer, autorefractor and corneal topographer. The i.ProfilerPlus measures the HOAs in each eye (Step 1). Using a proprietary algorithm that analyzes all of the wavefront aberrations of the eye, the i.Scription software calculates the combination of sphere power and cylinder power that maximizes the depth of focus for a medium pupil size in order to best balance the effects of aberrations at small and large pupil sizes over a range of viewing distances. However, there are some aspects of a subjective refraction that an autorefraction can never replicate. These include the patient's individual way of defining visual clarity, controlling the accommodation and binocular balancing (Step 2). Therefore, using a proprietary algorithm, the data from the aberrometer and the subjective are combined to produce the ideal wavefront-guided refraction (Step 3). The resulting prescription will typically differ slightly from the subjective findings, and since wavefront refraction is not limited to the increments of trial lenses, will be specified to a precision of 0.01 diopters (Step 4). Using digital measurements, lens design customization software and ultra-precise digital manufacturing techniques (Steps 5, 6 and 7), the final lens produced can deliver a new level of patient care.
    My emphasis.

    And...

    A UC Berkeley clinical study of 30 subjects compared wavefront-guided single vision lenses to conventional single vision lenses in a randomized, double-masked, crossover wearer trial. Performance was measured using subjective and objective tests. The results showed that subjects with low to moderate prescription powers preferred wavefront-guided lenses more often for distance vision, active vision, sharpness, changing focus and overall vision. Subjects preferred wavefront-guided lenses more often for night vision, vividness of colors and having less glare. Wavefront-guided lenses performed better than conventional spectacle lenses in measures of low-contrast and mesopic visual acuity by approximately half a line of acuity (Meister D. and Thibos L. "i.Scription by ZEISS: Setting the New Standard of Vision Correction." Carl Zeiss Vision, 2009).

    In a like German study of 159 wearers, 80 percent reported better visual comfort, 74 percent saw better at night and in low-contrast situations, over 66 percent reported clearer, sharper vision and 60 percent saw colors more intensely. (i.Scription wearer trial conducted by an independent optician with 159 of his customers in Germany.)


    https://www.2020mag.com/ce/taming-th...ont---pa-BE01F

    Hope this helps,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Quote Originally Posted by Robert Martellaro View Post
    ...

    https://www.2020mag.com/ce/taming-th...ont---pa-BE01F

    Hope this helps,

    Robert Martellaro
    Thank you very much. The piece about "low to moderate prescription powers" is interesting. I would say at least half, or more, of the patients we see are in the "high to severe prescription powers", so it sounds like the benefit for us would be quite limited. I have no doubt that they would have mentioned that group being benefited, since they are the hardest group to get good results for, if there was a statistically significant difference in the data for that group. Apparently there wasn't, no way to really know, since I doubt Zeiss would hand over the clinical raw data without a pint of blood and an NDA where they can leave you headless in a ditch if they even thought you talked about the contents.

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    Quote Originally Posted by Lelarep View Post
    Thank you very much. The piece about "low to moderate prescription powers" is interesting.
    That, and the part about "wavefront-guided single vision lenses to conventional single vision lenses"

    I've always had a distaste for studies which compare premium products to basic products. What's the point? Why not compare them to other premium product offerings? Happens all the time when marketing is the end game.

    9 out of 10 people preferred the perfectly cooked Ribeye over the McDonald's hamburger. What a shock. 4 out of 5 people surveyed reported that they liked using a flashlight over a candle. Whoop-de-doo.

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by Lelarep View Post
    Thank you very much. The piece about "low to moderate prescription powers" is interesting. I would say at least half, or more, of the patients we see are in the "high to severe prescription powers", so it sounds like the benefit for us would be quite limited. I have no doubt that they would have mentioned that group being benefited, since they are the hardest group to get good results for, if there was a statistically significant difference in the data for that group. Apparently there wasn't, no way to really know, since I doubt Zeiss would hand over the clinical raw data without a pint of blood and an NDA where they can leave you headless in a ditch if they even thought you talked about the contents.
    I suspect they couldn't find enough high myopia subjects to allow for a statistically significant result. Maybe they should have tried Shanghai U.

    It sounds like we both have clientele with similar refractive disorders. I'm seeing a repeat -18 D 1.74 PAL wearer next week. I hope to talk her out of the PAL and switch to SV with a Chemstrie Clip. Last week was congenital aphakia +14 D age 24 wearing CLs. The only lens for Aphakia that Walman could get was Bristolite aspheric full-field multifocal. He was wearing a +12 PAL!

    Best regards,

    Robert Martellaro
    Last edited by Robert Martellaro; 03-22-2019 at 03:24 PM.
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
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    Quote Originally Posted by Kwill212 View Post
    That, and the part about "wavefront-guided single vision lenses to conventional single vision lenses"

    I've always had a distaste for studies which compare premium products to basic products. What's the point? Why not compare them to other premium product offerings? Happens all the time when marketing is the end game.

    9 out of 10 people preferred the perfectly cooked Ribeye over the McDonald's hamburger. What a shock. 4 out of 5 people surveyed reported that they liked using a flashlight over a candle. Whoop-de-doo.
    THIS^^^^^


    Lelarep, you are asking ALL the right questions.

    Remember, guys and gals, the magnitude of the average eye's HOA is under 1/4D in most light conditions. (I can't prove that, but I'm generally right.)

    You have to understand, from a refractionist's perspective, just how miniscule this is. As Kwill alluded, the Zeiss effect I WOULD BE WILLING TO BET $100, would go to insignificance if the refractionist biased the final Rx by -0.12 DS for anti-spherical aberration at large pupil/night driving combined with a quality AR, good material, GOOD FRAME and VERTEX and PANTO adjustment, and a nice, digital atoric lens.

    My advice: fugedaboudit.

    (Speaking of hamburgers, Barry Santini puts "special sauce" on his, and he's generally right.)

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    Would it be correct to say,myself included, that no one commenting has tried out the equipment, nor dispensed the product ? Perhaps, if that is the case, it would be more prudent to ask Zeiss for a couple month trial, then judge your own criterium of data.

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    Quote Originally Posted by Kwill212 View Post
    That, and the part about "wavefront-guided single vision lenses to conventional single vision lenses"

    I've always had a distaste for studies which compare premium products to basic products. What's the point? Why not compare them to other premium product offerings? Happens all the time when marketing is the end game.

    9 out of 10 people preferred the perfectly cooked Ribeye over the McDonald's hamburger. What a shock. 4 out of 5 people surveyed reported that they liked using a flashlight over a candle. Whoop-de-doo.
    A very strong point. It seems like they were really picking their comparisons very carefully.

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    A gentleman was driving a barebones economy VW, eventually he graduated to his first BMW. He was “wowed” beyond belief. When he purchased his 2nd BMW, he did not have the same “wow” but still continued purchasing BMW. He mentioned this lack of “wow” to the salesman when he was considering a third Beamer. The salesman wisely said “let’s try out this model, then proceeded to take him on a test drive in an older bare bones VW. The customer was now disappointed, then purchased a 3rd and 4th BMW.

    Both the VW and the BMW got the customer from point A to point B. Both go forwards and backwards, both breakdown and require repairs between point A and B.

    Where do you want your practise to be ?

    Perhaps try the product, then let your client decide.

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    I got an iProfiler a week or two ago. Bought it second hand, the optometrist I bought it off has just bought the Rodenstock DN Eye equivalent. I believe the Rodenstock version does distance and near wavefront aberrometry and distance and near refraction. Zeiss only does distance. The lenses prescribed from the Zeiss iProfiler (iscription) can't reduce higher order aberrations because the eye isn't always looking through the centre of the lens. It simply modifies the prescription so when looking at a point source at night you have the best chance of seeing the least flare. So I'm not sure if this will translate to say less than perfect reading vision just to give better night time distance vision. Time will tell. For the first week I've just been getting my head around it's use, its an amazingly accurate autorefractor, it's a decent topographer (not as good as my Medmont) and I'm yet to learn how often I'll use the iscription option with it. Nearly every patient so far, when I look at the point spread function, it shows only marginal simulated benefit. In coming days I guess I'll start to get some patient feedback once lenses start arriving. I got the device so cheap, I don't care if iscription doesn't work, it's such a great autorefractor I'm already looking redundant, and with topography, keratometry and aberrometry, it'll have enough uses. But yes, ask me in a few weeks what the patient feedback is :)

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    In fact I do wonder, will it give better night time results than simply refracting with the room lights off? But I have a totally open mind. I was a bit surprised by a young staff member the other day. His cyl axis is 125 in one eye. Only an 0.50 cyl. My subjective axis was 125, I think the iprofiler auto refraction axis was 130, but the then calculated iscription axis was 165. I thought that's just crazy. That can't work. So i popped it in a trial frame at axis 165 and he said everything was clear. So then i got him to manually rotate the cyl axis himself to pick the best axis, and he kept picking 165 (without knowing what he was picking). But doing cross cyl takes him back to axis 125. So maybe, just maybe there is something in this iscription thing.

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    That's weird.

    I know that for the old folks (my age and up :)) I refract somewhere between their crappy 4mm pupil and the tropicamide-ed 6 mm pupil, lens opacification and tear film instability and all. Hey, I routinely show 1/2D sphere increments, and use a +/-0.50 Jackson X-cyl lens (yeah, hand-held, at that).

    I get repeatable results and a whole lot less confusion from the subject. I don't even often interpolate between increments, I just use it straight.

    My results? They love me.

    My conclusion: we can make this way too complicated. We aren't designing orbit-based deep-space telescopes.

    My question: what amount of wavefront aberration is induced by not cleaning your damned glasses, people?!

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    True, nothing beats a trial frame refraction. The golfing expression " you drive for show, you putt for dough" applies to refraction too. Phoropter for the theatre of the eye test, the trial frame for making sure you got it right :)

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    Quote Originally Posted by obiwan View Post
    In fact I do wonder, will it give better night time results than simply refracting with the room lights off? But I have a totally open mind. I was a bit surprised by a young staff member the other day. His cyl axis is 125 in one eye. Only an 0.50 cyl. My subjective axis was 125, I think the iprofiler auto refraction axis was 130, but the then calculated iscription axis was 165. I thought that's just crazy. That can't work. So i popped it in a trial frame at axis 165 and he said everything was clear. So then i got him to manually rotate the cyl axis himself to pick the best axis, and he kept picking 165 (without knowing what he was picking). But doing cross cyl takes him back to axis 125. So maybe, just maybe there is something in this iscription thing.

    Notes taken - ” I have a totally open mind”
    - the axis shift is also prevalent with low cyls using compensated rx’s with VisioOffice

  23. #23
    One eye sees, the other feels. OptiBoard Gold Supporter
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    Kudos to Zeiss for putting their hardware and software to the test. The majority of the lenses were prescribed for mild refractive errors, so I doubt that the favorable result is due strictly to POW and atoric/aspheric optimizations. However, as idispense reminds us, the law of diminishing returns comes into play, with varying results between individuals. Underpromise, as much as possible.

    FWIW, I also have a few clients who require Rx tweaking, recently a high astigmat who self-tests with my trial frame, preferring axes that deviate from the Rx by three to five degrees, and has consistently done so over the years from different prescribers. That discrepancy on a 4 DC is roughly equal to .75 D.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
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    Quote Originally Posted by obiwan View Post
    In fact I do wonder, will it give better night time results than simply refracting with the room lights off? But I have a totally open mind. I was a bit surprised by a young staff member the other day. His cyl axis is 125 in one eye. Only an 0.50 cyl. My subjective axis was 125, I think the iprofiler auto refraction axis was 130, but the then calculated iscription axis was 165. I thought that's just crazy. That can't work. So i popped it in a trial frame at axis 165 and he said everything was clear. So then i got him to manually rotate the cyl axis himself to pick the best axis, and he kept picking 165 (without knowing what he was picking). But doing cross cyl takes him back to axis 125. So maybe, just maybe there is something in this iscription thing.
    I have to admit, this does reignite my interest in the fact there may be more to it than meets the skeptical eye. I will be interested in two weeks time if you can report back and let us all know what your results are, if its as good as it potentially seems, or if this was just a one-off situation.

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    I'm a mild myope - about a buck and a quarter. We had this system in a previous office. I got my fancy pants lenses. I noticed no difference between the fancy compensated "wavefront" juju lenses, and a cheap pair of stock lenses whatsoever honestly. Actually, I did have a weird diffraction pattern caused by the laser marks in the lens, that made them almost impossible to wear at night, as every headlight, streetlight, and flashlight would create bright, dazzling crosshatch pattern glare at the mark locations of the lens. But in the day, they were ok. I wouldn't ever pay for them as a consumer, knowing the cost difference and lack of any subjective VA difference at all. YMMV of course...

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