tech time

Refractive Technology

Make sense of lensometers, autorefractors and phoropters.

SCOT MORRIS, O.D., F.A.A.O.

We can break diagnostic refractive technology into three major areas: lensometers, autorefractors and phoropters. Each play a role in the visual outcome of your patient's exam. Many O.D.s feel that visual analysis technology doesn't create a profit. They deem it a low priority on the “acquisition line.” I disagree. About 50% of your profit comes from the optical department, so visual satisfaction becomes crucial to your practice. If these diagnostic devices can aid you in improved workflow and provide better visual analysis, then they have value and may warrant replacing equipment with something more “high-tech.” Such purchases allow you to be more competitive, especially if you market your edge on technology.

Lensometers

These devices are essential but often overlooked, especially when that highly coveted, newly recruited patient complains about the glasses they purchased from your competitor. With an accurate lensometry reading, you can determine where your competitor erred and improve the prescription. New lensometers are user-friendly and designed ergonomically that have small footprints. They measure everything from pupillary distance to prism and progressive designs. Some even feature a UV detection unit to assess how much UV protection one's glasses provide.

Autorefractors

Now that you determined your patient's prescription, your staff can turn the patient's chair ever so slightly, and look into your new autorefractor (AR). I was never a huge fan of previous generations of ARs, but newer ARs have changed my mind. Some provide refraction, topography, wavefront analysis and a host of other features — all in one ergonomic package. (We'll cover wavefront and topography in future columns). Be sure to acquire a device that allows you to evaluate the patient's total visual system, allowing you to correctly diagnose and treat their visual complaints.

Phoropters

“Which is better: 1 or 2?” Patients hate this question even more than we do. It forces many patients to do what they like least — make decisions. And let's not assume that patients don't realize that this is the same exact test (on maybe the same piece of equipment) that they did five, 10 or even 15 years ago. As we noted, people expect advanced instrumentation. Additionally, you should consider any technology that makes the refraction more efficient and less stressful for you and your patients.

Many of the new automated phoropters allow you or a staff member to look at your patient's prescription, visual acuity and chart letters simultaneously. They also allow you to alternate very quickly between the patient's current prescription and their “new and improved” prescription, which helps patients see they need new lenses. The favored phoropter in our practice is quiet, fast, efficient, comfortable — and it also has the “cool” factor. It allows us to check, document and autopopulate in our electronic medical record (EMR) software the patient's unaided acuities, lensometer reading, acuities with glasses, autorefraction, subjective refraction values, associated acuities, phorias and even the keratometer readings. You can even check and document phorias, near acuities, near point of accommodation, near point of convergence and positive relative accommodation. If the device could read and fit soft contact lenses, it may not even need me. OM