XFRACTIONSM PROCESS
A New Age in Digital Refractions
The XFRACTIONSM Process integrates wavefront diagnostics and quickly reports a wealth of data in faster, more accurate refractions.
Ian Gaddie, OD, FAAO
Gaddie Eye Center, Louisville, Ky.
Refraction is the cornerstone of vision correction, and over the years, companies have designed faster and more accurate refractors to streamline the process. The latest advance, the XFRACTION process from Marco, combines two powerful tools — the OPD-Scan III autorefractor/keratometer wavefront aberrometer and the TRS-5100 digital refractor — to produce a wavefront-optimized refraction in less time. The savings in time alone can be significant, and according to Ben Gaddie, OD, owner and director of Gaddie Eye Centers in Louisville, Ky., this system elevates the comprehensive eye examination to an entirely new level of understanding the optical pathway. Here’s how.
Wealth of Information
The OPD-Scan III fills the optical pathway with light vectors, captures 2,520 data points, and provides more than 20 wavefront diagnostics in 10 seconds per eye. In addition to autorefraction, it measures corneal topography and identifies higher-order aberrations. “Most eye doctors have topographers, but we typically use them for our contact lens patients or when we suspect pathology,” Dr. Gaddie says. “Therefore, many of our patients don’t receive topography and the diagnostic value that comes from it. The OPD-Scan III measures topography automatically, presenting all of the data for me to easily analyze.
Identifying the Elusive ‘X’ Factors in the Visual Pathway
The XFRACTION process is so named for its ability to help doctors discern previously confounding x-factors that can compromise the total visual system. Dr. Gaddie has experienced this benefit.
“Since transitioning from my standard refraction to wavefront optimized refraction with the OPD-Scan III and TRS-5100, I’m able to identify acuity-limiting conditions that were previously undiagnosed. I’m amazed by how many patients who are seeing 20/20 with their current eyeglasses have the potential for significant visual improvement with wavefront-guided refraction,” he says.
Even patients who have significant aberrations and have never had crisp vision appreciate that Dr. Gaddie can demonstrate why they haven’t been able to see well. “For many, just understanding the reason why gives them a psychological boost,” he says. “All in all, patients are more engaged and impressed with the XFRACTION process.”
Axial map (topography) showing irregular, and asymmetric astigmatism indicative of corneal ectasia, as seen in this case of keratoconus.
“Sometimes, I’m surprised by what the topography reveals, especially if I obtained a good refraction and the patient is seeing well,” Dr. Gaddie says. “I’m reminded of the value of the OPD-Scan III every time I diagnose heretofore undetected pathology, such as keratoconus or pellucid marginal degeneration. This instrument simply helps me to be a better doctor.”
Cornea and Tear Film Testing.
Efficient Flow
Because the OPD-Scan III includes corneal topography, patient flow is streamlined. “We don’t have to move patients from one room for autorefraction to another for topography, load their information into the topographer, obtain the image and either print it or push it via our software to the examination room,” Dr. Gaddie says. “This saves at least 4 to 5 minutes per patient, which is time that could be better spent with patients or seeing more patients per day.”
Accurate, Reliable Data
With XFRACTION, preclinical data collected from wavefront-guided autorefraction and lensometry are transmitted to the lane and used for subjective refraction. “It’s a totally different refractive experience that patients receive,” Dr. Gaddie says. “In addition to being fast and efficient, pretesting with XFRACTION yields a more accurate starting point for subjective refraction. I can usually refine a wavefront-guided refraction in less than 2 minutes. In today’s pressured clinical world, time is money, and efficiency is the key to staying on schedule.”
Solving the Night Vision Dilemma
Another unique and valuable function of the OPD-Scan III is automatic acquisition of daytime and nighttime refractions. “We’ve all been stumped by patients who say they’re having trouble with driving at night, even though they’re seeing 20/15 in the office,” Dr. Gaddie says. “By analyzing the eyes in scotopic and photopic settings, the OPD-Scan III quickly identifies the small percentage of patients who experience a significant shift in vision as the pupils widen in dim light. Sometimes patients have media opacities that are not in the visual axis during daylight hours, but at night when the pupils dilate, all of a sudden they’re compromising the patient’s vision.”
Night and Day: This patient has a refractive shift from 3 mm pupil size to 5 mm size consisting of 0.50 D increase in myopia and a decrease in astigmatism of 1.00 D. The scenes demonstrate the “uncorrected” vs “corrected” views to the patient.
Being able to demonstrate to a patient that he has a significant change in vision at night and to explain the reason why supports Dr. Gaddie’s recommendation of a second pair of eyeglasses with a prescription specifically for nighttime activities, most importantly, driving.
Dr. Gaddie also appreciates being able to integrate clinical testing data with his EMR. “The time saved by not having to read, record and transcribe this information into our electronic health record may be incrementally small, but over the course of thousands of patients, it translates to real money for the bottom line,” he says. “And, more importantly, the seamless accuracy and integrity of data recording allow me to spend more time discussing visual problems and solutions with patients.”
Increased Optical Conversions
Optical conversions depend on many factors, not the least of which is a patient’s perception of his need to update his prescription. According to Dr. Gaddie, one of the most common questions patients ask after a refraction is, “Has my prescription changed?” Usually, the answer is yes, so the next question is, “Has it changed enough for me to need new glasses?”
“With the OPD-driven TRS-5100 automated refraction process, I can compare today’s refraction with the prescription in a patient’s current eyeglasses,” he says. “With one touch of a button, patients can instantly compare their old and new prescription and see for themselves the improvement they will gain with their new prescription. A change that might be inconsequential for one patient might be a big improvement for another, and I can’t judge that based on the magnitude change of a number. Being able to simultaneously compare new versus old prescriptions is a game-changer for patients, and my conversion rate and multiple-pair metrics have never been higher.”
New Level of Precision
Wavefront optimized refraction represents a new age in digital refractions. “I have used various autorefractors in my career, and many have provided a good starting point for subjective refraction,” Dr. Gaddie says. “However, with the OPD-Scan III and the TRS-5100, I now have the accuracy of wavefront-guided refractive data to quickly and precisely generate the best refractive endpoints and visual satisfaction. To be able to optimize an autorefraction based on the aberrations in each patient’s visual system takes refraction to a whole new level of precision ... and personalization.” ■
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