[The INTEGRATED Practice]

Creating a High-touch Experience With High-tech Equipment

The XFRACTION^SM process saves time, improves efficiency and enhances the patient’s experience.

After purchasing his Tampa, Fla., practice in 2006, then renovating and rebranding it as Bright Eyes Family Vision Care, Nathan Bonilla-Warford, OD, still had some key pieces of equipment on his wish list. Several years later, in 2012, he was able to check off the OPD-Scan III wavefront aberrometer and the TRS-5100 digital refractor from that list and incorporate Marco’s XFRACTION^SM process into his practice routine. “What’s unique about the XFRACTION process is that it quickly provides accurate clinical data in an efficient way that saves time and doesn’t interfere with patient flow,” Dr. Bonilla-Warford says. We asked Dr. Bonilla-Warford to recap some of the outstanding features of the XFRACTION process.

Fast, Accurate Data Acquisition

The OPD-Scan III combines the functions of an autorefractor, a keratometer, a pupillometer, a corneal topographer and a wavefront aberrometer. It produces 2,520 data points across up to a 9.5-mm and automatically selects the best refraction as the starting point to finalize a patient’s prescription. (Corneal topography mapping utilizes an additional 11,000 locations.) The TRS-5100 digital autorefractor completes the required refraction with speed and accuracy. In less than 1 minute, you can discern which patients will need minimal refinements to their prescriptions and which patients will require full refractions. According to Dr. Bonilla-Warford, this knowledge is particularly helpful, given his patient population.

“The demographic makeup of my practice is somewhat unusual for Florida,” Dr. Bonilla-Warford says. “About 40% of the patients I see at my primary office are children under the age of 18, and the adults tend to range from 30 to 60 years old. With this young, healthy patient population, I believe they can achieve 20/20 or better visual acuity. Before I started using the XFRACTION process, I would enter the examination room for a routine eye examination assuming everything would be normal. If it wasn’t, and if a patient didn’t achieve 20/20 visual acuity, I would spend an inordinate amount of time performing manual refractions, trying to get there.

“Using the XFRACTION process, however, I already know if a patient’s prescription will be more complicated than the norm — perhaps because of early cataracts or a corneal deformity — before I enter the examination room. That knowledge helps me set my expectations as well as the patient’s expectations before we begin the process. Not only does the XFRACTION process save time, but it also helps my chairside manner.”

Patient Education Tool

Data acquired from XFRACTIONs also help Dr. Bonilla-Warford educate his patients. “I find it’s incredibly useful in explaining a patient’s condition, particularly if the best-corrected visual acuity of one eye differs from the other,” he says. “I can show the patient the asymmetry and some of the measurements and explain why, given this irregularity, he will not be able to achieve the same level of acuity in both eyes. Knowing why there is a difference gives patients some peace of mind. Similarly, if a patient has atypical or unusual topography and I need to refer him to a corneal specialist, for example, I can show him the differences between two pictures and explain what the issue is and why he needs to see a specialist.”

Dr. Bonilla-Warford has realized an unexpected benefit of the OPD-Scan III when examining children for the first time. “Occasionally, a parent will bring in a child because a screening at school or at the pediatrician’s office indicates the child is having trouble seeing clearly. If I find a deficit that can be corrected with eyeglasses, I explain this to the parents. With the OPD-Scan III, I can also demonstrate to parents how their children are currently seeing without correction, and then I can show them how their child will see with eyeglasses. It is a persuasive way to show parents the true need for vision correction for their children.”

Efficiency in Orthokeratology

When performing orthokeratology, Dr. Bonilla-Warford routinely uses the OPD-Scan III to track each patient’s progress. He evaluates changes in the shape and power of the cornea and the visual effects caused by those changes. “I can show patients their baseline status and the chronological progression of their corneal reshaping over time,” he explains, noting the OPD-Scan III provides all of the relevant data in one instrument.

“I used to have to go through a separate set of workup steps on a different instrument to obtain all of the information I needed, and then access it in the examination room,” Dr. Bonilla-Warford explains. “But now the patient sits at one machine, I obtain multiple readings, which I can pull up and click through in the examination room in front of the patient. I’ve been performing orthokeratology for a long time, but in the past, it was more time-consuming than I wanted it to be. The OPD-Scan III had made it much more efficient for me to see these patients.”

Don’t Stress, Demonstrate

Dr. Bonilla-Warford also appreciates the direct comparison feature of the TRS-5100. “Being able to show patients the difference between their current prescription and what I’m finding today is remarkable, because there really isn’t a good way to do that with a manual phoropter,” he says. “In the past, after I had completed a manual refraction, patients often would ask, ‘How much of a change is there? Is it a little change? A big change?’ These questions are sometimes difficult for optometrists to answer. When patients can directly compare their prescriptions, they will tell us how big of a change it is. Using the TRS-5100 as part of the regular workflow minimizes a patient’s uncertainty about the need for new eyeglasses. What’s more, the opticians in my office appreciate it, because it makes their job easier.”

A High-touch Experience

There’s no doubt that XFRACTIONs improve efficiency and save time. “In my practice, we aim for a high-touch experience,” he says. “I like having more time to talk to patients, to ask about their families and what’s going on in their lives. In some cases, we have a more serious conversation about their vision and eye health. Many patients comment that they haven’t had an eye doctor in the past who really listened to them. Basically, I have more time to focus on my patients.”

Although patients may not appreciate that the extra time is a product of the type of equipment in Dr. Bonilla-Warford’s practice, he certainly does. “By having my diagnostic equipment integrated with my EHR, I can push a few buttons, all of the information is entered into the chart, and I can write the prescription, all while I’m talking,” he says. “Without this efficient technology, I would not have the same amount of time to dedicate to conversing with patients. In this day and age, patients notice new technology in the practice and like the personal focus I can give them.”

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