ONE OF the many things I’ve had to do repeatedly in my 34-year career is buy new equipment and replace old equipment. Whether it’s replacing the non-contact tonometer or upgrading the current OCT, most of us will eventually have to decide when it’s time to toss out the old and bring in the new. When determining whether to upgrade or add equipment, I always ask myself several questions.

Here, I discuss these questions and why the answers must always be “yes” before you proceed.

Q1: HAS THE NEW TECHNOLOGY ECLIPSED MY CURRENT TECHNOLOGY?

My best example here is OCT. I purchased my first retinal scanning laser device in 1999. Six years ago, my partner and I made the last payment on our first- generation time-domain OCT, thinking we had finally upgraded to all the imaging technology our practice would ever need.

Shortly thereafter, however, second-generation spectral-domain (SD)-OCT became the preferred technology, so we, again, upgraded. Fast forward to this year, and third-generation OCTA imaging technology is available, so we upgraded to that as well. The reason for these upgrades: The technology changed to where my answer to this first question was, “yes.”

Some of you may be wondering, “How could you justify the acquisition costs of and time to learn a new OCT when your current, paid-in-full SD-OCT works just fine?” My answer is, “better patient care.” Specifically, OCTA detects blood flow in the back of the eye, enabling me to catch ocular disease even earlier. With my diabetic patients, for example, I can see subclinical pathology via OCTA.

Q2: WILL IT ALLOW FOR EARLIER/MORE ACCURATE DIAGNOSIS AND TREATMENT?

Another example: Although I already have first- and second-generation electrodiagnostic testing devices, I recently added a VEP+ERG testing device that has testing protocols specific to patients who have diabetes and diabetic retinopathy, enabling me to diagnose and begin treatment earlier.

Also, because the testing device is portable and can easily be moved from room-to-room, I’m able to use it on wheelchair-bound — among other special-needs — patients, whereas this was problematic with my existing devices.

Lastly, as the patient preparation procedure with this testing device takes two to three minutes vs. the 10 to 12 minutes it takes with my existing technology, my staff is able to acquire the data I need much faster and on more patients.

All three of these features meet my criteria for saying “yes” to this question.

Q3: WILL REPLACING OR ADDING NEW TECHNOLOGY PROVIDE A GOOD RETURN ON MY INVESTMENT?

As long as you won’t lose money, you should consider acquiring new technology. Because of low reimbursement fees, many optometrists mistakenly believe it can be difficult to recover the costs of an expensive instrument through time. However, by adding or upgrading to an OCTA instrument, for example, you can easily achieve a positive return-on-investment on the back-end, if you look at the big picture.

Specifically, because OCTA imaging allows me to identify diabetic retinopathy in patients earlier than before, their diagnostic workups may include other tests, such as threshold VF exams, electrodiagnostics, dark adaptometry examinations and extended color vision testing. These tests, used to detect diabetes-induced neurodegeneration and early functional vision loss, would never have been ordered and performed if the patient’s subclinical disease was not detected with the OCTA technology. The monthly fees from these diagnostic tests and examinations are new business to the practice and more than cover the monthly acquisition costs of the OCTA technology.

Alternatively, some ROI decisions are easy. Reimbursement for electrodiagnostic testing, for instance, is still robust, making it relatively easy to achieve a positive ROI with only a few patients being tested each week. (See “You Have to Start Somewhere,” p.26.)

Q4: DOES PRACTICE SIZE MATTER?

The answer: “Yes.” We practice in a 6,000 square-foot building, and it was too small 10 years ago! During my career, I have visited more than 100 optometry practices as a guest or consultant and the most common complaint is running out of room as their practices grow.

Sometimes, when you are running out of room, new technology that is portable or has a small footprint is the way to solve problems or add services. For optometrists who designed their office space years ago, the most common regret in hindsight is not planning for growth and not having enough space for new instruments.

IT MAKES CENTS AND SENSE

My long-term patients expect me to have new technology when they come to the office. They tell me it’s one of the reasons they return year-after-year, and I believe it’s one of the reasons my word-of-mouth referrals are still so strong.

If you can answer “yes” to these questions when trying to decide whether it’s time to upgrade or add equipment, I say move forward, and deliver the best care possible. OM

DR. THOMAS is a partner of First Eye Care – Southwest Dallas and a noted consultant, lecturer and author. He is a consultant for Konan Medical USA and Johnson & Johnson Vision Care. Email him at thpckc@yahoo.com.