3 Advantages of Advanced Contact Lens Tools in the EHR
Todd Zarwell, OD FAAO
Contact lens fitting is an art. We assess our patient’s needs, then use observations, experience, and intuition to find the best way to meet those needs.
Contact lens fitting also involves math and data, requiring us to take measurements, do calculations, and use this information to search for the best lenses for our patient. It’s critical that we find ways to work efficiently, yet showcase the skills that make optometry special. Ideally, we want to find ways to speed up the process of contact lens fitting while still giving our patients the time and attention they need. This is complicated by the fact that we need to completely document every step of the fitting process.
In the end, there are limitations to how quickly we can get lenses into our patient’s eyes, make our measurements, evaluate the lenses, and decide on what to do next. We can delegate some or most of these steps however these are all essential elements of a contact lens examination. This is the artful side of contact lens fitting and it’s not the place to cut corners.
Ultimately, there is a lot of room to speed up the math and data facet of contact lens fitting. In many cases, calculating a contact lens power and choosing a lens is not difficult. And when it does get more challenging, we can get assistance from multiple resources such as slider tools for calculating vertex powers, online calculators, and lens databases & catalogs.
These tools are helpful, but they could be significantly more useful if combined with the data contained within a capable EMR. For one, wouldn’t it be nice if the most recent refraction recorded in your EMR could be vertexed to a contact lens power without having to use an external resource? And, now that you know what power of contact lens you need, if you could search for suitable lenses without having to page through a catalog?
However, I see no reason to stop there. An intelligent EMR could also use trends to make smart suggestions. I hate to admit this, but we ODs tend to be pretty predictable. We all tend to default to a small handful of our favorite lenses. My technicians are very good at anticipating what brand of lenses I’m going to try, even before I ask them to pull the trial. I envision my EMR working the same way: Like a good technician who pays attention to what I’m doing.
The combination of these three things – watching for trends, vertexing refractions, and intelligent lens searches – could help us eliminate some of the rote tasks associated with contact lens fitting. Imagine this scenario: I’ve refracted my astigmatic patient, and my EMR vertexes my final prescription. It then presents me with five appropriate toric lens options, prioritized by my favorites brands. In addition to finding those lenses, it also suggests the best initial parameters by rounding to the closest available sphere, cylinder, and axis (all while maintaining the spherical equivalent, of course).
Is it essential that our software perform these tasks? Absolutely not. Optometrists are very capable of manually doing every step of this process. However, I see three advantages to automating this process:
- 1. Automatic vertexing. We’re all pretty good at doing this in our head, but this to a computer would eliminate errors and spare us the burden of using external tools and calculators for this task.
- 2. Parameter lookups. I like Brand X Dailies, but do they come in axis 40º? My EMR knows!
- 3. LESS TYPING AND CLICKING! This is the big one. Recording contact lens parameters is a cumbersome job. For a patient wearing a toric lens in both eyes, we need to enter data into at least 12 different fields. Rather than doing this, wouldn’t it be nice to be presented with a handful of options, pick one for each eye, and have most of those fields populated automatically? Even if we decided to make a few changes – say, round to axis 90º instead of 80º – we would come out ahead.
The idea of letting software calculate and propose contact lens options may make some of us a little uncomfortable. It shouldn’t. Vertexing refractions, paging through contact lens catalogs, and manually typing parameters into our EMRs is not what makes us contact lens experts. Let’s use our computers as the tools they’re intended to be and harness them to deal with the math and the data. The time we save on bypassing these tasks can be spent concentrating on what makes us truly special: Understanding our patients and using our skill and expertise to meet their needs.
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