Written by John Warren, O.D., Warren Eye Care Center, Racine, Wisconsin
Discover how my personal experience with a system translated into better visual outcomes for my patients.
With all the interest surrounding the move into primary eye care, including treatment of ocular surface disease, glaucoma and posterior segment diseases such as macular degeneration and diabetic retinopathy, many of us are guilty of leaving our “bread and butter” behind. The gains in technology in the diagnosis and treatment of ocular disease have been incredible, resulting in much better access to superior care for most of our patients. I’ll bet that just about everyone reading this article has added one or more devices devoted to the treatment of ocular disease in the last 5 years. How many of you have done the same when it comes to the diagnosis and correction of refractive errors?
Because there’s only one reimbursement code for refraction, and it’s not something that’s usually billed to major medical plans, there’s no “new revenue” stream to be tapped into when it comes to refraction. That doesn’t mean there haven’t been any tangibly valuable improvements in the gathering and analysis of refractive error data. Whether you see a direct or indirect return on your investment when upgrading your refractive care technology, your patients all come in contact with your lensometer, autorefractor and phoropter during your eye care cycle. In fact, it’s usually the portion of your professional care that has the biggest impact on most of your patients’ visual well being.
We’ve been correcting lower-order refractive errors for so long that as eyecare providers we take them—and their correction—for granted. Not only can we provide a superior measurement and correction of lower-order aberrations than ever before, now we can measure and correct higher-order aberrations, either directly with new technology in eyeglasses and contact lenses, or indirectly by taking these aberrations into account both during and after we complete the refractive data-gathering process.
Taking Another Look at Refraction
Until recently, I was a lensometer, retinoscope and manual phoropter practitioner. That changed in 2007 at the AOA meeting in Boston when I personally underwent refraction with a “refracting system.” One of the Marco area managers used a 3-D Wave (auto-refractor, topographer, pupillometer and aberrometer combination unit) and an RT-5100 to perform a refraction on my post-RK presbyopic eyes. After seeing how quick and easy the refraction process could be, I looked into the specific capabilities of automated refracting systems.
The programmability of the systems automates the whole refraction process, from lensometry and autorefraction to the subjective testing, and finally the comparison of the current subjective refraction to the habitual prescription from lensometry. With button-pushing sequences, the phoropter is set up for each test in order, the chart is changed to the one desired and the refraction progresses smoothly from start to finish. If other testing is required during the refraction, or if the patient can’t undergo one or more tests, you can “freestyle” as needed, abandoning the programmed refraction or continuing as desired.
Within 15 minutes, after discussing the system and all of its capabilities, I was talking about delivery and installation times. The decision was that simple. Let me share some specifics of my decision-making process.
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