Original Article Published in Women in Optometry
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Like every doctor who purchased a practice in mid-2019, Nyssa d’Hedouville, OD, could not have anticipated that just seven months in the future, the COVID-19 pandemic would force her to close Mashpee Vision Care, the Mashpee, Massachusetts practice she acquired, for two-and-a-half months. But she sees some positive developments that came out of that time. “I updated every area of the practice while we were closed to routine patient care,” she says.

While the practice did have a visual field analyzer and older optical coherence tomography equipment, she wanted a higher-tech experience for her patients.

She added Marco diagnostic and lane equipment, include the TRS 6100 automated refraction system, the OPD-Scan III and iON imaging system. The advanced technology has been a benefit in a number of ways.

First, it has sped up the time it takes to get an accurate refraction. “The technician measures the patient’s current eyewear in the lensmeter and performs an OPD scan. That is all uploaded into the TRS when I come into the exam room,” she says. Patients love not being asked the old “1 or 2” question, and she sees an immense benefit to being able to toggle back and forth between their previous prescription and the new one. “Patients are much more likely to purchase new eyeglasses if they understand what the difference in their vision is going to be. It’s much faster than dialing the prescriptions in and going back and forth,” she says.

The simulator that generates a depiction of the patient’s visual acuity is great for patients – and parents of young patients. “I had a young man who came in with his father. The patient had been diagnosed with keratoconus and could not achieve clear vision with eyewear. I was able to use the simulator to show his father how higher order aberrations made his son’s vision so poor. Suddenly, the father understood why getting the son fit with specialty contact lenses became imperative. Because I had those measurements ahead of time, I could save time, instead of repeating what had happened so often before when doctors were unable to get him seeing clearly with eyeglasses.” Similarly, that strategy works well for parents of young children, too.

Best of all, she can conduct her exam with just as much personal attention – but at a great distance with the TRS and iON. “I’m able to sit further away than I could during earlier slit lamp examinations. Plus, it’s great for patient education,” she says. She can share the images with the patient and explain what she’s looking at, whether that’s blepharitis, dry eye, nevi or lid lesions. “It’s so much easier for the patient to understand what we can see when they look at the image. It helps show the value of what we do, especially when we can use the first day’s measures as a baseline and then show them the effectiveness of the treatment.”

Just as important as the physical distance – the feature that most attracted her when she was able to start welcoming patients back into the office – is the patient education aspect. The result is increased face time, where she’s talking directly to the patient about a refractive or ocular health issue.

The diagnostic instruments also provide her with a better idea of what she’s facing. For example, the patient may have said nothing about dry eye symptoms, but the OPD-Scan III data indicates that the patient might have dry eye. “So often, when I tease out whether the patients have symptoms, they tell me that they do, but they did not think it was significant or that I could do anything about it.”

Finally, the data from the TRS is uploaded directly into her electronic medical record, which means she doesn’t have to worry about transposition errors.

As these benefits revealed themselves, they reinforced the value of bringing this equipment it. “As business owners, we’re always worried about our return on investments. But rather than ask whether it’s something you can afford, take a look at how it can affect your practice. For me, this technology has halved the amount of time I need to do a refractive exam. My technician has already gathered good data, and I can finish that portion of the exam more quickly. The patient can see whether the new eyewear would help, so it has resulted in more sales and a higher capture rate,” she says.

“I got it because I was worried that I wasn’t going to be able to open without having this technology. But now I enjoy it for all the other benefits it brings.”

Original Article Published in Women in Optometry
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When Monica Brown, OD, purchased Baymeadows Vision Center in Jacksonville, Florida, one of the two exam rooms had a TRS refraction system from Marco, while the second had a manual phoropter. “I kept the manual for a while because I do a lot of orthoptics, and I was comfortable with the process. I didn’t know if the TRS would do it as well.” Dr. Brown earned a master’s degree in orthoptics before attending optometry school.

However, the more she worked with the TRS system, the more she learned that she could use it for prism and binocular testing, as well as, if not better than, the manual system. Nearly three years after she bought the practice, she converted her second lane to include a TRS system, too.

She has found that adding the second automated refraction system helped her improve her efficiency, in large part because it allows her to look over other pretesting data and enter information into the chart from the patient’s history. “Patients have the wow factor while they’re going through this very easy refraction, and I am minutes ahead in my data collection and entry,” she says.

During her practice remodel in October, she also added the TruVue viewing system. “It’s a digital screen, and the clarity is unbelievable.”

For the past year, the added efficiency and speed, as well as the increased sales that result from using this system, “have been a godsend. Patients love seeing how clearly they would see with new eyeglasses. Even if it’s just an axis change, many patients can see the difference. And when I show them, saying, ‘Here’s how you could see with today’s new prescription,’ the majority say, ‘I want that.’”

PHYSICAL DISTANCE

Even as restrictions on physical distancing are lifted in some settings, providers and patients still expect and want some physical distance in a medical setting. “With the TRS, I’m not right there in the patient’s face for the whole exam. I’m at my desk; they’re in the chair. I barely have to get behind the slit lamp with the data I’m able to obtain now.”

OPD INSIGHTS

Adding the OPD-Scan III into the workup room routine has saved her even more time. The technicians run the process, and with the push of a button, that information is transferred to the exam lane. “I can show patients an unusual topography or tear film deficiency. It provides us with a quick and understandable explanation for why we might not get the vision to 20/20,” she says. Regularly, it saves her time because the OPD-Scan shows her a higher order aberration or other data point that will impact the final prescription. “I can explain to patients why, no matter how much we tweak the prescription, we are not going to be able to achieve 20/20,” she says.

For patients with tear film deficiency, however, she can also help them understand why compliance with a dry eye regimen she provides can help address their comfort and vision. Plus, on subsequent visits, she can compare the results from the most recent OPD-Scan.

Having the data on hand can help her describe her patient’s visual symptoms sometimes even before they do. “I might say, ‘Is this what you see at night?’ They are surprised and often tell me that I’m describing their exact experience,” another “wow” experience for those patients.

By staying current with technology, she meets the goals of her mission statement: to provide each and every patient a lifetime of healthy vision through superior comprehensive eye care thereby enhancing their quality of life.

ERGONOMIC BENEFITS

Dr. Monica Brown wants to avoid the physical pains that some ODs experience, so she has incorporated ergonomic features like a stand-up desk when she remodeled the practice. Her Marco TRS refraction system has also been helpful. “I can operate the console, and I don’t have to reach my arms up. I try to keep my elbows at my side as much as possible,” she says.

Original Article Published in Women in Optometry
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Shonda Achord, OD, of Achord Eye Clinic in Baton Rouge, Louisiana, hasn’t looked back since switching to the Marco Diagnostic Solutions TRS Refraction System. While she had already outgrown paper charts, she still found the switch expedited the whole process. “I can’t imagine the practice without it,” she says. The five-lane practice has a TRS in two lanes where Dr. Achord works, and her associates use the other lanes but can rotate through these two in her absence.

When she first brought in the TRS Refraction System, she found the refraction process to be so much faster that she felt her whole day could be restructured. “I felt like I could do four to five more exams per day—even before I added the OPD-Scan III wavefront aberrometer,” she says. “It’s just that efficient.” She has also found that with great technology comes a great reputation. “Patients were really impressed with it… so all that plays into the practice’s reputation. The wow factor is present, too. Patients always comment on it.”

GROWING, GROWING, GROWN
Part of Dr. Achord’s growth is attributed to an expansion she undertook. “I went from 1,600 square feet to 3,750 square feet, and I already wish I had more space,” she says. The practice has three doctors—Dr. Achord and two associates. While there are only two of them at a time there daily, the five exam lanes plus workup room/exam lane are always in use. She has seen a major change in patient flow already, with 30 percent of her patients currently being new to the practice. “I couldn’t do that before because we didn’t have the space or capacity for more patients,” she says. Despite her initial reluctance to move to a larger space, the lesson is the same one she passes on to doctors about equipment and technology: “If you don’t spend money, you won’t make more.”

“When I first added Marco technology, growth was the point,” she says. “Being able to fit in more patients and do it well was what I wanted. Now my goal is efficiency. I’m not trying to see a huge number of patients per day, but it frees up time that I can use in conversation and communication.”

Patients prefer it, too. “Refractions make people nervous,” says Dr. Achord. “When I have to dial it into a manual phoropter, it’s not as impressive as showing them their earlier prescription and the new one with the push of a button.” She has found that patients being able to see the differences for themselves has translated into the sale of more eyewear. “I didn’t like being the one to say, ‘Well, it changed this much so you should get new eyeglasses.’ If the Rx change didn’t make enough of a difference to them but I had told them they should buy new eyewear, then they may not trust me as much.” With the new system, Dr. Achord and her associates are able to let the patient decide for themselves with all the information in hand. Dr. Achord also has found few to no transcription errors, which has led to fewer remakes of eyeglasses.

The new system has proven to be useful in making up for closings and reduced volume during the pandemic. “We want to get patients in and out as fast as we can,” she says. At the same time, “We have to see people and catch up for the time we were closed, so we have to be efficient.” When it comes to the OPD, Dr. Achord praises its efficiency in helping her assess the issue. “It gives us topography, so right away I can see if there’s a reason that the patient might not achieve 20/20,” she says. “It’s an amazing instrument, and it saves me and the patient time and frustration.” She finds that the more information she has, the better she can advise the patient moving forward. “I can explain that the topography shows what issues we can’t overcome easily and what the options and/or compromises might be.”

She’s happy to share with her colleagues inside and outside of the Vision Source network how much more efficient the Marco technology has made her practice, and she emphasizes how even small time-savings with each patient add up. “I feel like if you don’t invest back in the practice, it’s not going to be successful.”

Ergonomic Benefits
For herself and her future well-being, Dr. Shonda Achord is also thankful she added the TRS Refraction System. “I’m only 5’3”, and I would rest my wrists and hands on the top of the manual phoropter because my arms got so tired,” she says. “I developed pleurisy, and it would hurt to breathe. My doctor asked if I did exercises that kept my arms and shoulders up—but it was my work.” She also notes that the new autorefraction system allows her to sit more throughout the day rather than standing all day like she was before. Another perk? “In the days of pandemic and flu, I’m five to six feet away from people,” using the tabletop controller.