Tag: doctors

Blepharitis: With So Many In-Office Procedures, How Do I Determine Which is Best?

By Dr. Paul Karpecki

Blepharitis, including meibomian gland dysfunction (MGD), affects over 35 million people and that number underestimates the true population who suffer from this condition.  While most patients are treated with artificial tears and eyelid hygiene, I’ve found that in-office procedures can be more effective in moderate to severe cases.  With a plethora of options from microblepharoexfoliation to thermal pulsation to photobiomodulation, what’s the best choice to bring the most relief to patients?

Anterior Blepharitis

The decision of how to treat anterior blepharitis patients depends a lot on what you see clinically.  There are three types of blepharitis one can diagnose and different treatment options for each: demuxed blepharitis, staphylococcal blepharitis, and seborrheic forms.  While microblepharoexfoliation (MBE) or Blephex might work in all three cases, they are most effective in seborrheic and bacterial forms like staphylococcal blepharitis.  Additionally, LLLT treatment with the blue-light mask can positively affect bacterial blepharitis.  In my experience, the most effective options for demodex blepharitis are blue-light Low Level Light Therapy (LLLT) and Intense Pulsed Light (IPL).   Blue LLLT alone will work but there is an enhanced effect when combining it with IPL.  This can even be followed by microblepharoexfoliation (MBE) to de-bulk the collarettes.  In my experience, MBE does not kill demodex like blue light LLLT with IPL, but it helps remove the remaining collarettes and debris.  If you do not have access to MBE, you can use lid scrubs – preferably one with Manuka extract – after the LLLT procedure.

Posterior Blepharitis/MGD

The more difficult decision may come from the multitude of treatments for posterior blepharitis that range from thermal pulsation to IPL and LLLT.  Fortunately, that decision can be made based on the pathology.  For example, a patient with easy meibomian gland expression, but paste-like or turbid meibum, can do well with thermal pulsation or red-light LLLT.  A patient with ocular rosacea, often identified via telangiectatic vessels on the lid margin, will do better with IPL.  Likewise, patients with no visible meibomian gland expression diagnostically seem to do better with IPL followed by red-light LLLT.

Hordeola/Chalazion

I haven’t had a lot of success with using IPL for chalazion in my practice, but I have had positive outcomes with red-light LLLT.  Likewise, hordeola responds very well to LLLT treatments with the red-light mask.

With so many options for in-office treatment of blepharitis, it helps to look closely at the specific pathology and then customize the treatment.  For the majority of conditions LLLT is most versatile, but combining IPL with LLLT can be extremely effective as can MGE with an LLLT for anterior blepharitis.

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The Right Exam Lane Technology Can Make The Day Easier – And More Fun – An Article From Women in Optometry

Original Article Published in Women in Optometry

Karen Wrigley, OD, with two practices, Wrigley Eye Associates and Visual Eyes, in the Philadelphia, Pennsylvania, area, has always tried to keep her practices updated with the latest technology. Yet when she brought in new exam lane equipment from Marco recently, she was impressed by not only how it sped up the refraction and exam process but also by how much patients are enjoying the experience.

Dr. Wrigley originally added an OPD-Scan III, and a Marco TRS automated refraction system to one of her two exam lanes in each office. She added a second TRS and a new slit lamp with the ION camera in June of this year. In the pretest area, technicians can capture wavefront aberrometry, topography and keratometry, among other features, with the OPD-Scan III. This data provides the doctors with more information about the surface of the patient’s eye before they are even in the exam room, which is particularly helpful with specialty lens fittings. Now, those patients with complex fitting needs can receive even more customized contact lens prescription, helping them see and feel better. The updated slit lamp has also allowed for a more precise patient examination.

WOW THE PATIENTS

Dr. Wrigley’s office serves as an internship site, and she says that while the manual phoropter provided interns a good learning experience, it was outdated and more difficult. It’s ergonomically stressful for the user, and the process can be stressful for the patients.

“If we’re going to update our technology, let’s wow our patients,” Dr. Wrigley says. The new slit lamps have updated camera software so that Dr. Wrigley and her team can show patients their images right there in the exam room. Plus, the new TRS technology lets doctors use a tabletop console to sit a distance back from the patient, supporting social distancing, which puts both parties more at ease.

The TRS and OPD systems in her two offices have created more efficiency while allowing the doctors to provide even better care to their patients. Dr. Wrigley has been able to minimize downtime in exam lanes, thanks to the updated technology in her offices. She or her technicians can complete the refraction faster, and she gains the measurements she needs accurately.

Leveraging her Vision Source member benefits, Marco brings doctors the “best bang for their buck” on upfront costs, lease programs and technical support, she says. Marco’s support is stellar; technician assistants will fix equipment on-site or remotely, which has also helped save the practice time and avoid downtime as, in many cases, they no longer have to ship equipment out for repairs or updates. She also appreciates that her representative is just a phone call away for pricing, advice, support and tech questions.

Dr. Wrigley has seen a positive return on investment and the intangible benefit of happier customers with the Marco systems. “Our vision statement at the practice is helping patients see well and look great. The new technology has helped us achieve this,” Dr. Wrigley says. “My goal is to always keep up and push forward.” She says her patients have even noticed the office updates. Those who have jumped to another practice for their eye care often come back to her because “they know we keep up with the latest and greatest in the industry,” she says. “It is so nice that they see what I’m trying to provide for them.”

Dr. Wrigley has been able to prioritize the best care for her patients without it burdening her team or herself; in fact, it actually makes her days easier.

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Blepharitis, Dermatitis and Modern-Day Management

By Dr. Paul Karpecki

Blepharitis is one of the most common conditions eye care practitioners (ECPs) diagnose and yet it is one of the most under-diagnosed conditions! The reason is that blepharitis isn’t usually diagnosed until it is severe, which involves loss of meibomian glands, thinned lashes, advanced erythema, lid edema, and dry eye disease. The fact is that blepharitis, inflammation of the eyelids, begins years or decades prior and only subtle signs exist. Recent research has shown significant bacteria to be present within the follicles of lashes (where you can’t observe) or surrounding the base or in the meibomian glands or lash follicle orifices. Clinicians must look for blepharitis sooner, such as for debris at the base of the lashes; as the lashes grow out, they may include discharge to collarettes. I suggest that ECPs have their patient look down at the slit lamp and scan the upper lash margin for collarettes. Early diagnosis is key to preventing future chronic issues and permanent tissue loss.

While commercial lid scrubs and hydrating compresses are helpful and recommended, additional treatments are necessary. Think of the dental model: the dentist (or more likely the dental hygienist) performs in-office cleaning and various procedural options, but you still brush and floss your teeth at home. Likewise you should see your ECP for in-office procedures and use lid scrubs and hydrating compresses at home.

In office treatments include micro-blepharoexfoliation (MBE) and photobiomodulation such as intense pulsed light (IPL) and low level light therapies (LLLT). We typically combine these treatments. The photobiomodulation kills the microorganism and the mechanical treatment removes debris, residual bio-film, and in the case of demodex, mites and eggs. Advantages of LLLT/IPL include killing the organ-isms as opposed to simply removing them (like MBE). Some disadvantages of tea tree include potential toxicity and damage to meibomian glands, as well as patient discomfort in higher concentrations. Lower concentrations work on milder presentations but may not affect a severe blepharitis presentation. Anti-biotic drops or ointments as well as surfactant-based cleaners will work for bacterial blepharitis but not demodex.

LLLT is a particularly helpful technology for blepharitis. In my experience, we’ve seen dramatic improvement in all forms of blepharitis including bacterial and demodex – especially when combined with IPL. In infectious cases we use the blue LLLT mask, which has particularly good anti-microbial effects, followed by the red LLLT.

Blepharitis is common and needs to be diagnosed early and treated aggressively the moment the first signs of disease are present. Combining at home treatment with in-office procedures appears to best address infection and dermatological forms of blepharitis

1. Nattis A, Perry HD, Rosenberg ED et al. Influence of bacterial burden on meibomian gland dysfunc-tion and ocular surface disease. Clin Ophthalmol. 2019 Jul 12;13:1225-1234.

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Advancing Eyecare Announces Acquisition of Santinelli International

Jacksonville, Florida, January 5, 2022 – Advancing Eyecare, North America’s leading provider of ophthalmic instruments and portfolio company of Atlantic Street Capital (ASC), announced today the acquisition of Santinelli International, a respected leader and award-winning provider of optical finishing equipment.

Advancing Eyecare is currently comprised of Lombart Instrument, Marco Ophthalmic, INNOVA Medical, S4Optik, Santinelli International and other leading brands. Founded in 1973, Santinelli International is the leading provider of lens edging equipment in the United States. The combined scope of Advancing Eyecare offers the broadest product portfolio, the most knowledgeable people, and the most reliable service in the industry.

Brad Staley, Chief Executive Officer of Advancing Eyecare, said, “As we continually anticipate ways to help ophthalmic practices thrive, the addition of Santinelli International is a natural fit. Santinelli International is a respected leader and well-recognized provider of optical finishing equipment in the U.S. In fact, they have won 13 consecutive Vision Monday EyeVote Readers’ Choice awards as favorites in the in‐office lab equipment, finishing equipment, and overall optical equipment categories. Santinelli International’s strong reputation for top-quality products and their commitment to after-sale service and customer satisfaction have contributed to their dominant market share in this space. We recognize the expertise this brings to Advancing Eyecare, and it introduces a new line of prestigious products and services to be made available to our customers.”

Gerard Santinelli, CEO of Santinelli International, commented, “This represents a tremendous opportunity for our customers, our valuable employees, and the Santinelli International brand. It is a testament to our proud heritage as we join this group of best-in-class solutions providers. Santinelli International has served the market for nearly 50 years and is a cultural and professional fit to Advancing Eyecare. We are thrilled to add our edgers, blockers, tracers, consumables and accessories to the Advancing Eyecare portfolio of products.”
Visit www.advancingeyecare.com for more information.

About Advancing Eyecare

Advancing Eyecare™ is the leading provider in the eyecare instrumentation marketplace established to offer the best products and service solutions in the ophthalmic equipment industry. Currently comprised of Lombart Instrument, Marco Ophthalmic, INNOVA Medical, S4Optik, Santinelli International, and other leading brands, the combined scope of the organization has the broadest product portfolio, the most knowledgeable people, and the most reliable service in the industry.

About Santinelli International

Founded in 1973, Santinelli International is a leading distributor of optical finishing equipment in the United States. The company also provides thousands of supplies to eyecare practitioners through Sios Optical, their optical supply and accessories division. Santinelli International is headquartered in Hauppauge, New York. For more information, go to www.santinelli.com and www.siosoptical.com.

About Atlantic Street Capital

ASC is a private equity firm that invests in lower middle market companies poised for the next level of growth. The firm targets entrepreneurial management partners and fundamentally sound companies between $4 million and $25 million of EBITDA that will benefit from capital investment and ASC’s value-added strategic and operational support. As a result, ASC works closely with management to unlock their business’ underlying value and help them succeed. For more information www.atlanticstreetcapital.com.

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Media Contact:
Chris Tofalli
Chris Tofalli Public Relations, LLC
914-834-4334

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Post-Pandemic Safety Concerns Prompted Purchases That Have Yielded Far More Benefits – An Article From Women in Optometry

Original Article Published in Women in Optometry

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.”

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Two Equipment Additions Provide OD With Efficiencies, More Data And Patient Wow Factor

Original Article Published in Women in Optometry

After being shut down for two months at the start of the COVID-19 pandemic, Melissa Richard, OD, wanted to make some changes at Spectrum Vision Care in Chalfont, Pennsylvania, the practice she opened in March 2016.

Her first step was to furnish a second exam lane, which would allow her to bring on a second contact lens specialist one afternoon a week to help accommodate the growing patient load. She had her eyes on the Marco TRS automated refraction system, and the built-in social distancing features made it an obvious fit.

She moved her manual phoropter to her new second lane, but the Marco lane is by far her preferred exam room. “I use that second room more for medical services and consults,” she says. She wanted Marco anyway because that was the system she used in her previous setting and was already “sold” on its quality and benefits, “and it’ made a lot of sense coming back after COVID-19,” she says. “It’s faster, and I can hit one button that allows patients to compare what today’s prescription looks like compared to what their current prescription is. It’s been really great for sales of eyeglasses,” she says. Without having to dial in the changes and have patients try to compare those, “this feature provides an instant ‘oh wow’ from my patients,” she says.

However, the added benefit of being able to conduct this refraction process from a distance made her and her patients feel much more comfortable. “I can operate the TRS from six feet away, and patients love that.”

A SECOND UPGRADE

At the same time that she was making these changes in the summer of 2021, she also added the Phoenix Meibography Station from Marco. The unit has a topography workstation, and she wanted a topographer to help provide additional clinical data to her contact lens specialist. But she quickly realized that the Phoenix would help her with the dry eye patient management, too. “I remember thinking that the Phoenix dry eye module would be great once I could start my dry eye patients back,” she says.

The Phoenix provides her with a dynamic view of non-invasive tear film break-up time with tear meniscus height imaging and measurement. She can image the tear film dynamics as a video, too.

Dr. Richard began to realize how much more prevalent dry eye signs and symptoms were once she started screening all of her patients with the neurolens lifestyle questionnaire. “There’s a question on dry eye in there, and if dry eye is a patient’s primary issue, we will bring that patient back in for dry eye testing,” she says.

“Patients don’t always tell me about their dry eye symptoms unless we specifically ask,” she says. The lifestyle questionnaire has them grade their dry eye signs on a scale of 1 to 5. “If it’s a 3, 4 or 5, I’d call that significant,” she says.

As a result, she’s seeing about a three-fold increase in Meibomian gland dysfunction and blepharitis, much of it due to increased screen time and mask-wearing, as well as more chalazion and stye. “We’re able to do infrared meibography and start addressing tear volume,” she says.

She shares the report from the Phoenix, which “validates for the patient what they’re feeling and helps monitor improvement,” she says. It also helps improve compliance and patients’ willingness to return when they can see objective improvement that coincides with how much better they’re feeling.

EFFICIENCIES

Dr. Richard says that her Marco technology has added efficiency to her practice. The Phoenix Meibography Station with a topography workstation is in the pretesting area while the TRS is in the exam lane. Because the TRS is linked to her practice management system, there are fewer transcription errors and fast transmission of the results to whomever needs them. “Patients are impressed with the technology. I’d say that the TRS 6100 is the patient favorite,” she says.

That could be because nearly every patient interacts with it, unlike advanced equipment used to detect and monitor ocular diseases. Plus, patients love that they can skip the “1 or 2” questions that adds stress for so many.

Dr. Richard became a Vision Source® member when she opened, noting that the buying power helped her stretch her opening budget.

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Refraction System Provides Efficiency, Accuracy And A Little Distance – An Article From Women in Optometry

Original Article Published in Women in Optometry

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.

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Spend Money To Make Money – An Article From Women in Optometry

Original Article Published in Women in Optometry

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.

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Replicate A Model That Works – An Article From Women in Optometry

Original Article Published in Women in Optometry

Dora Sudarsky, OD, had been considering the right time to equip a second exam room at her practice, Chroma Optics, in Burlington, Vermont. Her son will be graduating from optometry school in May 2021 and will join her in the office, so she knew the change was on the horizon. “I knew I needed to add another lane, and with COVID, I decided now was the time to do it,” Dr. Sudarsky says. She added a second TRS system from Marco as well as the ION slit lamp earlier this year, and working between two systems is allowing her to be more efficient seeing patients. She can alternate from room to room, which leaves more time for cleaning between each visitor. “It’s been awesome.”

TECHNOLOGY IS A TOP PRIORITY

Dr. Sudarsky opened the practice in 2015, renovating and redesigning the space that was a former video store. She did most of the interior design and decorating herself to allot more of her funds to her instrumentation. Marco was on her wishlist from the start, and she opened her doors with one TRS system and the OPD III in her pretesting area. “The OPD III was above and beyond what anybody else had, and that was a big appeal,” she recalls.

Many patients followed Dr. Sudarsky from the optical where she had previously offered her optometry services, and in that space, she did not have any advanced technology. So the impression on patients has been huge and continues to be when new patients come to her office. “They tell me they’ve never seen so much technology, and while it may not all be brand-new, not every eye care practitioners embraces it the way that I have.” She recalls as she was preparing to open the practice that a colleague told her to wait and add automated refraction technology in five years. “I wanted to have it now so patients would tell their friends; that word of mouth makes a huge difference,” she says. “Some people say that they can’t afford to do it, but I say you can’t afford not to.”

BENEFITS FOR PATIENTS AND PRACTICE

Dr. Sudarsky says the staff adapted well to learning how to use the technology from Marco, and the data transfers automatically to her exam rooms so she can discuss the results with patients. “One of the things I love about the TRS system is that it’s a lot easier on my body—doctors don’t always think about that,” she says of the repetitive movement of traditional refracting. After experience her new, upgraded TRS in the second exam lane, Dr. Sudarsky is a fan of the improvements Marco has made, such as a bigger touch screen and even more intuitive software. It’s easier for her, but the experience is also simplified for patients. “Being able to press a button and show their old prescription vs. new prescription has a big impact, and I do think it has helped with upgrading and updating eyeglasses,” she adds.

The new ION Slit lamp in her exam room has become a great patient education tool in just a few months. “I can take pictures, put them on my computer screen and share with the patients.” Dr. Sudarsky was recently recommending a switch to wear daily disposable contact lenses to a patient. “I was trying to convince her, and with the picture, I could show her that her current contact lenses were dirty, even when she said they were clean. A picture is worth a thousand words.”

The OPD III has been a great asset for fitting contact lenses, and in particular, multifocal contact lenses. “It has a lot of great tools,” Dr. Sudarsky says. “I can tell if the patient’s visual axis is not the same as the center of the pupil, and I will know if multifocal contact lenses will work for them or not.” That can save her and the patient some frustration, especially compared to a system where she may have tried multiple lenses before reaching this conclusion.

Dr. Sudarsky says her efficiency has improved working with this technology, and she’s able to spend more time with each patient. “I have fewer remakes and better refractions,” she says. “I wonder how I practiced before it.”

Dr. Sudarsky didn’t know any colleagues who had technology from Marco when she took the leap, so she’s relied on the support of its team who have helped her with any question or issue that arises. She’s particularly thankful to her Marco support representative, who is a master at the OPD III and who helped Dr. Sudarsky understand how to utilize the many features and functions that the instrumentation has to offer. “They are just a text away and always willing to help,” she says.

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High-Tech Exam At A Personable But Appropriate Distance – An Article From Women in Optometry

Original Article Published in Women in Optometry

When Patricia Haller, OD, added Marco technology to her Chillicothe, Ohio, practice in 2015, physical distancing was not even a thought. But when she closed her office to routine care for four weeks during the stay-home orders in the state, she realized how this same technology allowed her to see emergency and urgent cases and still maintain some distance. Dr. Haller’s practice reopened at a lighter schedule to routine eye care in early May. She discovered that Marco was a “hidden gem” in the post-COVID era.

REFRACTIONS AT A DISTANCE

With the tabletop controller for her Marco 5100, she is able to conduct her refractions and sit about six feet away from the patients. “It’s also very easy to sterilize because all mechanisms are housed inside, so we wipe down the exterior casing without worrying,” she says.

She already knew its value. “I purchased my first TRS in 2015 when I built the new office. I left a manual phoropter in one of my exam lanes,” she says. However, she quickly realized she didn’t want to use that room for patient exams. So now she has three units—one in each exam lane.

“It helps to keep the process streamlined. I can control the speed at which the refraction takes place,” she says—an even more important factor in the post-COVID opening. “We want patients moving through the office efficiently so that we do not have any backup in the reception area. With the TRS, it’s quick to arrive at a final refraction, and patients can see and justify their decision to buy new eyewear.”

READY TO BUY

That’s helpful because every practice is faced now with trying to make up time and lost revenue from being closed to routine care. Happily for her, she says that patients are returning, ready and eager to buy. “I was prepared for the fact that patients might not be ready to make purchases. The staff and I discussed ways in which we could help patients with their essential needs if their finances were tight,” she says. She’s not finding that to be a hindrance, however.

“They’re excited to be back and have been updating their prescription eyewear without any of the hesitation I thought that we’d see.” Dr. Haller says that it is helpful that patients can see the steps that she and the staff members are taking to keep the practice and optical clean and sanitized. “We have a UVC wand that we are using to sterilize every frame that a patient tries on before those frames are placed back on the boards. We used to wipe down our frames on a regular basis, but now they’re sterilized.”

The practice staff works on maintaining physical distancing, and opticians are masked. Patients who don’t wear a mask are offered one—and patients who would like to wait before coming in are rescheduled.

UNEXPECTED SURPRISE WITH iON

Dr. Haller added the iON imaging system to her slit lamps, allowing her to take an anterior segment image and immediately pull it up on the computer screen. She can pivot the screen toward the patient or toward an attending family member so that she can explain what she’s seeing.“I purchased the iON because I thought it would be terrific to do anterior segment documentation in the exam room where I could enhance details. The unexpected surprise is the physical distancing that I gain with this—while still providing patients with a comprehensive exam,” she says.

Dr. Haller uses Marco’s autolensmeter and autorefractor, appreciating how quickly information can be downloaded into the electronic health record. “Even before the patient is escorted to the optical, the opticians already know the lens designs and recommendations,” she says.

She knew the equipment she has been purchasing would bring her speed, accuracy and efficiency. “But the help it provides in this time is something no one could have foreseen,” she says. The combination of a high-tech, highly efficient exam process and the sanitization and safety protocols that are on display are raising the likelihood that patients are talking about the practice to their friends. “Patients are saying, ‘I had my exam there, and it’s safe to go in.’”

That feedback makes Dr. Haller happy. She says that she missed her patients. “Nothing replaces that feeling of seeing the smile on a patient’s face, knowing that you helped. It’s been challenging, as I’m a hand-shaker and hugger, but we’re managing. It’s great to see my patients back.”

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