Tag: doctors

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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The Power of “Wow”

Our practice, Virginia Eye Consultants, is a tertiary care referral practice specializing in cornea, refractive, uveitis, retina, glaucoma, and oculoplastics. We firmly believe in collaborative care, and we work closely with the optometric community. Recently, our practice celebrated our 50th anniversary providing world-classspecialty eye care to our Hampton Roads community.

We house 17 providers, including 13 ophthalmologists, 4 optometrists, and 225 support team members, and we perform in excess of 5,000 surgical procedures annually, with the majority being cataract surgical procedures. We have four locations throughout the Hampton Roads area, with our main office located in Norfolk, VA, and three satellite offices located within 30 minutes of each other.

Several years ago, we made one of our best strategic and business decisions when we acquired Marco’s EPIC-5100 for our main office. This is where the majority of our providers are based and most of our cataract and refractive evaluations are performed.

The EPIC-5100 combines two of Marco’s most advanced visual pathway assessment technologies: the OPD-Scan III wavefront aberrometer and corneal analyzer and the TRS-5100 digital refractor. The two technologies can be used together to evaluate the entire visual system in a fraction of the time it takes traditional manual systems.

Indeed, we chose the EPIC-5100 system specifically to address and improve our patient throughput and efficiency, and we couldn’t be more pleased. To say the EPIC-5100 has improved our performance in this area would be an understatement. The majority of our patients are referred to us for cataract and refractive surgery from our optometric referral network. Utilizing this technology has improved our efficiency through the technician workup alone.

Prior to implementing the EPIC-5100, our technicians took nearly 40 minutes to perform a patient workup, gathering data from visual acuities to topography to refractions. In the time since we’ve acquired the EPIC-5100, we have been able to get the same amount of data in just 15 minutes, allowing us to improve both efficiency and overall time for cataract/refractive evaluations.

The user-friendly platform enables technicians to quickly gather the critical data that are used to determine each patient’s optimal treatment, whether that is for cataract or refractive surgery. A wealth of information critical to each patient’s visual system from the refraction — wavefront measurements, pupil size, angle kappa, and corneal topography — is gathered swiftly and efficiently using the EPIC-5100. The EPIC-5100, combined with the OPD-Scan III, can give us more than 20 measurements to utilize in our decision making. Even better, all of the data can be captured in about 10 seconds.

Additionally, we have an OPD-Scan III at each satellite location, which allows us to gather the clinical information necessary to make our recommendations.

Patients and Practitioners Both Benefit
The decision of whether or not to adopt new technologies can be challenging. However, when it comes to innovative technology such as the EPIC-5100, the decision was easy for us. From the “wow” factor to patient education to informed clinical decision making, patients and practitioners both benefit from the EPIC-5100 and the OPD-Scan III.

Our biggest challenge prior to adopting the EPIC-5100 was patient wait times due to bottlenecks resulting from lengthy patient workups. As in any practice, patient wait times play a significant role in the patient experience, and it is important to continuously evaluate our practice processes and procedures to optimize care. With the Marco products, we are able to utilize the technology to improve throughput as well as the staff and patient experience.

The EPIC-5100 and OPD-Scan III technology differentiate our practice and provide information we can share with our patients. It gives them the confidence that they’re in the presence of state-of-the-art technology that will be used to determine which procedures and surgeries are best for them. We measure patient satisfaction with surveys after each visit and gauge the patient experience by using the Consumer Assessment of Healthcare Providers & Systems survey; they show definitively that patients believe they’re receiving the care they need and deserve. Each survey provides different information about the experience they had and the level of satisfaction with their care.

Enhancing Patient Education and Experience
Regardless of the condition for which a patient presents, patient education is key to successful outcomes. With the OPD-Scan III, we have the ability to educate patients about the impact on the ocular surface using the placido rings from dry eye to pterygium to other corneal surface irregularities. We can use the topography maps to discuss either the normal or abnormal corneal curvature, which shows why patients may have compromised vision and what we can do to address the condition.

Another feature of the OPD-Scan III that we take advantage of to educate our patients is simulating their vision before or after correction. In a practice like ours, this is turning out to be a vital tool in helping patients recognize the benefits of a new refraction, contact lens prescription, or surgical procedure.

As an optometric referral center, our practice’s success and growth is focused on patient experience and outcomes. The “wow” factor experienced by the patient while going through testing as well as our ability to minimize wait times and the amount of time patients are seen for their cataract/refractive evaluation determines our success. The information the technology provides give us the ability to make a solid recommendation for treatment.

Marco has been a great partner with our practice in providing the support and resources we need to successfully implement and utilize their technology. From the initial training for the staff to the support for providers on how to understand and utilize the technology, Marco has truly helped us to maximize the technology in daily practice.

Innovative Technology Is Key to Success
It’s also worth noting that implementing innovative technology is a key way to help differentiate your practice, prepare it for the future, and, perhaps most importantly, protect it against competition of all kinds. Online refractions, for example, provide limited data with questionable reliability. Technologies, such as the EPIC-5100 and OPD-Scan III, however, provide an unmatched experience and information that patients simply can’t get online.

With changes in optometry due to supply and demand in eyecare providers, optometrists will be called upon to provide more medical eye care for our patients and communities. The EPIC-5100 and the OPD-Scan III can aid providers in gathering reliable data in an efficient manner while allowing us to concentrate on our patients’ medical needs, such as diabetes, glaucoma, and cataracts, something the online competition cannot do.

Optometrists would do well to recognize these benefits and respond accordingly.

– Walter Whitley, OD, MBA, FAAO, is the director of optometric services at Virginia Eye Consultants, which serves the Hampton Roads region of Virginia.

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TRS-5100: A Win-Win

In using a manual refractor, I was facing two major and increasingly burdensome challenges. First, the technology was simply outdated compared to all the other technology I have in my practice, such as the OPD-Scan III (Marco), digital retinal photography, OCT, osmolarity testing, Visioffice, and my EMR system. Simply put, the refractor did not complement the level of care and patient experience I was providing throughout the rest of the examination and beyond, including the various touch points I have with patients through electronic media.

The second major challenge I faced was the inefficiency associated with manual refraction. I work just 3 days a week, so I need to maximize efficiencies to best serve my patients and my practice. The several extra minutes it takes for a traditional refraction really adds up, especially in a practice with patient volume averaging about 15 to 20 patients per day. I would prefer to spend that valuable time educating patients and making recommendations about eyewear and ocular health.

I reviewed auto-refractor systems from other companies, but I ultimately went with Marco’s digital technology because of their established success and consistency. Further, I received many strong recommendations from other doctors who successfully use Marco refractive technology in their own practices.

My selection of the TRS-5100 has proven successful in addressing my issues of compatibility, consistency, and efficiency. The system has improved the overall efficiency of the practice, and its compatibility with the OPD-Scan III wavefront aberrometer has proven to be invaluable. Combined and integrated with the OPD-Scan III, the TRS-5100 gives me a much better idea of a patient’s likelihood of achieving 20/20 vision, and a far more comprehensive picture of the patient’s complete optical pathway.

The OPD system delivers a statistical indicator (RMS, or root mean square), which gives the practitioner an idea of potential best-corrected outcome. This statistic is obtained via aberration measurements, topography, pupil sizes, and day and night refraction differences, among other data points. As a result, I know about how long I should spend refracting my patient with the TRS if his potential visual outcome is limited. I generally save several minutes per patient, and several minutes more on patients with more complex refractive errors (i.e., patients with moderate to advanced cataracts and corneal irregularities).

Positive Staff and Doctor Impact
My staff quickly embraced the system. They appreciate its ability to free them up for other tasks. The automated data transfer through the IC card-loading system minimizes staff involvement, as the patient’s refractive data is loaded onto a data card in the pre-test area, and the card is inserted into the TRS module in the exam lane, loading all data instantaneously. Staff members no longer have to enter refractive data, which saves time and reduces costly transcription errors.

As for myself, I really appreciate the system’s customizable ergonomic preferences. Although I see patients only three days per week, the upper shoulder and back strain I suffered prior to acquiring the TRS-5100 was nearly
constant. I’m sure other ODs who have used manual refractors can relate. Today, I have far less upper shoulder pain and back issues, thanks to the system’s ergonomics — ergonomics that may actually lengthen my career.

Positive Patient Response
The patient response to the new system has been overwhelmingly positive, both within and outside our practice. New patients and those unfamiliar with the system hear the TRS-5100 uploading data as they sit in the exam chair and are excited to see how it works, even before I start refracting. Patients who pay attention to medical technology can immediately appreciate how advanced our practice is compared to others.

Indeed, the system provides a true wow factor with patients. The TRS-5100 allows for a one-touch comparison of the patient’s current eyeglass prescription with the new prescription. Patients can immediately see for
themselves — in vivid detail — the impact of updating their prescription. While the previous processes left a fair number of patients uncertain about whether or not to purchase new eyewear — even with doctors’ recommendations — the TRS gives them far more confidence in their purchasing decisions, and applies more value to our practice.

Outside the office, my practice is enjoying many more positive online reviews, and our online referral stats are up by about 100% compared to the year prior, when we didn’t have the TRS. In addition, the comments from patient surveys now cite our technology, our professionalism, and the comprehensive, thorough nature of our eye exams as positive attributes in the patient experience.

Positive Financial Impact
In all honesty, except for the refraction, our exam flow hasn’t changed dramatically, so the transition was painless. I believe it’s the additional time I get to spend with and educate patients — enabled by the automation of the TRS-5100 — that is responsible for the favorable patient impressions. Thanks to this technology, I have more time to prescribe and recommend eyewear and contact lenses, and discuss treatment plans and general eye health with patients. All of this, of course, benefits our practice’s bottom line. Revenues-per-patient are already up about $50 over the previous year, and our capture rate in optical is up 10% since purchasing the TRS-5100. This automation further delivers a reduction in manual transcription errors and the cost of prescription remakes.

Bottom Line
With respect to improving exam flow efficiency and patient care, competitive standing among local optometry practices, and practice profitability, there’s simply no reason not to consider improving your practice with the TRS-5100. We are told to make purchasing decisions based on the goals of enhancing data, knowledge, profitability, and our care of patients. Marco’s TRS-5100 not only helps us meet all of these goals, it also makes our workday easier and far more pleasant. It’s a win-win for ODs and patients.

– Gina Wesley, OD, owns and operates Complete Eye Care of Medina, Medina, MN.

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Achieve Results and Manage Expectations

It is my belief that an excellent postoperative patient result begins with detailed attention to preoperative testing. With its diverse pre- and postoperative evaluation capabilities, the OPD-Scan III has improved my surgical outcomes and has increased overall patient satisfaction. Furthermore, I use the images on the OPD to discuss diagnoses and treatment plans with patients.

Pre-op Screening for Optimal Post-op Results
To achieve the best postoperative results, we must screen patients preoperatively to identify certain corneal disorders that may affect outcomes. The OPD-Scan III measures a large amount of data, all of which are helpful in determining the best treatment options for patients. We are constantly finding new ways to maximize its advantages. The OPD has led to reduced postoperative issues and complaints by helping me to properly select those patients who would be good candidates for premium IOLs.

For example, the OPD identifies corneal diseases — such as irregular astigmatism, higher-order aberrations (corneal coma or corneal trefoil), high or low spherical aberration, and visually significant pterygiums with irregular astigmatism extending into the central pupillary zone. In each of these situations, the patient would be considered a poor candidate for a multifocal IOL.

I also evaluate the placido rings to look for irregularities. Irregular placido rings can be caused by a wide variety of corneal diseases, including dry eye disease, pterygiums, keratoconus, Salzmann’s nodules, corneal scarring, and epithelial basement membrane disease. If I decide to treat the corneal disease prior to cataract surgery, I obtain a repeat scan after surgery to show patients the subsequent improvement in the placido rings. This helps demonstrate the benefits of having an additional surgery prior to cataract surgery.

The OPD is especially helpful for identifying subtleties of dry eye preoperatively that I may not have otherwise noticed. It is easily seen as irregular placido rings, which can be shown to patients for educational purposes. From there, we begin a more thorough dry eye evaluation. After treating the dry eye disease, I repeat the preoperative testing and IOL calculations. Always address dry eye disease before surgery.

In addition, I evaluate all patients who have had previous LASIK, PRK, or RK. I am looking for irregular astigmatism, high spherical aberration, or a decentered ablation. I discuss these findings with patients preoperatively, explaining that prior refractive surgery may affect their final postoperative result, and because of this, it is possible that not all glare or decreased contrast sensitivity problems will be resolved.

The OPD also measures corneal spherical aberration, which allows me to customize my choice of IOL to best correct it. This helps to optimize each patient’s postoperative visual outcome.

Pre-op Screening of Premium IOL Patients
The OPD is especially valuable when evaluating patients who are interested in a toric IOL. The axial map is useful in confirming the planned axis for the orientation of the toric IOL, which should be very similar to the axis obtained via optical biometry. If the axis from the axial map and optical biometry are not similar, I repeat testing and look for the previously mentioned corneal disorders.

The OPD-Scan III also assists me in the multifocal IOL decision-making process. When evaluating multifocal patients preoperatively, I look for corneal disease. In general, the more irregular the cornea, the less likely I would be to use a premium IOL. For example, if a patient has significant higher-order aberrations, I would not use a multifocal IOL. In addition, I evaluate the mesopic and photopic pupil size. If the mesopic pupil size is greater than 6 mm, I have a discussion with the patient about an increased risk for halos and glare postoperatively. However, if the patient has a small photopic pupil less than 3 mm, I generally use a multifocal IOL in which the near vision isn’t dependent on pupil size. I also use the OPD to evaluate angle kappa. If angle kappa is greater than .43 mm, I use a multifocal IOL with a larger central zone.

Consistent Results with Post-op Screening
I obtain postoperative OPD-Scan III studies on all of my multifocal patients. Approximately 1 week after surgery, I obtain a dilated reading. This allows me to see if the central zone of the IOL is centered within the visual axis of the patient. If not, I know the IOL has shifted postoperatively, which frequently results in patient complaints of decreased vision and glare. Complaints usually can be resolved by surgically repositioning the multifocal IOL onto the visual axis.

I will also perform an OPD scan 1 week post-op on patients who received a toric IOL. Again, the scan is obtained with a dilated pupil. In this way, I can measure the axis orientation of the toric IOL to ensure that the toric IOL didn’t rotate away from the intended axis of surgical orientation. Correct toric alignment is critical because the power of the astigmatic correction is reduced 10% for every 3 degrees away from the intended axis of orientation. If there is significant rotation of the toric IOL, I will take the patient back to the OR to realign the toric IOL to the proper orientation.

More Information = Happier Patients
The OPD-Scan III has significantly reduced the number of post-op complaints from patients. With more information to guide me through the entire process, I’ve been able to largely avoid unhappy multifocal IOL patients by identifying the best candidates up front. Before we acquired the OPD, we were inconsistent when making these pre-op decisions.

Making the right decision as a surgeon is only one component of meeting or exceeding patient expectations. It’s also important that I educate patients at each step along the way. Pre-op tests help me manage expectations by educating patients with the aid of easy-to-understand test results. Visual aids help explain variables to improve patient understanding. For example, using OPD results, I can show a patient that his lens is well centered and his toric IOL is well positioned. Patients can see irregular placido rings consistent with dry eye syndrome, which reinforces the need to treat their dry eye prior to surgery.

Imaging can also show patients why irregular astigmatism may prevent them from being premium IOL candidates. With this information and education, patients better understand why you’re making certain decisions, they recognize that you’re trying to make the best decision for them — and they appreciate that.

Customization = Efficiency
The varied capabilities of the OPD allow us to create a specific map for pre- and post-op testing to meet the needs of each patient. We created a customized map to include all the important information we need to preoperatively evaluate the patient. By consolidating all the important measurements on one map, pre-op patient evaluations are much more efficient and allow us to create a personalized treatment plan for each patient. It’s amazing how many options there are with this instrument. We have customized it for our needs, and certainly other offices can adjust their maps to accommodate their needs as well.

We have also developed a comparison map to evaluate pre- and post-op LRI data to evaluate femtosecond laser LRI treatments. The outcome analysis can be used to adjust your LRI nomogram for any under-correction or over-correction of astigmatism. You may also use the comparison map to look for any increase or decrease in higher-order astigmatism, which may occur after an LRI.

Improve Satisfaction and Results
We acquired the OPD-Scan III about 5 years ago in an effort to improve our outcomes and patient satisfaction. It has delivered by helping us to preoperatively detect corneal issues that may affect outcomes, identify the best candidates for premium IOL surgery, improve surgical outcomes, and increase patient satisfaction.

– Dr. Ludwick specializes in cataract surgery and is the Medical Director at Ludwick Eye Center, with locations in Maryland and Pennsylvania. He is also an assistant clinical professor at Penn State Hershey Medical Center

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Better Information, Better Outcomes

I purchased the original OPD-Scan 8 or 9 years ago, and upgraded to the OPD-Scan III in December 2014. The original OPD-Scan was an absolutely spectacular piece of equipment, and the OPD-Scan III was enough of an improvement that I thought it was worth my while to make the investment. After more than a year, I am confident that I was right.

Better Delivery of Information
The OPD-Scan III is clearly an improvement on what was already great technology. It provides much of the same useful information but in an improved format, and in an easier, more efficient manner. The OPD-Scan III has better resolution and interface, and provides useful, integrated summaries that weren’t readily available in the original model. For example, now my techs can easily obtain a cataract, cornea, diagnostic, or toric summary for me to review and make assessments.

Corneal Wavefront Integration
The ability of the OPD-Scan III to examine the corneal wavefront is a huge improvement, because it helps me to determine the best course of treatment, be it LASIK or cataract. It also helps provide an overview of the patient’s visual status and problems. Every LASIK or cataract evaluation patient has those scans done prior to me even walking into the room, so I have a vast amount of relevant information right in front of me. With better information, I am able to achieve better outcomes for both refractive and cataract patients.

Improved Decision Making
The OPD-Scan III makes my job much easier, and it helps me achieve the best possible outcomes. Let’s say, for example, a patient is in for cataract surgery. I can easily explain to the patient which lens I want to place based on the information that the OPD-Scan III provides. In addition, if I’m considering a multifocal IOL, I can evaluate the corneal wavefront aberrations and quickly make an educated decision as to whether or not the patient is a good candidate for a multifocal IOL, based upon the corneal aberrations that I’m seeing. Or, the information might help me realize the patient is a better candidate for a different lens. I can look at the topography and the regularity of the astigmatism in the corneal surface. The OPD-Scan III is also very good at helping to assess corneal astigmatism. I’m also able to help patients with less-than-perfect vision after cataract or LASIK procedures, whether performed by me or another physician, because data from the OPD-Scan III can help me figure out what is going on with the patient’s vision. It also allows me to see what astigmatism might be coming from inside the eye — either inside the lens and/or the posterior cornea. I have many referrals, complicated patients, or patients who are not seeing well after cataract or refractive surgery, and the ability to take all of these measurements and look at all of the various pieces of information often helps me identify the patient’s problem. This, in turn, helps me make a determination as to what is the right solution for the patient.

Technicians’ Seal of Approval
Because my technicians perform the tests with the OPD-Scan III, it is critical that my staff is proficient in using this technology. It is equally important to me that they like the equipment — and they do. My techs appreciate that the information from the OPD-Scan III is more detailed and the equipment is more user-friendly than the previous model; they have fully embraced its capabilities. And because the OPD-Scan III harvests more than 23 diagnostic metrics in 10 seconds per eye and provides so much integrated information, my technicians often will make a decision for a given patient as to what summary I might need, which is extremely helpful. Sometimes, I have to go back and ask for a different summary or scroll through different images, but that’s simply because there is so much information available at my fingertips if I need it.

An Office Favorite
If you’re looking to provide improved care for your cataract and LASIK patients, there is no question that the OPD-Scan III is worth the investment. The equipment is fantastic, and the customer service that Marco provides is remarkable. The support team comes in to help customize and set up the summaries that will best suit each office’s needs. They are always accessible and helpful. There are many pieces of equipment that I have and love, and I could probably get away with just using them. But I wouldn’t be seeing the whole picture concerning each patients’ optical path. With the OPD-Scan III, I can obtain the basic information — and so much more. There are so many things that this piece of equipment can illuminate for me, that I’m sure I haven’t even scratched the surface yet. It’s my favorite piece of equipment and I can’t imagine practicing without it.

– Dr. Horn specializes in cataract and laser eye surgery at Vision for Life in Nashville, Tenn.

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With Marco, You’re Guaranteed to Succeed

Our 67-year-old Tennessee practice, Vision Source of Newport, recently opened a 9,500-square-foot facility, operating with three physicians and 18 staff members. We see roughly 350 patients each week, and we’re well on our way toward reaching our goal of becoming a $2 million practice. For the past 5 years, we’ve been using an OPD-Scan III integrated aberrometer and three TRS-5100 digital refractors in our office. Both have greatly contributed to our success.

Easier on Patients and Optometrists
As an optometrist, what’s good for my patients is also good for me. I can hit two buttons on the TRS-5100 and seamlessly compare their current refraction to their previous prescription. It makes it much easier to show the patient the difference, which increases Rx satisfaction and eyewear sales. In particular, the “night vision” refraction feature is helpful; I always perform this test on patients who complain that they just can’t see well at night. With only one machine, the OPD-Scan III, we can measure higher-order aberrations, detect corneal dystrophies and degenerations, show patients their cataracts, use images to explain why they’re having trouble seeing at night — and even find a floater. Also, the ability to measure phorias and tropias (both horizontal and vertical) in 0.1 steps using the TRS-5100 system helps uncover problems that manual refraction cannot catch. It is amazing how a vertical heterophoria even as low as 0.5 diopters can cause severe issues, especially in children and others still in school. I prescribe eyeglasses for these patients and refer them to our vision therapy specialist. This technology truly sets us apart from other offices.

Increased Efficiency
As someone who travels and lectures throughout the United States, being efficient in the office means a great deal to me. Between working with the OPD-Scan III
and the TRS-5100, I simply don’t have the words to describe how much efficiency has improved since we implemented these two technologies. Instead, I’ll let the numbers do the talking: Before I began using the Marco technologies, I was averaging collections of $3,400 per day. Now, with the OPD-Scan III and TRS-5100, I
average $4,500 per day (>32% increase). Utilizing scribes and the Marco technology has resulted in $200,000 more in revenue per year than we were achieving with manual equipment and without a scribe. This does not take into account additional savings from avoiding lens remakes, or the value of patient retention.

Training and Customer Service
One significant perk of purchasing Marco’s technology is that the company can train several members of your team at their Technology Vision Institute, in Jacksonville, FL., by teaching staff how to use the products and about the refraction process, various optometric terms, visual issues, and eyeglass prescription terms (phorias, vergences, binocular testing, etc). Marco also makes online courses available 24/7 to you and your staff.

Guaranteed to Succeed
In summary, Marco’s OPD-Scan III and integrated TRS-5100 provide an amazing array of diagnostic testing that a regular autorefractor does not. They make the patient’s experience easy and enjoyable. The improved efficiency has led to greater profitability, all while delivering educational and emotional “wow” factor for patients. With all this, your practice is guaranteed to succeed.

– Kurt Steele, OD is an optometrist with Vision Source of Newport in Newport, TN.

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