Tag: trs

In New Practices, Patients Want to See New Technologies

Showing patients their new Rx also removes “awkward conversation”

There’s a conversation that Keri Dennis, OD, no longer has with most patients. She isn’t put on the spot to make a judgment whether a patient “needs” new eyewear. Since she joined Ridgeview Eye Care in Olathe, Kansas, in August 2019, that’s one of the fea­tures that makes having Marco TRS automated refraction systems most enjoyable. It’s also why the practice added TRS systems to the new loca­tion in Lenexa, Kansas, that recently opened.

“Being able to show patients the difference between their habitual prescription and the one from that day’s exam is one of the most valuable aspects. Being able to toggle back and forth between the two helps patients see for themselves if it’s valuable to purchase new eyewear,” she says.

It removes an “awkward conver­sation” from the patient encounter, but it also adds efficiency to the process. In the original Olathe office, two of the three exam lanes have the TRS system. The third is dedicated primarily to pediatric pa­tients. “When I’m working, I want one of the rooms with a TRS,” she says, laughing.

The technicians who conduct the pretesting insert a card into the TRS system that provides the data. There are no transcription errors or time spent dialing in refractions. “It saves our technicians time and reduces er­rors, and all of those factors add up to speed and efficiency. Patients love that,” she says.

It’s not that they’re necessarily in a rush to get through their exam, but most patients found the old refrac­tions – which is better? – frustrating.

“Patients want a modern practice to have modern technology. If they come here from an office that did not have it, they say, ‘Wow. I’ve never seen this before.’ We get that all the time.”

A little social distance

An unexpected benefit of having the TRS systems in place during and right after COVID-19 was the fact that she could complete her refractions with some social distancing. “The timing of having these systems in place then was have to lean right in and spin dials,” she says.

There are also ergonomic and efficiency advantages to this sys­tem. Because she can control the automated refraction system from a tabletop device, she can go home with no shoulder or neck pain at the end of the day. “It’s also a faster process because I don’t have to turn around from the phoropter and write down notes. In fact, I can do quite a bit of multitasking because I can pull up optical coherence to­mography scans and images. While I’m doing the refraction, I can look at data that can help me determine if there’s something else affecting their vision. It’s a more streamlined process because I’m not sitting in front of the patient spinning dials,” she says.

With three doctors working at the same time, each moment that the patient is in an exam lane is valuable. So being able to use the time that might otherwise be spent in the manual refrac­tion process to gather data that supports her clinical decisions is important.

Patients also appreciate being able to get through the process without the stress or extra time involved. With the added benefit of being able to show them their previous and new prescriptions, the practice
is capturing more eyewear sales. “It absolutely makes a difference because it’s difficult for patients to assess whether an updated prescription would be better if we need to dial the comparison in. We find that if patients detect an improvement of any sort in these TRS comparisons, it improves the capture rate tremendously.”

Growing practices

The practice opened its Lenexa location in an area of rapid com­mercial and residential growth. Having advanced technology that wows patients is an important part of the attraction, she says. Patients want a whole experience at their eye care provider’s office-from a beautiful location, friendly staff and the expectation that they are getting a thorough and efficient eye exam.

Being able to provide that from the start in both offices contributes to the culture of excellence and efficiency, evidenced through the practice’s nearly 5-star Google reviews.

Article originally published in Vision Source OD magazine. Learn more about Vision Source here.

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Automated Refraction System Was “Practice-Changing” – An Article From Women in Optometry

Original Article Published in Women in Optometry

Of her three exam lanes at Vision Source of Brandon, in Brandon, Florida, owner Laura Vizzari, OD, avoided one. It was the only one of the three that didn’t have a Marco TRS automated refraction system in it. “I was embarrassed to bring patients into it because they were used to advanced technology. It would have felt like a less-than experience for them,” she says.

But using it as a dilation-only room or for consultations made her realize that was ineffective. “I realized I couldn’t avoid the room anymore,” so she added the TRS to it and now has three fully functional exam spaces that she and her associate can use.

Her focus on improving the patient experience and capabilities of this practice has been at the top of her list since she acquired it in 2004, when it was an optical shop. “There was nothing else to it, so I completely rebuilt it with a focus on high-end frames and high-tech instruments,” she says.

Components of the TRS automated refraction system - a table and automated phoropter
The TRS automated refraction system

She moved to a larger location in 2007, but she continued to work with a manual phoropter until 2012, when she added the TRS and the OPD-Scan III. Five years later, she added a second TRS system in a second lane.

“Even though we’ve been using this system for more than a decade, patients continue to be impressed with it,” she says. “I’m surprised at how often people say, ‘Remember when you used to have all those dials?’ It’s almost ancient history, but they remember that. The wow factor stays strong with this technology,” she says.


One of the most helpful aspects of the TRS system in terms of patient flow is how easy it is to show patients the difference between their old prescription and the one from that day’s exam. “Patients want to know if there’s a change, so I can show them what the difference is. Now I can tell them, ‘If you can see a difference, then you can benefit from new eyeglasses.’ It’s amazing how much a 0.25D change can make for some people,” she says.

She knows that from personal experience. She just tweaked her own prescription for a 0.25 degree of astigmatism. “I’m really surprised by the impact. I can see so much more clearly, even with such a small numerical change,” she says.

By doing phoria testing and binocular balance with all patients, she can arrive at a more customized prescription, too. “All I do is hit one button and the chart changes. Overall, it takes less time to get to a precise prescription,” she says. It’s very helpful, she says, because “I’m ruling something out, or I’ll find new information because I chose that extra test. Patients routinely tell me they’ve never had such a thorough exam.”

These features helped increase her sales of eyewear, and it also helps get patients out of the exam lane more quickly and into the optical. If patients set aside a certain amount of time for their annual exam, the more quickly she can achieve an accurate prescription, the more time they can shift to picking out their new eyewear.


OPD-Scan III instrument
Marco OPD-Scan III

As a part of every exam, patients stop at the Marco OPD-Scan III Visual System, a combination autorefractor, keratometer, corneal topographer, pupillometer and wavefront aberrometer. “I look at that data first,” Dr. Vizzari says. “Before I start the exam, I want to see data on their eyeglasses, their vision and their OPD. It helps me know whether I’m expecting a big change or if there’s something unusual and the data doesn’t match. It allows me to start thinking about keratoconus or know what other questions to ask,” she says.

This data is also very useful as a patient education tool. “I can show them a picture and say, ‘This is why I cannot make your vision perfect.’ Or it’s an opening to talk about specialty contact lenses,” for example, she says.

Dr. Vizzari says the amount of time that she saves with each patient compared to the days of using a manual phoropter are significant. For now, the doctors are doing the refractions, but she sees the opportunity for training a licensed optician to do the testing. “As I’m trying to expand the practice, that may be one way of increasing efficiency,” she says.

But she says she cannot imagine why some doctors are hesitant about adding the technology. “I’m surprised when I talk with a colleague who doesn’t have it. I tell them, ‘Just do it. It’s practice-changing.”

As someone who has changed the nature of an eye care business, from a generic optical shop to a full-service, high-tech primary eye care practice, she knows how much difference the right equipment can make.

Read other WO stories from Marco here.

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Fast, Efficient Refractions Allow Doctor Time for Deeper Discussions

One of the first investments that Michelle McReynolds, OD, made when she opened cold was with the Marco OPD Scan III Wavefront Aberrometer and TRS automated refraction system. “I was looking for anything that would make my work faster because I didn’t have a technician when I first opened. It was just me doing everything,” she recalls. She opened West County Vision Center in St. Louis, Missouri, in 2011.

Being able to have a system that could streamline everything from keratometry and refraction and transfer the data to her Revolution electronic health records system made everything easier. “In fact, I’m still using the same TRS and OPD that I purchased then. I’ve not had any issues with that equipment,” she says.

However, she has expanded the usage of it. As she got busier and equipped a second exam lane, she installed a second TRS system. “Once you have it, it would be hard to go back to a manual phoropter,” she says. “I knew that if I didn’t add the TRS to the second exam room, I wouldn’t want to use that room.”

Being streamlined is just as important now as it was in the beginning. When she opened, her mother worked her front desk, and she had an optician. Now she has two full-time front staff, a technician and optician, and she is looking to expand. “We’re busier than we’ve ever been, and I’m booking two months out,” she says.

Good data from the start

So she is grateful for the technology that helps her save time and provide excellent data on each patient. Patients interact with the Marco technology right at the start of their experience. In the pretest room, they sit at the OPD Scan III, which serves as a combination autorefractor, keratometer and topographer. “So many patients comment that they haven’t seen technology like this before,” she says.

Based on the data that Dr. McReynolds gains from the OPD, she can make decisions about the patient’s care plan. “I have detected a lot of early keratoconus, since we do a topography on every patient. The OPD obtains a topography automatically,” she says, noting that she can recommend crosslinking to help slow down the progression of keratoconus.

After those patients have been referred out for crosslinking treatment, she can fit them with scleral lenses if necessary. “I also love that I can show patients their cataracts with the retro illumination image. I can point to the dark opacities on the image and explain that I might not be able to correct their vision to 20/20 due to the opacities in the cataract,” for example, she says.

Refractions made easier

As patients move into the exam room, they continue to be impressed by the technology she has brought in. “Patients make comments about how high-tech everything is. I love being able to say to patients at the end of the exam, ‘This is the prescription you had, and this is what I’m getting today.’ Showing them is so much better than me trying to explain what a half diopter increase or decrease means.”

Toggling between the old and new prescription, patients can decide for themselves whether they want to purchase new eyewear. She can even use it to add validity to a complaint by a patient who says night driving is more challenging. The OPD will indicate if the patient needs a stronger prescription for night verses during the day.

Dr. McReynolds says that she enjoys the refractions process. “Optometry was founded on doing refractions, and I get a lot of satisfaction knowing that I am getting the best possible results for my patients. Plus, patients feel the refraction is an extremely important part of the exam.”

But because she relies on the technology to support her findings, she can also use that time to talk with patients about other concerns or conditions. “I’m talking to them throughout the refraction and listening to how they respond,” she says.

iON boosts education

More recently, Dr. McReynolds added the iON imaging system from Marco and has found that it helps her with her rigid gas permeable (RGP) fits and patient education. She can capture video of the RGP lens on the eye and upload it to her specialty lens consultant. “That helps a lot,” she says.

For patients with foreign bodies or oil gland dysfunction, she has also found that the video image helps them understand their condition better. “If they can see what I am looking at, they are more motivated to follow my treatment recommendations. Patients tell me, ‘No one has ever explained that to me.’”

The value of that comprehensive exam and customized solution is as important to her today as it was on the day she first opened.

Article originally published in Vision Source OD magazine. Learn more about Vision Source here.

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Automated Refraction System Allowed Practice To Grow Without Expanding – An Article From Women in Optometry

Original Article Published in Women in Optometry

Since its founding in 2007, Northern Sight Vision Clinic in Phillips and Tomahawk, Wisconsin, has been growing. One of the original partners, Jessica Stromberg, OD, brought in Brittany Lemke, OD, in 2013. Dr. Lemke soon bought out Dr. Stromberg’s mother, who was one of the original owners.

Dr. Stromberg
Dr. Lemke
Dr. Treml

“These are Northern Wisconsin small towns,” says Dr. Lemke. Associate Lauren Treml, OD, works at the Tomahawk location, and the two partners each spend two different days each week at each location.

About 10 years ago, the doctors started feeling the pinch for space. “We added electronic health records in 2014,” Dr. Lemke says. That helped reclaim some of the space that had been dedicated to paper charts, but it still felt a little crowded. “We were considering purchasing another exam lane, but a Vision Source® colleague recommended that we install the TRS automated refraction system from Marco first,” she says.

The doctor did that – and it brought relief. “We were doing accurate refractions so much faster, and we were able to show patients with the click of a button what their current eyeglasses prescription was and what a new prescription would look like,” she says. The result was that patients were able to spend quality time in the exam lane, with the doctor discussing important ocular health issues, and get into the optical more quickly.

Marco automated refraction technology
Marco TRS

In fact, this measure allowed them to work in their small Tomahawk location for an additional three years before they moved to a larger space in 2017. The goal was to see more patients in a day – and it worked. The pretest technicians upload information to the TRS system, and the doctors finalize the refractions. “Usually, while I’m refracting, I can also work on the charting and talk with the patient. It’s a good time-saver,” she says

Today, both locations have two exam lanes, and all for are equipped with the Marco TRS-6100. “It helps with our efficiency. It was imperative to have the Marco technology in both lanes,” she says.


It has been important to these providers that patients in these small communities have access to the same level of care that they could get in larger cities. Indeed, their mission statement says the practice is committed to improving “the quality of our patients’ lives by providing state-of-the-art eye health and vision care.” They do so by maintaining high standards, incorporating technology and pursuing education and the best products. “It’s exciting to see our mission statement come to life. Patients comment all the time on the technology.”

They appreciate that they don’t have to answer the old “which is better” questions that stressed them. “I attended a seminar where the speaker pointed out how many questions a patient is asked before the patient reaches the exam room. If we can make it faster and let the patient feel calmer, that’s a better experience. I can assure them that they will not give any wrong answers and that I’ll double- and triple-check the refraction,” she says.


Dr. Stromberg and Dr. Lemke at a Wisconsin Optometric Association meeting

The doctors and staff have by now used every nook and cranny of space in their Phillips location, so they’ll be remodeling. That plan includes adding the layout for a third exam lane if they need it in the future.

By making sure that they can provide patients with fast, accurate prescriptions, they can maximize the time they have with each patients and bring more patients into the practice. “We see patients from the surrounding area. Around here, patients are accustomed to traveling for health care. If they need a specialist, they’ll need to commute for an hour,” she says. So it’s important that they can bring patients in as quickly as possible. The ability to exceed patient expectations has been the major contributor to the practice’s growth in the past – and it will be in the future, too, Dr. Lemke says.

Let Me Walk You to the Optical

Dr. Brittany Lemke loves to style patients for their new eyes. First of all, it’s a great small-town touch, but it also provides another opportunity to make a connection with the patient. “I’m the one who has established what they do during the day and what their free-time activities are. I enjoy the retail experience, too,” she says.

Plus, it only takes a moment. “In just a few minutes, I can pull a few frames and make some comments, such as ‘I love this color on you.’ Hearing it from me is an invitation to find something fresh,” she says.

The optical staff can take over, but Dr. Lemke says the transition from exam room to the optical is enjoyable for both the doctor and the patient.

Read other stories from WO about women ODs using Marco technology to improve their efficiency and patient experience.

Visit Northern Sight Vision Clinic here.

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An Excellent Refraction Is The Pivotal Point In An Exam – An Article From Women in Optometry

Original Article Published in Women in Optometry

Kathleen Joyce, OD, of EYECARE for You, makes a firm distinction between the different automated refraction systems out there. “My refractions are doctor-driven, but I love having the technology that helps me get to an accurate subjective refraction more quickly,” she says. That is important to her in her two practice locations where she focuses on medical services and custom fit contact lenses. “The refraction is a pivotal part of the exam, and my Marco TRS automated refraction system improves my overall efficiency,” she says.

In 2018, Dr. Joyce started her practice cold in Richboro, Pennsylvania, a northern suburb of Philadelphia. She had used the TRS system in a practice where she had been an associate, so getting her two exam lanes equipped with Marco technology in her new office was a priority.

Then she acquired a practice in Newtown from a retiring physician, who continues to work part-time. That location had a different brand of refraction system, “but I like the function of the Marco TRS system. I did look at a few others, but when it comes to the ease of use and integration with other technology, I liked this the best,” she says. She says that it’s also wonderful how supportive the selling optometrist was about making the switch to her preferred technology. She converted both of those lanes to the Marco TRS technology.


Marco TRS-6100

“I saw the return on my investment,” she says. “The initial results are incredibly accurate. When I cross check my results with retinoscopy, my subjective refraction is very similar to the autorefraction. Allowing the patient to see side by side images results in greater patient confidence during the subjective refraction,” she says.

The system plays an important role whether it’s a routine comprehensive eye exam or a more medically-driven one. “By saving time during the refraction, I have more time to spend addressing a patient’s chief complaint in greater detail.  This allows my examinations to be more patient- and problem-focused.  It also affords me the opportunity to explain the need for follow up care beyond the comprehensive eye exam, ultimately resulting in greater patient satisfaction,” she says.

During more routine eye exams, Dr. Joyce estimates she can shave five minutes off the time the patient is in the exam room. “If I have several routine patients scheduled that day, it means I can see an extra one or two patients a day. If the average revenue is $300 a patient, one extra patient per day can be a $75,000 increase to my annual gross revenue,” she says.


It also means that these patients can spend those extra few minutes in the optical, where the message about second pairs of eyewear or backup eyeglasses is reinforced by the optical staff. In contrast, patients who feel like they’ve been challenged in the refraction or whose exam took longer than they expected are often the ones who want to rush out and delay buying their eyewear – or skipping the step altogether.

Plus, those extra one or two patients a day who can be seen each day also mean one or two additional customers passing through the optical. “The industry average for capture rate is around 50%. If I can bring two more patients in a day, that can translate to at least one more patient a day buying eyewear.”


In more complex cases, she appreciates having the data from the Marco pretest autorefractor  because it gives her a solid starting point. “I can make decisions about the data I’m getting from the autorefractor, and if results subjectively don’t make sense, I know I have to take another approach,” she says. She looks for the red flags that might indicate something is unusual – such as a dramatic prescription change—as she’s doing her own testing.

An automated refraction process never takes the place of her experience and knowledge. “But it can free up time that I can use on patient history or education, as well as discussing follow-up care,” she says.

With the two offices just a 15-minute drive apart, Dr. Joyce spends some time in each one every day, although she is full-time in the Richboro office. She also has an associate who covers there, and the retiring doctor continues to see his patients in the Newtown office. All three doctors see the technology as an enhancement to their exams as well as a positive return on investment.

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The Power of the Current and New Prescription Toggle Switch

After about nine years of having an automated refraction system in the practice, Heavin Maier, OD, of Eyes for Life in Spokane, Washington, couldn’t imagine practicing without it. When she added another lane of equipment, the Marco TRS Refraction System was part of that. “It’s part of our standard operating protocol now. The flow works well,” she says. She has other Marco technology in her practice, and it adds to the overall efficiency when the equipment “speaks” through the card system that moves patient data from the lensmeter and OPD Scan III Wavefront Aberrometer to the TRS system.

Patients as decision-makers

What she loves about the process is the ease with which patients can make the decision on whether new eyewear will benefit them. “I hated having to dial in the prescription manually and show patients what the difference was between their current and new prescriptions. Keeping track of axis and cylinder and sphere shift was mind-boggling,” she says.

With the Marco equipment, it’s a simple toggle switch. “I can show them each eye individually, or I can show it as two eyes together,” she says.

She appreciates that it’s not up to her to make a judgment call or try to convince a patient that a prescription change is “big enough” to warrant new eyewear. “There have even been patients where I think they cannot possibly notice this change, but they immediately say, ‘Oh, that’s so much better.’”

When patients are assured that the new prescription will help them see more clearly or more comfortably, they’re happy to make the purchase.

The patient experience

It’s important, too, that patients see that the practice invests in the patient experience. Since nearly all patients engage with the OPD and TRS systems, new patients have the immediate perception that the practice isn’t outdated or old-fashioned with its technology.

Goodbye, shoulder pain

Dr. Maier has been in practice for 19 years. “Within the first year of practicing, my shoulder was killing me,” she recalls. She began wondering whether the cost of doing manual refractions was going to involve her own comfort and shoulder mobility. “After switching to the TRS system, I realized that I was no longer in pain at the end of the day, so that’s priceless. I cannot imagine why there are doctors wrecking their shoulders,” she says.

She has gotten good support from her Marco team, and she credits Marco President Jocelyn Hamilton as a true professional committed to helping doctors succeed.

Dr. Maier says that she would have a very difficult time going back to a manual system. The Marco equipment she has provides her with a solid starting point for her prescriptions, and she uses that to achieve her endpoint more quickly. It saves her time showing patients the difference between old and new prescriptions and improves patient engagement in their own care decisions when changes in the prescription are numerically small. And she can walk out of her building at the end of the day without her shoulder throbbing.

Article originally published in Vision Source OD magazine. Learn more about Vision Source here.

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“Nearly Instantaneous” ROI on Marco Technology

Claudio Lagunas, OD, is a builder of practices. He has owned nine—with four at one time—but now has just two. One is his established practice in Woodlands, Texas. He and his wife Grisel Lagunas, OD, recently acquired an existing practice in Spring, Texas, when the opportunity was too good not to jump at it.

In order to grow a practice so that it becomes more profitable and efficient, Dr. Lagunas invests in technology. In his practice in Woodlands, there is an OPD3 wavefront system from Marco that he put in nearly 18 years ago. Then about seven years ago, he added the TRS refraction system. “I needed shoulder surgery, and I wanted to be proactive about protecting my other shoulder by being able to sit down and be comfortable versus reaching up and spinning the dial,” he says.

The surgery went well, and he regained full functionality. An associate, he jokes, “commandeered” the one exam lane he had converted to a fully digital system. He had been OK with that because he felt like he was completing exams efficiently with a manual phoropter. But as the doctors are building a new location to move that practice into, “all of our new lanes will be digital with the Marco systems as their quality and durability can’t be matched,” he says.

The six ODs in the larger Woodlands office cover the 50 hours a week that practice is open. In the smaller practice, there are four ODs. Creating efficiency and moving patients through the exam process more quickly result in additional time that patients can spend in the optical and help open the schedule for a few more patient exams.

In addition, the TRS includes what he calls “the money button” — a toggle switch that allows the patient to compare their current prescription with the one derived that day. “Patients can justify the purchase of their new eyewear more easily when they see that there’s a difference. It has increased our multiple pair sales and our capture rate,” he says.

Metrics he needs

What he most appreciates about the OPD-Scan III is its five-in-one functionality and space-saving design. It is an autorefractor, keratometer, pupillometer, corneal topographer and integrated wavefront aberrometer that captures diagnostic measurements in less than 10 seconds per eye.

That helps the doctors determine whether there are aberrations that might make a soft contact lens unsuitable. “Using the wavefront analysis, we can see right away if a soft lens isn’t going to work and can steer the patient to a specialty lens fit,” he says. And then they don’t have to rely on a series of empirical fittings to get to the final fit. “As doctors, we look really good when we can get the specialty lens fi t right from the start,” he says.

Exceeding expectations

For these two pieces of instrumentation, Dr. Lagunas says that the return on investment was “nearly instantaneous.” He justifies that by noting that they make the exams more efficient and quicker, allowing doctors to fit more patients into the day. They minimize transcription or other errors, virtually eliminating remakes due to this kind of mistake. They have helped increase the number of contact lens specialty fits and the capture rate.

With the remote control function now available that can allow doctors to operate the equipment remotely, the implications for being able to “see” patients in other locations or if the doctor is not onsite add to the appeal.

Dr. Lagunas has also added the Olleyes VisuALL from Marco, which helps him consolidate equipment into a single, portable headset. “We will be using this more extensively in our new location. It allows us to bring in virtual field testing without sacrificing floor space or efficiencies,” he says. He can also run these tests without having to dedicate a dark room to this testing. Since it’s so portable, the patient doesn’t have to be as mobile, or a test can be done in the exam room rather than taking the time to move the patient in and out of a special testing area. “In small locations, every square foot counts, so multifunction equipment is a benefit.”

These investments in technology are important to his patients, too. “They like to hear what we’ve added since their last visit,” he says. While some of the specialty instruments that he brings in are used only for patients with certain conditions, every patient sits at the OPD and many experience the TRS autorefraction system, too. They enjoy the experience and the knowledge that they are benefitting from technology that is going to help the doctor deliver the most customized visual solution for them.

Article originally published in Vision Source OD magazine. Learn more about Vision Source here.

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Automated Refractions Make Exams Faster And Easier – An Article From Women in Optometry

Original Article Published in Women in Optometry

Automated system for refractions brings physical relief, too.

Since opening her own practice in 2003, Rachel Tellez, OD, has moved Vision Source Leon Springs in San Antonio, Texas, into a newer location just a few hundred feet away, seen patients grow and bring in children of their own and added an associate OD.

Something that has continually aided the practice’s growth, she says, has been the Marco technologies that bring efficiencies to the exam process. For the first almost 30 years of her career, Dr. Tellez utilized an old-fashioned, bulky phoropter that required her to spend much of her days with her arms outstretched, spinning dials.

Dr. Tellez—a regular at physical therapy with two bad shoulders—read a colleague’s account of using an automated refraction system. A visit to The Exchange®, the Vision Source annual meeting, in 2016, held in her hometown that year, solidified her decision to update her lanes with the Marco TRS-6100 Automated Refraction System with Infinity Remote Software.

“I only updated one lane and kept the old phoropter around in case we ever needed it,” Dr. Tellez says. “It didn’t take me long before I realized we needed the same equipment in our other two lanes. I was never going back.” Rather than relegating her other exam lanes to
second-tier status because she didn’t OD want to use them, she added the Marco equipment to both. The advantages were immediate.


Patients who have been seeing Dr. Tellez for years are able to experience some of the high-tech instrumentation. Every patient sits at the Marco TRS, so they all appreciate the change from the stress of having to answer questions about clarity of numbers.


With the process of obtaining the refractive correction more quickly, Dr. Tellez and the patient have more time to talk about other ocular health issues, the need for backup eyewear, dry eye treatments or other concerns the patient may have. Or the patient is able to get into the optical area faster to pick out their new eyewear.


With the OPD-Scan III Wavefront Aberrometer and the VisuALL virtual reality visual field perimeter, Dr. Tellez captures more information on each patient. The systems talk to each other, so staff members don’t have to load data manually. And Dr. Tellez has all the topography and perimetry data right on her screen.

Since the VisuALL system is portable and allows the user to perform several tests without having to move the patient from one machine to another, that system has also sped up the data-gathering process. “Within a minute or less, the refraction, keratometry and topography are all on one screen, showing both eyes, much faster than compared to performing these tests with three separate instruments,” Dr. Tellez says.

She easily can find results that are automatically saved onto a data card and then transferred into the TRS. “We don’t have to input the data manually, which increases accuracy and definitely saves time,” she says.


It’s challenging for any doctor to determine whether a small refractive change means that the patient “needs” new eyeglasses. The OPD screen features side-by-side comparisons so
patients can compare their current prescription to the one she derived that day. This puts the decision on whether new eyewear is worth it in the patient’s hands. Even small
refractive changes can make a big difference to some patients, and if they decide that’s the case, they feel great about buying new eyewear.


Dr. Tellez says that technology mastery is not one of her strongest suits, but within 15 minutes of sitting down with her Marco representative, she felt confident with the technology and what it could do. Patients also appreciate how easy it is.


Dr. Tellez can operate the autorefraction system by tabletop console, so she can relax her body. The shoulder pain that bothered her has completely disappeared, she says.

Advanced technology not only makes patients more confident in the care they receive, Dr. Tellez says, but it also ensures she is giving her patients the most appropriate options. “These patients are getting a more in-depth exam, and it’s easier on me and my team,” Dr. Tellez says.

Hearing about the experiences that her colleagues have had with products and technologies gave Dr. Tellez the push she needed to learn more. She’s grateful she listened and cannot imagine still practicing the way she did just a few years ago.

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Five Benefits of Digital Refraction

Number one or number two? Better or worse? Refraction is about choices, and if you’re still turning dials, you’re missing out on the benefits of digital refraction.

Digital refraction technology has been available for nearly 30 years, but some practices still need to embrace it. So, if you’re one of the stragglers or are interested in upgrading to a cutting-edge digital phoropter, here’s your guide to the game-changing benefits.

1. Improved Patient Experience

Patient experience is a big deal, and digital refraction can improve several aspects of a typical office visit.

It can reduce patient stress.

While refractive tests are a standard check for vision errors like farsightedness, nearsightedness, and astigmatism, manually cycling through one lens at a time can be stressful for patients.

“No one likes pop quizzes,” says Chris Sarakaitis, Director of Sales, Eastern USA for Marco. “For many patients, manual refraction causes anxiety during and after the exam when they think back and worry if they made the appropriate choices.”

Digital refractors allow the patient to see two images simultaneously, eliminating the back and forth of manual devices and enabling patients to feel more confident about their responses.

Happy patients generate revenue.

A pleasant, comfortable experience can not only decide whether someone schedules another appointment with your practice, but it also influences how much money patients spend during those visits.

“The Marco TRS Automated Refraction System has proven to be the most significant addition ever made to our practice,” says Dr. Richard K. Levin of Levin Eyecare in Baltimore, MD. “The ‘wow’ factor has increased optical sales by 15% in the first year and continues to enhance the patient’s experience in our practice.”

Provide a cutting-edge experience.

Thanks to smartphones, consumers have endless decision-aiding information in their hands. They want state-of-the-art care, and if you’re not offering it, it’s easy to find someone who will. Providing a high-tech experience with digital refraction will not only increase patient retention, but also referrals.

“I’ve gotten patient referrals from other customers exclusively based on how impressed they were with my equipment,” says Dr. Andrea Knouff of Eyeclectic Vision Source in Atlanta, GA. “In today’s internet-savvy world, we must stay up to date on technology and separate ourselves from the competition.”

2. Superior Accuracy

When technology outperforms the status quo, it’s a sound investment. For example, where traditional refraction relies on manual measurements and subjective evaluations, digital refraction uses sophisticated computer algorithms.

The result is highly accurate and precise measurements of a patient’s visual acuity, allowing optometrists to quickly and easily identify changes in a patient’s vision. This translates to more accurate diagnoses and the ability to provide more effective treatments.

“You can do more testing, more precisely and efficiently, with digital refraction versus a manual refractor,” says Sarakaitis. “Simply put, digital refraction makes you a better doctor.”

3. Reduced Human Error

While optometrists and ophthalmologists still need to interpret the data generated by their automated refraction system, digital refraction makes it easier to maintain accurate and up-to-date records of patients’ vision. This can be useful for tracking changes over time and identifying potential health problems.

During the exam, optometrists will find that digital refraction eliminates the potential for human error caused by factors such as poor lighting or difficulty reading the patient’s responses.

When the exam is complete, that data must be entered into the patient’s records. No matter how careful or well-trained your staff is, transcription errors happen. Digital phoropters eliminate human error by transferring exam data directly to the patient’s electronic medical record, saving time and resources by freeing up staff for other tasks.

4. Better User Experience for Clinicians

While stressful for the patient, turning the dials for manual refractive tests is no party for the clinician. Throughout a career, seeing several patients daily can cause a lot of wear and tear on the neck and rotator cuffs. One study determined that more than 80 percent of optometrists surveyed reported work-related discomfort in their neck, shoulder, or lower back.

Digital refractors use automated technology that consolidates those manual adjustments to the push of a button. In addition, some models — such as the Marco TRS-6100 Automated Refraction System — can be operated with one hand. As a result, physicians can remain seated or find a position that makes them comfortable, potentially reducing repetitive stress injuries.

5. See More Patients

Traditional refraction methods can be time-consuming and labor-intensive, taking up valuable time that’s better spent on other aspects of patient care. Digital refraction, on the other hand, is quick and easy to use, allowing optometrists to see more patients throughout the day while spending more quality time with each patient.

“Without this efficient technology, I would not have the same amount of time to dedicate to conversing with patients,” says Dr. Nathan Bonilla-Warford of Bright Eyes Family Vision Care in Tampa, FL. “In this day and age, patients notice new technology in the practice and like the personal focus I can give them.”

Contact your Marco Area Manager for more information about how digital refraction can benefit your practice. 

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Efficiencies In The Refraction Process Improve Entire Patient Experience – And Sales – An Article From Women in Optometry

Original Article Published in Women in Optometry

The refraction process has long been the “least favorite part of the exam for Loretta Seraly, OD, of Seraly Eye Care Associates in McMurray, Pennsylvania. After injuring her shoulder in a fall, the process became painful as well as dreary. “I would trade almost anything to not have to do the refraction,” she says, and when she heard that the Marco TRS-6100 automated refraction system could bring efficiencies and physical relief, she purchased one for each of two exam lanes and then added a third later.

The shift brought joy to her and her patients. “It’s much more enjoyable, and it’s faster. When she comes into the exam room, the pretest data has been transferred into the electronic medical record and she loves to show patients with a push of a button how the prescription today differs from the one that they’re currently wearing.

“I can choose whether I want to start with the new refraction or the patients’ old glasses. Then I can show them the improvement. It helps us avoid trying to answer that common question: ‘Do I need new glasses?’”

Dr. Seraly calls herself a low-key salesperson. “I’m not pushy, but we do have to sell ourselves. This feature lets patients determine if the 0.25D change is worth their time, money or energy. But I will always remind them that we have stylish frames, and a second pair or backup pair is a great option, too,” she says. Having no lag time between the before-and-after comparison does encourage many patients to opt for new eyewear.


Patients don’t like the traditional refraction process any more than she does. They worry about giving the wrong answer that might saddle them with eyeglasses that don’t work well for them. But the addition of this technology has improved her whole practice flow.

“Our goal is to provide the best patient experience – and that means efficiency. We aim to have patients greeted and through pretesting within 15 minutes of their arrival,” she says. This includes autorefraction, topography when called for, an optomap image and an OCT. Then the refraction and anterior segment evaluation and other elements of a comprehensive exam is another 15 minutes. She’ll instill dilating drops if needed.

She also likes the split prism function of the TRS-6100, which allows her to check astigmatism and show the patient simultaneous comparisons so that they can look at the right and left images and tell her which one is clear. It’s helpful in fine-tuning the prescription.

Most patients are done with the evaluation within 25 to 30 minutes of their arrival. “If doctors do not get the exam elements done in that time, patients are fatigued, and sales go down.”

More importantly, patients feel respected when the practice staff make their experience efficient. “It’s not about making money; it’s about serving the patient. They feel heard and appreciate our acknowledgement that their time is valuable.”

Dr. Seraly alerts opticians when she’s finishing the refraction. “By the time I’m done with the anterior segment exam, the optician will be in the room, and I can relay precisely what my recommendation are. I might say, ‘The patient has a high degree of near sightedness, so we discussed high-index lenses,’ for example. Introducing the patient to the optician and sharing a little information about them increases their satisfaction,” she says. The opticians will escort any patients who are dilated during this time back to the exam room after selecting eyewear. “Almost every patient is in and out of the office within 45 minutes to an hour. That drive sales and patient satisfaction.”


TRS refraction system
Dr. Seraly can use the console in the hallway outside the exam room, allowing her to stand and creating a little distance during the refraction.

Dr. Seraly purchased her first two Marco TRS-6100 systems in December 2019, with no real inkling of an upcoming pandemic. “When March 2020 rolled around, I realized that I was able to leave the room and conduct the refraction. I placed the controller outside the door, so I could step into the hallway and tell the patient he or she could pull down their mask for this part of the exam,” she says.

In fact, she still does it this way for a few reasons. First, it gives her the opportunity to stand up for a few moments. But more importantly, the practice is mask-optional and there are patients who prefer to wear masks. “They appreciate that I’ll step away and they can pull down their mask more comfortably. It also avoids fogging the equipment, which can add time to the process.”

At this point, Dr. Seraly conducts the refraction process still. “I’ve cut the most disliked part of my day down to nearly half of what it used to be,” she says. She has also gained so much confidence in the system that if she choses to delegate that process to a technician, she says that would add even more efficiency because she would simply review the findings.


Dr. Loretta Seraly will be heading to Cambodia this winter, joining a mission group, facilitated through the international Red Cross and founded to distribute wheelchairs to people in Vietnam and Cambodia. This will be her second trip with this group, having gone to Vietnam in 2019. “It’s such a cool thing to be able to experience this kind of mission trip and explore the world,” she says. She’s the only OD, but the group sees about 500 patients during the days she is there. She’ll be traveling with new eyeglasses that she acquired from donations of discontinued lines. “I bought 500 sunglasses, and we have single vision lenses from +4.00D to -6.00D with us. To see someone’s eyes literally open wide when they can see the world around them is so gratifying.”

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