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

Original Article Published in Women in Optometry
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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.

“HERE’S YOUR CHANGE”

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.

A GREAT STARTING POINT

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

Original Article Published in Women in Optometry
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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.

SMALL COMMUNITY, BIG CARE

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.

GROWTH CONTINUES

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
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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.

EFFICIENT PROCESS

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.

MORE EXAM PATIENTS=MORE OPTICAL CUSTOMERS

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.”

SOLID STARTING POINT

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

Original Article Published in Women in Optometry
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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.

THE WOW FACTOR

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.

FASTER REFRACTIONS 

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.

MORE DATA, MORE QUICKLY

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.

PATIENT CHOICE

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.

SHORT LEARNING CURVE

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.

GOODBYE, SHOULDER PAIN

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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