The motivation for new diagnostic equipment has changed over the years. When I graduated, a well-known practice management consultant told me to determine how long it would take for reimbursement to pay for the equipment. If it was less than a year, consider it; if less than six months, buy it. How times have changed! Frankly, if the diagnostic equipment was valuable for proper disease diagnosis, identifying pathology I might miss or increasing efficiency, the reimbursement would be a last consideration.

Let’s look at some newer diagnostic equipment that meets the above criteria in various areas of clinical practice.


This condition is relatively complex, even though it should be simplified to identify a glaucoma suspect vs. glaucoma patient and if they are progressing or not. This often requires diagnostics that reveal information we can’t identify on optic nerve evaluation alone. The precision of intraocular pressure (IOP) measurements can be improved by including corneal hysteresis, using the  Ocular Response Analyzer (Reichert Technologies), which provides a “true” IOP and an indicator of disease progression potential. OCT is the perfect example of essential technology for glaucoma management. Newer versions such as Cirrus Photo 600 (Zeiss) take 100,000 B-scans per second with a wider field of view. One innovation in visual field (VF) testing includes virtual reality (VR) headsets—more about that later.

One of the more impressive innovations for 2024 is ObjectiveField (Konan Medical). No longer do we have to rely on sketchy subjective patient responses. The device uses subtle pupil responses to assess neurological field defects. It takes about three minutes per eye, uses familiar VF displays but provides information beyond current field testing, including latency responses and total deviation plots. That’s the type of technology where the value of diagnosis far exceeds reimbursement.

Refraction and Eye Misalignment

Accurate lensometers such as the Visionix VX 40 (Visionix) to more precise refractors are forcing a sea change in practice. One day these will be so accurate that doctors will need to focus more on the analysis of data collection than being expert refractionists. An example concerns eye misalignment. The N3 VR Headset (Neurolens) can measure phorias at distance and near, AC/A and determine exact misalignment down to a fraction of a prism diopter. This three-minute test has essentially eliminated the need for subjective Von Graefe testing and Maddox rods, saving immense time and greatly increasing accuracy. 

Ocular Surface Disease

The Keratograph M5 (Oculus) supports the best diagnostic methodologies to provide everything from non-invasive break-up time to meibography. In the near future, it will incorporate artificial intelligence to help determine optimal treatment directions. New technologies use ray tracing to identify dry eye patients, such as Tear Film Index software for the iTrace (Tracey Technologies), to interferometry of the tear layers, such as Tear Film Imager (AdOM), both of which continue to advance diagnostics. A new device to help diagnose dry eye known as Idra (Mercoframes) is also set to reach the market soon.

Retinal Disease Evaluation

I recently saw a patient, who had been on Plaquenil 400mg per day for over nine years, for slight vision changes. A recent fundus photograph showed no noticeable pathology. With confocal imaging using the Eidon TrueColor Widefield Confocal Scanner (iCare), we were able to clearly see a bull’s eye maculopathy and have the medication stopped. While fundus photography is reimbursable, this information, which prevented further permanent vision loss, is invaluable. Handheld ERG (RetEval, LKC), while effective in glaucoma, AMD, hypertensive retinopathy and other conditions, is extremely valuable in assessing diabetic retinopathy progression.

Efficiency and accuracy, information not available by other means, and perhaps reimbursement make these new technologies formidable, help us avoid missing essential pathologies, prevent malpractice lawsuits and—most importantly—save vision. They also make clinical practice far more enjoyable as we put the pieces of the puzzle together to make an accurate diagnosis, leading to more effective management.

Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.