A 66-year-old white female came into the office of John G. Randall, O.D., of Sherman, Texas, with complaints of decreased vision. Upon examination, her best-corrected visual acuity in her right eye had decreased to 20/50 since her last exam, with evidence of corneal edema. There was no evidence of cataract or retinal pathology.

“Specular microscopy helped to identify her cornea as the reason for the decreased vision,” Dr. Randall says. He diagnosed her with Fuchs’ endothelial dystrophy and prescribed Muro 128.5% (sodium chloride, Bausch + Lomb). Within days, her best-corrected visual acuity improved to 20/30.

“I don’t use the specular microscope on every patient,” Dr. Randall says. But “I feel that every optometrist should have one, especially if they fit contact lenses. Without being able to see the corneal endothelium, we are fitting contact lenses blind.”

This is but one example of how new technology can improve a practice’s patient care.

If “improving patient care” is the primary reason why you bought that new piece of equipment, you’re in good company. More than four out of five (82%) of your fellow optometrists think the same way. Way down on that list are the other reasons, such as “increasing revenue” (5%), “upgrading technology” (5%) and “improving efficiency” (4%).

Even in these troubled economic times, optometrists are putting patient care—not profits—first. Indeed, most optometrists surveyed (69%) say their most recent major equipment purchase had increased their profit only “somewhat.” About one in five (20%) say the instrument had no effect on profitability. Only 8% say the purchase increased profit dramatically.

These are the results of our Annual Diagnostic Technology Survey, based on the responses from 228 optometrists to an e-mail questionnaire.

O.D.s’ Most Wanted
What’s at the top of most optometrists’ wish lists for new equipment?

• Digital fundus camera. Nearly half (46%) have bought or want to buy a digital fundus camera. It “has helped to monitor any changes that a patient has. Patients also like seeing what the back of their eye looks like and having it explained to them,” says Tammy L. Warmouth, O.D., of Luzerne, Pa. “We have been able to bill for this new service, and it has increased our revenue along with increasing patient retention and new referrals.”

Optometrist Larry Cusma added a digital retina camera to his private practice in Scotia, N.Y., to help increase his primary care services. “I’m seeing a lot of diabetics referred by area practitioners, and I always send a detailed report, including a copy of the latest retinal photos,” Dr. Cusma says. “Sending a detailed report plus a photo has increased the number of referrals to our office dramatically over the past few years. My practice now is more geared towards treatment and management of eye disease, and less dependent on eyewear sales.”

• Electronic medical records. Two in five (39%) of respondents are sizing up EMR systems and/or software that integrate equipment and practice management programs.

“There’s no more looking for a patient’s chart that was ‘eaten’ by the office,” says optometrist Buck Buchanan, of Montrose, Colo. And, “it’s a major time saver for insurance filing.”

“Our computerized appointment book, which was six years old, died from over-expansion,” says Caren Weisz, M.Ed., O.D., of Joliet, Ill. “Officemate had a medical records and practice management offer that made sense and will prepare us for the future.”

Why prepare for the future? Because Uncle Sam says so. In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act mandates that if you don’t adopt an electronic records system by 2015, you’ll be penalized 1% of your Medicare payments, increasing to 3% over three years.

Currently, 46% of survey respondents use EMR—that’s up from 39% last year. Compared with only 20% of all physicians nationwide who use EMR, optometrists are apparently among the early adopters.1

• Perimeter/visual field analyzer. About three out of 10 O.D.s (29%) have one of these instruments on their shopping list. “I wanted to be able to be on the same level as M.D.s when I refer to them,” says Ivan Tsai, O.D., of Huntington Beach, Calif. “The [Humphrey Visual Field Analyzer] has allowed me to be able to have the whole picture of treating glaucoma patients, and allows them to stay in-house completely.”

Optometrist Joseph Lawless, of New Baltimore, Mich., purchased a visual field analyzer “to provide quick field screenings for routine eye examinations, as well as accurate and patient friendly threshold field analysis,” he says. “This instrument has served its purpose well. Through routine field screenings, we have detected such conditions as previously undetected brain tumors. Also, through threshold testing and tracking patients with current visual field loss, this instrument provides another source of income. Patients have been very receptive [because] the testing is easier and quicker.”

• Corneal topographer. Some 28% of O.D.s want to add a corneal topographer to their practice.

Why? “The pachymeter and topographer help me fit and manage my keratoconic patients,” says James Cohen, O.D., of Santa Ana, Calif. “They also allow me to do a LASIK evaluation without sending the patient to a laser center.”

Leslie Cucuzza Falcon, O.D., recently purchased a three-in-one autorefractor/keratometer/topographer for her solo practice in Chandler, Ariz. “I chose this instrument as it was more economical than purchasing an autorefractor/keratometer and a topographer separately, plus I love the decreased footprint of one vs. two (or three!) machines,” Dr. Falcon says. “Even in this economy, my practice has grown 30% from last year because I’m now doing over 60% of my contact lens fittings as medically necessary RGP and hybrid.”

• Automated refraction system. Some 26% of respondents bought or want to buy one of these time-saving systems.

But such systems aren’t only for ramping up your exam speed. “About two years ago, we purchased an automated refraction system—not for improving patient flow, but for practice marketability,” says Elizabeth M. Atkinson, O.D., of Algonquin, Ill. “Patients are very impressed, and often remark how old fashioned that ‘other thing’ (phoropter) was at their other eye doctor’s office. If you really look at it, [the phoropter] does look old fashioned in today’s electronic world.”

Sometimes it’s not about the patient, but the doctor. “I purchased the [Marco] TRS-5100 for both of my examination rooms because I was diagnosed with osteoporosis,” says Amy M. Keller, O.D., of Reed City, Mich. “It has made a tremendous difference in my posture, and my back is so much more comfortable. I no longer have to reach and extend my arms in front of me so long to do refractions. I am enjoying refracting once again.”

• Digital anterior seg camera. One in four (25%) O.D.s want one of these babies, often to complement their retinal camera.

“Two retinal cameras and six anterior seg cameras have allowed this practice to grow,” says optometrist Douglas Stine, of Schofield, Wisc. “Patients can see that I ‘get it’—that I can see their problem and that are getting the treatment they need.”

• OCT and SD-OCT. More than one in five (22%) optometrists are browsing for optical coherence tomographers. Among all instruments, the OCT generated the most comments in this survey.

“Cirrus HD-OCT has revolutionized my ability to manage my retina cases,” says Paul Heersink, O.D., of Monte Vista, Colo. “It gives me an incredible boost in confidence of being able to see what’s going on at the retina level. It’s an unbelievable tool and I don’t think I could practice without it anymore.”

Optometrist Agnes L. Palys, of San Antonio, echoes that sentiment. “The Cirrus OCT was our largest purchase and the best decision I ever made,” she says. “It really allows me to be a better diagnostician and to provide better patient care. It has definitely paid for itself. I am also more confident in my diagnoses and referrals.”

More Results on New Technology
• According to our survey, 68% of respondents have a pachymeter (or some instrument that measures corneal thickness). But 32% do not.

• More than half (51%) of respondents say that the recent economy has caused them to delay buying new equipment. However, 46% say the economy has had no effect, and 3% say that the economic situation actually spurred them to buy new equipment in order to recover revenue.

• Comparing new equipment to used or refurbished equipment, 80% say their next purchase will be new equipment, while 17% plan to buy used/refurbished equipment.

“If every time a patient comes in and nothing has changed in your office, you run the risk of losing that patient,” says Robert Dors, O.D., of Owen Sound, Ontario, Canada. “Changes don’t have to be dramatic, but you need to look like you’re making strides to keep up with the world around you. Timely introduction of new technology keeps doctors, staff and, ultimately, patients happy.”

1. Pear R. Standards Issued for Electronic Health Records. The New York Times Online.com. 2010 July 13. Available at www.nytimes.com/2010/07/14/health/policy/14health.html (accessed July 27, 2010).