Youve done your homework, read the studies, and now its time to invest thousands of dollars into a new piece of technology for your practice. Whether you decide to invest in a new fundus camera, a pachymeter, or the latest practice management software, the likely reason why you add new technology to your practice is to improve patient care, according to interviews with optometrists and results from the Review of Optometry 2007 Diagnostic Technology Survey.

In fact, 79% of the 288 doctors of optometry who responded to our survey cited improved patient care as the number one reason to buy new equipment, followed by potential to generate revenue (7%), and better efficiency and office flow (also 7%).

We are constantly evaluating our equipment from the doctors perspective and the patients perspective, and putting money into the practice so we can better serve our patients, says Jason R. Miller, O.D., M.B.A., who recently added a Panoramic200 imager (Optos), a GDx (Carl Zeiss Meditec), Eyemaginations patient education software, and MaximEyes (First Insight) electronic medical record (EMR) system to his Powell, Ohio, practice.

What"s New in High Tech: Cool "Toys" for Optometric Practices

Whether you consider yourself a tech nerd or not, there are a lot of new products out there to consider. Some promise to be revolutionary additions to your practice, while others offer new and improved models that claim to work better than before.

A few of your tech-savvy colleagues offer their advice on whats new, whats the most practical in the bunch, and what sounds promising in the future.


High Resolution OCTs

The hottest topic right now in optometry circles is high-resolution optical coherence tomography (OCT) imaging systems for both the anterior and posterior segments.

This field of new products is amazing at the very least, says Anthony Diecidue, O.D., of Stroudsburg, Pa. The new high-speed OCTs are approximately 65 times faster than current models. This provides for increased resolution and accuracy in each scan. If you are in a retinal specialty practice, it is worth looking into these new instruments.

Optometrist Kris May, of Coldwater, Miss., points to three new OCT instruments on the market: the Spectralis, the SL-OCT and the RT-Vue.

  Spectralis HRA+OCT (Heidelberg Retina Angiograph and Optical Coherence Tomograph, Heidelberg Engineering).
This instrument captures HRA and OCT images simultaneously in any of four imaging modalities: autofluorescence, infrared, fluorescein angiography and indocyanine green angiography. The Spectralis scans the retina 40,000 times per second, providing detailed images of the retina, according to the company.

The Spectralis has a high price tag but it does have good capabilities, Dr. May says, especially in the area of angiography.

SL-OCT (Slit lamp-optical coherence tomographer, Heidelberg Engineering). This device is used for cross-sectional anterior segment imagingthis is the first commercial application of OCT for anterior segment imaging. It mounts on a slit lamp, which can save space and costs. It offers chamber angle, pachymetry, flap thickness, corneal curvature and comprehensive biometric measurements, as well as pre- and post-surgical comparisons.

RTVue-100 (Optovue). This is an ultra-high-speed, high-resolution OCT retina scanner used for retinal imaging and analysis. The RT-Vue uses second generation Fourier-Domain OCT, in which the entire A-scan is acquired by an electronic (i.e., non-mechanical) camera simultaneously.The company says it is 65 times faster (26,000 A-scans per second) than current technology for 3-D and high density mapping.

Visante (Carl Zeiss Meditec). This is another OCT of note, according to optometrist Harvey Bonner, of Billings, Mont. The company says it the first standalone, high-resolution OCT imaging system for the anterior segment of the eye, including the cornea, iris, angle and the lens. The Visante OCT can measure corneal thickness, corneal flap thickness and residual stromal thickness following refractive surgery. The instrument also aids postoperative evaluation of cataract surgery by measuring and imaging intraocular lenses and implants.

The technology is valuable in evaluating anterior segment disease, Dr. Bonner adds. Practical tools enable detailed planning and measurement of anterior segment structures, including anterior chamber depth, anterior chamber angles, and the angle-to-angle distance (anterior chamber diameter).

There are many photography- and digital imaging-based technologies currently available on the market, providing good tools for documenting, charting and evaluating retinal disease, Dr. Bonner says. But, they should not be used as a sole method of diagnosis. With the current standard of care, you still need to dilate every patient, Dr. Bonner says. The imaging technology should be used for documentation, not diagnosis.


AMD Monitoring

The ForeSee Preferential Hyperacuity Perimeter (NotalVision) has been around since 2004, but it is finally hitting its stride with ease of use and increased reimbursement, Dr. May says. The ForeSee PHP is a non-invasive visual field analyzer for monitoring age-related macular degeneration (AMD) and early detection of conversion to choroidal neovascularization (CNV).

Detection and management of AMD have taken huge strides in just the last year or two, Dr. May says. The ForeSee improves on earlier models with better patient interface and less technician involvement in testing, as well as a far more robust printout. Location, severity and statistical analysis of lesions now tell us exactly where we need to focus attention.


The End of the Puff Test?

In Dr. Mays coolest new toy category is the iCare rebound tonometer (Tiolat). Is this the death knell for the puff test? he asks. The iCare tonometer is newly approved by the FDA for use in the United States and will soon be available. It is a handheld device with accuracy comparable to the Tono-Pen (Reichert) and Goldmann tonometer, but it does not require anesthetic drops.

The tonometer is based on a new measuring principle, in which a very light probe makes momentary contact with the cornea. The measurement is barely noticed by the patient and often does not even cause corneal reflex, according to the company.

It could be ideal for screening in situations where using anesthetic or fluorescein is unwanted. Once you get the hang of it, this might be one of those things you cant live without, Dr. May says.


Lab in a Box

The Adeno Detector (Rapid Pathogen Screening) is a self-contained lab test that screens for viral conjunctivitis in 10 minutes. It is a neat tool that does not require a CLIA-approved lab, Dr. May says.

The upside is that it is actually reimbursable from Medicare for about $16. The downside: a five-pack is $145, or $29 each. Similar tests that will screen for other conditions, such as dry eye and allergy, are in the offing.


Corneal Thickness Measurement

New technology on the market now provides broader measurement of corneal thickness over the entire cornea and mapping of the posterior corneal surface with increasing sophistication and detail, Dr. Bonner says. Specifically, he points to three updated technologies:

Orbscan IIz (Bausch & Lomb).
This advanced topographer measures the shape of both the front and back surface of the entire cornea, and can provide a complete picture of the thickness of the cornea, according to the company.

CC-7000 and SP-9000 (Konan Medical). Both these specular microscopes have a built-in pachymeter in addition to their main function of cell analysis. The CC-7000 measures corneal thickness at the same time that it photographs the endothelium. The SP-9000 model can measure thickness at any spot on the cornea, and has built-in software to calculate averages of multiple readings in any one area.

Pentacam (Oculus). This instrument images the anterior segment of the eye with a rotating Scheimpflug camera to create 3-D pictures of the cornea. The measurement processwhich evaluates 25,000 true elevation pointslasts less than two seconds because it simultaneously captures and corrects for minute eye movements. The instrument displays a color image of corneal thickness, showing the entire area from limbus to limbus.

Adds Dr. Bonner: The Konan SP-9000 produces multiple pachymeter readings over the cornea, but not with the detail of the other two technologies.


Lets face it: There are a lot of new technologies out there that may change the way you practice. Stay tuned for new additions on the technological frontier.

 For Anthony Diecidue, O.D., of Stroudsburg, Pa., the recent addition of the Optos retinal imager and a Briot edger/blocker system had a positive impact on his practice and, in turn, improved patient care. The Optos imager allows Dr. Diecidue to screen every patient for potential retinal disease and, in some cases, it can be used when a patient wants to avoid a dilated exam. It has also increased his bottom line, and allows him to do a more thorough exam in less time with more comfort for the patient. In addition, the Briot edger and blocker allows Dr. Diecidue to edge glasses in a small space with relative ease.

New technology can give you the ability to be a better practitioner, he says. This translates to better patient care. And anything that makes you a better doctor is important.

Less important, but certainly not of least importance, is that new technology can increase your revenue, Dr. Diecidue says. Whether it is by adding new services or tests to your routine or by giving you the opportunity to delegate more, new technology can increase your bottom line by revenue from the test itself or by freeing up your time for other tasks.


 Boosting Your Bottom Line

Of course, a new technology purchase needs to ensure an adequate return on investment (ROI) for a practice. A majority of survey respondents report a positive revenue boost as a result of new technology purchases. In fact, 69% say a new technology purchase increased revenues somewhat, and 15% say revenues increased dramatically due to the investment. Still, 14% of responders said their new technology purchase had no effect on generating additional revenue for the practice.

I bought a GDx and I took in about $10,000 extra last year solely from GDx reimbursements, says one O.D. Aside from the obvious benefit of better diagnostics for glaucoma, the GDx changed my paradigm. Previously, I might say to a glaucoma suspect, Come back in three months, and well recheck your pressure and do your visual field. They would usually return in a year or so when they broke their glasses. Now we say, While youre here, well do your visual field and GDx. So, I get the information I need on the spot, and we bill the insurance for three things: exam, visual field and GDx.

Optometrist Mark Zebrowski, of Grapevine, Tex., adds: GDx allows me to better diagnose and treat glaucoma patients. Now I can practice to the fullest scope my license allows, and patients know I am a specialist in that area. It has and will continue to generate more revenue and referrals from outside doctors.

The majority of optometrists who responded to the survey are making significant financial investments when purchasing new technology. In fact, 52% say the cost to purchase new equipment was more than $20,000, followed by 16% who say their budget was between $15,000 and $20,000. Collectively, only 32% of optometrists who responded to the survey say their cost range was between $1,000 and $15,000 for a new equipment purchase.

When considering ROI criteria, practice management consultant and optometrist Gary Gerber says he has never seen a piece of properly used and properly marketed technology not make money for a client.

Keep in mind that in the grand scheme of things, technology [for optometric care] is really still quite affordable, he says. Speak to doctors in other medical disciplines and theyll tell you they wish the most expensive thing they could buy was about $60,000!

What Youre Buying

Pachymeters remain the hottest technology: 64% of respondents say that this is the type of new equipment that they considered purchasing or had purchased in the past three years. Pachymeters have remained a popular technology and a staple of standard of care for optometrists since results of the Ocular Hypertension Treatment Study were reported in 2002. While many O.D.s added pachymeters as a necessity to their practice, reported results of ROI and use were mixed. [I] purchased a pachymeter, says one O.D. I rarely use it. Its not paying for itself. But, [Im] glad to have it due to standard of care.

Just on the heels of pachymeters are fundus cameras, with 63% of responders ranking this the second most popular technology either recently added or their wish lists. The addition of a digital fundus camera helps provide better patient care and patient education, says one O.D. in Winter Haven, Fla. In addition, patients are impressed with seeing their own retina immediately following this procedure.

Upgraded computer/electronic records came in a close third; 55% of O.D.s name this technology as their top choice. In addition to adding several new instruments, Tania Sobchuk, O.D., of Lake Havasu City, Ariz., says electronic medical records (EMR) have greatly improved efficiency and patient flow and resulted in significantly less work for staff and fewer errors in transcription. And, her patients love it, Dr. Sobchuk says.

Optometrist Brian Chou, of San Diego, Calif., recently began the major process of converting to EMR with ExamWRITER (OfficeMate) and OfficeMate practice management software. One of the challenges of a practice with several different doctors is developing consistency and legibility in charting to make things as simple as possible for our staff, Dr. Chou says. The conversion to EMR has already brought some nice efficiencies, since it imposes structure to certain office operations.

He adds: One of the features I enjoy is that I am able to remotely access the server from home to check my patient schedule or access patient information to facilitate handling after-hours calls.

Corneal topographers and retinal  tomographers also rank in the top tier of the survey, at 42% and 38% respectively. The addition of a corneal topographer helped one O.D. better identify the source of vague contact lens symptoms and, in turn, helped identify problems that patients were unaware of. An O.D. from South Dakota says that he initially bought a corneal topographer for fitting corneal reshaping lenses, but that he also uses it for comanaging post-op cataract and LASIK patients. In turn, it is generating good revenues and patient interest.

Retinal imagers and analyzers also ranked highly on the survey. [Optos] OptoMap has revolutionized how we show patients what we are looking at and why. It has allowed us to not have to dilate as often, and patients love that. It has also allowed us to pick up and follow retinal details that we may have missed with traditional dilation, says an O.D. from Guthrie, Okla. The Zeiss Meditec OCT has also allowed us to not have to refer out glaucoma patients as often as we used to. Now patients do not have to go out of town for this testing.

optometrist Michelle Monkman adds: We purchased a GDx to improve our ability to follow our glaucoma patients. It has improved both our comfort level in our management and our patients perceptions of our practice as cutting edge. We also have an Optos imager in our office; our patients are very impressed by the pictures we are able to show them, and we feel very comfortable having a permanent record of the retina.


Can You Have Too Much?

Of course, many O.D.s are adding numerous instruments to their practices at once. Dr. Chous office has accumulated several diagnostic instruments during the last few years. As a result, all these new technological instruments have posed a challenge.

Space is becoming an issue, along with how patient flow is sequenced and how long it takes, Dr. Chou says. Well need to seriously consider if we can replace one of our existing instruments with a better technology, or perhaps use a new instrument that combines functions of some of our existing technology.

Of course, optometrists cant purchase every new technology that comes on the market. We have to pick and choose where we can spend our money, and sometimes that means choosing one technology over another, Dr. Diecidue says. The great thing is that there is probably an O.D. down the street that has the instrument/technology that you dont and by sharing these instruments and promoting intra-professional referrals, we all profit both financially and professionally because we can provide all the care our patients need, even if its not in our office.

Vol. No: 144:08Issue: 8/15/2007