Many O.D.s are not integrating their computers with their instruments. But, they are buying new instruments, especially pachymeters. This is according to results of Review of Optometrys annual Ophthalmic Product Research

Why these results? Potential technology glitches, keeping up to date with new instruments and the influence of the Ocular Hypertension Treatment Study (OHTS), your colleagues say. A total of 2,000 O.D.s received this survey, and 46.4% responded.

One reason O.D.s are not integrating their instruments with their computers is that communication between systems is difficult because different technologies use different database languages.

Instruments and Technology
In this technological age, some optometrists surprisingly are not taking full advantage of computer systems. Some 4% still do not have computer systems in their offices.

Almost half of respondents who do own computers own newer systems. Some 42% reported that their computer systems are 2 years old or newer. However, almost a quarter of computer users may be using outdated systems. Some 22% reported using computer systems that are 5 years or older.

While computers do not need to be brand new, those who are using outdated systems are probably missing opportunities, says optometrist and practice management consultant Gary Gerber of Franklin Lakes, N.J. For example, some software wont run on older computer systems. If O.D.s do not purchase a new piece of technology because it wont run on their older computer systems, they are missing the forest for the trees, Dr. Gerber says. The revenue generated from the new technology will easily pay for a computer upgrade, he says.

Many computer owners are taking advantage of the Internet for professional use. O.D.s need to leverage their most limited resourcetheir timeand the Internet is a great way to do it, says Dr. Gerber. For more information on what O.D.s are researching, see What O.D.s are Doing Online."

Although optometrists are keeping up with technology by using their computers for Internet research, many are not integrating them with their diagnostic instruments. For example:

Some 76% of respondents have not connected their corneal topographers to a computerized database. 

Some 88% have not connected their slit lamps to a video imaging system, and 89% have not connected their slit lamp to a computerized digital-capture imaging system.

 About 67% have not connected their fundus cameras to a computerized, digital-capture imaging system.

 Only about 9% linked their automated perimeters to a computerized patient records system.

 Some 39% use software to analyze visual fields. 

About 14% do not submit claims electronically.

These findings do not surprise optometrist Murray Fingeret of Hewlett, N.Y. Many O.D.s are likely not integrating because some software can be difficult to get to work, and many O.D.s have likely heard horror stories from other O.D.s about their bad experiences, he says.

Another possible reason that many optometrists have not yet integrated their diagnostic instruments with their computers: Communication between systems is difficult because different technologies use different database languages. This has improved in recent years but is still an issue with certain technologies, says Dr. Gerber (For more on integration, see Why O.D.s Should Integrate.)

Why O.D.s Should Integrate
Why should you consider integrating your diagnostic instruments with your computer systems? There are several possible advantages, says optometrist and practice management consultant Gary Gerber. Among them: 

You can store all collected data on one central database for convenience. One word of caution, however: This can be a big disadvantage if a network crash occurs, unless the database is backed up, Dr. Gerber says. 

Integration allows for uniformity in data collection. All data will be stored in uniform files. 

Integration results in few transcription errors. Thats because technicians are not interpreting the data.

 You can save time and money. You do not need to record or print results, so you will not need to constantly replace ink cartridges and paper.

 Youll spend less time researching patient information. For example, instead of looking through pages of data to find a visual field printout, you can simply search for the information on the computer.

Several of my instruments are integrated with a computer. It is a great way to practice because I can see fundus photos on a computer monitor and print out visual fields, adds optometrist Murray Fingeret.

Given the advantages, Dr. Gerber recommends that, when possible, you integrate instruments and computer systems. If you are concerned about problems or have problems integrating, you can run the technology across a network, he says. This way, a technician can test in one room, and you can view the results in another.C.R.

Primary-Care Instruments
Even if optometrists are not integrating their instruments with their computer, they are buying newer instruments, the survey results show. Many respondents purchased instruments within the past few years. Specifically: 

About 51% of respondents have purchased a direct ophthalmoscope since 2000. Some 23% of these ophthalmoscopes were purchased within the past two years. 

Some 47% have purchased a new binocular indirect ophthalmoscope since 2000. About 15% of these were purchased in the past two years. 

About 61% have purchased an automated refractor since 2000. About 18% were purchased in the past two years.

Some additional findings: About 45% of respondents own three or more binocular indirect ophthalmoscopes. Also, some 42% own three or more slit lamps, and about 84% own three or more lensmeters.

Glaucoma Instruments
More optometrists plan to purchase a pachymeter in the next 12 months than any other instrument. About 50% of respondents already own a pachymeter, and nearly 27% plan to purchase one in the next 12 months.

The Ocular Hypertension Treatment Study demonstrated that central corneal thickness is a powerful predictor for the development of primary open-angle glaucoma. So, more O.D.s want pachymetry measurements to aid in their glaucoma management decisions, says optometrist Greg Black of Fort Lauderdale, Fla.

 Revised clinical practice guidelines from the American Academy of Ophthalmology due to OHTS now state that measuring corneal thickness is as important as measuring IOP, Dr. Fingeret adds.

Corneal thickness measurements are in patients best interest, and a pachymeter is relatively affordable, easy to use and billable to most insurance carriers, Dr. Black says.

Pachymetry purchases also may be increasing among optometrists who comanage LASIK patients and need to ensure that patients have sufficient corneal thickness before referring them for the procedure, says optometrist Brian Chou of San Diego.

Optometrists also continue to add automated perimeters to their practices or replace older ones, the survey found. Some 55% of survey respondents have purchased an automated perimeter since 2000.

Automated perimeters today are better than everfast and user-friendly, Dr. Chou says. They are useful for screening for a variety of conditions that cause visual field defects, including glaucoma, central nervous system lesions (e.g., stroke, tumors) and retinal scars.

Cornea Instruments
About 37% of respondents currently own a corneal topographer. Some 62% of these have purchased their topographer since 2000.

However, only about 6% of optometrists use their topographer in all comprehensive eye exams. Most of the O.D.s surveyed use their topographers for specific patient encounters. These include: keratoconus patients, as cited by 96% of respondents; refractive surgery comanagement, 86%; corneal dystrophies, 68%; and contact lens patients, 65%. Some 14% of respondents plan to purchase a corneal topographer within the next 12 months.

As optometrists learn new information about the eye through such studies as OHTS or add services such as refractive surgery comanagement, new instruments can become necessary for appropriate patient care. Also, as technology kinks are ironed out, more optometrists will likely integrate their instruments with their computers. Besides the benefits that integration offers, survey research that my company has performed indicates that a high-tech office also impresses patients, Dr. Gerber says.

Vol. No: 142:8Issue: 8/15/2005