Autorefraction systems help ODs increase efficiency, improve patient care

When the first automated refractor was introduced in the United States in the 1970s, the instruments required a skilled operator and delivered questionable readings that were difficult to interpret.

As automated refracting technology improved, automated refractors became more reliable and easier to use, ushering in a new movement of refractive capabilities. The latest advancement is the automated refracting system, which is a series of equipment including an autorefractor and a phoropter that allows refractions to be taken and automatically transferred for subjective refraction. This technology enables doctors to see more patients over the course of a day and eliminates the possibility of human transcription error.

Automated refracting technology can be classified into three main categories: automated objective refractors with or without visual acuity capability, fully automated refracting systems with subjective capabilities and wavefront refractors.

Automated refractors, though not widely embraced as replacements for traditional refraction, are gaining popularity as screening devices for children and nonverbal patients. Many clinical trials require data to be taken by automated refractors, citing their consistent readings without operator influence. Some of the newer models of automated refractors include the RM-8900 from Topcon Medical Systems (Paramus, N.J.), the RK600 from Reichert (Depew, N.Y.) and the EPIC and TRS from Marco Ophthalmics (Jacksonville, Fla.).

Fully automated refracting systems differ from automated refractors in one respect: these automated refractors can be electronically linked to digital phoropters, Lensometers and chart projectors, giving clinicians the ability to subjectively refine the results obtained. By working with the patient, clinicians ensure that the best possible refraction can be reached on an individual basis. One such model using this technology is Topcon’s KR-8000PA, an automated refractor that can be connected to the CV-5000 phoropter.

Wavefront refractors have the ability to detect lower- and higher-order aberrations and are considered the future of automated refractors. Providing accurate results for the majority of patients, wavefront refractors work by objectively quantifying all aberrations of the eye, even those that were unable to be measured in the past. The Z-View Aberrometer from Ophthonix (Vista, Calif.) and the 3-D Wave aberrometer from Marco are examples. The 3-D Wave connects to the EPIC or TRS to provide the HD Eye Exam.

Automated refractors a starting point

Automated refractors are able to “get you in the ballpark” so you can perform a manual refraction using the data from the automated refractor as a starting point, Alex Crinzi, OD, said in an interview with PCON.

Automated refractors are especially useful when screening children, nonresponsive individuals or those with dementia. “No response is necessary from the patient,” Dr. Crinzi said. “With nonverbal people, it’s a great instrument to be able to get an idea of what’s going on,” he said.

Dr. Crinzi noted that some conditions may present a challenge to an autorefractor such as keratoconus, cataracts and small pupil size. Postsurgical patients do not pose a challenge, he added.

A time saver

According to Michael Dolan, OD, automated technology helps practices save time on administrative tasks such as transcribing. “People neglect to realize the amount of time technicians and doctors spend writing numbers down,” he said. “They tend to underestimate the amount of face-to-face time it takes away from a patient.”

By streamlining the administrative tasks associated with refraction, doctors find it allows them to see more patients each day.

“It saves time and saves money,” Dr. Dolan told PCON. “You save 3 minutes on each patient a day, and after 15 patients that’s an extra patient a day, so $100 extra profit. Over 5 days, that’s $500 extra profit. Multiply that by 52 weeks and now you’re talking $26,000 dollars a year you’ve earned by saving 3 minutes on each patient,” he said.

Dr. Dolan, who uses the CV-5000 phoropter and KR-8000PA fully automated refracting system from Topcon, feels that the true time-saving benefits of automated systems will be realized when the federal government begins mandating electronic medical records in the year 2015.

“When we get electronic health records, we’re going to see even more time savings,” Dr. Dolan said. “After the doctor or technician does the refraction, the results can be printed out or transferred to an electronic health system. This saves time and money and lets you concentrate on the patient by eliminating the need to write the autorefraction results, Lensometer results, refraction and visual acuities in the chart.

“The technician and the doctor spend less time and this improves patient flow while reducing transcription errors,” he continued. “When connected to an electronic health record, all prescreening results are automatically downloaded into the computer.”

Wavefront diagnostics

PCON Editorial Board member Louis J. Catania, OD, FAAO, discussed the uniqueness of wavefront technology being used for in-office diagnostics vs. refractive surgery.

“There are numerous wavefront technologies, most of them suited for guiding excimer lasers in corneal refractive surgery,” he told PCON in an interview. “But the 3-D Wave is designed for refractive purposes, for ocular surface diagnoses, for pre- and post-care management of intraocular surgery patients, in particular for the new premium forms of ocular lenses and an array of other diagnostic, pathological and disease diagnosis.”

Dr. Catania described the technology’s utility in identifying capsular contraction problems in IOL patients. “Early peripheral capsular fibrosis, often not visible with a slit lamp but causing significant postoperative visual reductions, will reveal a distorted wavefront map that indicates the need for YAG capsulotomy.”

“It makes a big impression on the patient,” John Warren, OD, said in an interview. “We use the technology on nearly every patient who comes in for an eye exam. It provides superior refraction in less time.”

Tom Motisi, OD, who uses the Z-View Aberrometer from Ophthonix, was surprised at the accuracy of the wavefront refractor’s results.

“When we first bought the Z-view, we were told that it was more accurate than I was,” he said in an interview. “I’ve been practicing for 26 years, and obviously I didn’t believe it. But there’ve been many times when I’ve done the refraction and put the Z-view script in there afterwards to see how it compares, and it’s not unusual for a patient to say they like it better, even though subjectively they’ve just given me different answers.”

Loren Azevedo, OD, and his staff at A to Z Eyecare find that they are able to work faster because of the wavefront refractor. “The efficiency is so much better that it helps both your optical department as well as the assistants — it speeds things up,” he said. “It’s so accurate that our assistants are actually putting the iZon reading in the refractor instead of the old glasses.

“The wavefront refractor completely changed the way I fit contact lenses,” Dr. Azevedo told PCON. “We found that we were fitting 20% clearer spectacle lenses because of this technology. We questioned why we’re fitting blurry soft contact lenses. Now, we offer gas-permeable lenses as our primary choice,” he said.

Dr. Dolan has also found that this technology has relieved him of the physical strain of performing refractions.

“You hear people complaining about their posture and their backs,” he said. “With an autophoropter you just feel better at the end of the day, after years of having to reach up and stretch.”

For more information:

• Alex Crinzi, OD, can be reached at Eye Care Professionals, (716) 833-2020; e-mail: acrinzi@eyecarepros.com. Dr. Crinzi has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
• Michael Dolan,OD, can be reached at (585) 243-2020; e-mail: mjdolan@frontiernet.net. Dr. Dolan has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
• Louis J. Catania, OD, FAAO, can be reached at Nicolitz Eye Consultants, (904) 398-2720; e-mail: lcatania@bellsouth.net. Dr. Catania is a paid consultant for Marco.
• John Warren, OD, can be reached at Warren Eye Care, (262) 752-2020; e-mail: jwarrenod@mac.com. Dr. Warren has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
• Tom Motisi, OD, can be reached at Eye Site Vision Care Center, (262) 789-6929; e-mail: newberlin@eyesite-vision.com. Dr. Motisi has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
• Loren Azevedo, OD, can be reached at A to Z Eyecare, (707) 822-7641; e-mail: loren@atozeyecare.com; Web site: www.atozeyecare.com. Dr. Azevedo has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.