TECHNOLOGY: Instruments Dynamically Digital Refraction By Cheryl G. Murphy, OD Monday, November 17, 2014 12:04 AM RELATED CONTENT Dynamically Digital Eyewear Dynamically Digital Dispensing Dynamically Digital Frames Dynamically Digital Lenses Dynamically Digital Finishing The refractor or phoropter has been a long-standing symbol of eye exams and optometry. But in recent years noteworthy advances have been made in the realm of refraction and to the phoropter itself. These innovations are changing the face of the exam room and the way in which subjective refractions are performed. Some eliminate or digitize the phoropter. Many incorporate wavefront aberrometry measurements to achieve a higher level of clarity. All improve the accuracy, efficiency and speed of the refraction process. PHOROPTER-LESS REFRACTIONS Imagine patients walking into an exam room and not seeing a phoropter. Some of the latest refraction systems may be posed to do just that for the majority of patients. Phoropter-less give optometrists the capability to produce individualized, precise prescriptions. They accomplish this by measuring higher order aberrations and refining prescriptions to a superior level of accuracy (either 0.05 or 0.01 D) than that of the traditional phoropter (0.25 D). Patients are still engaged, giving subjective responses at the turn of a dial but without having to wrestle with “which is better, one or two?” When paired with digital, free-form lenses, customized to a person’s position of wear, lens power, pupil size and PD, it is said that patients can feel the difference a digitally derived prescription and highly customized lens can make. The systems include the PSF Refractor from VMax Vision, i.Profiler Plus from Carl Zeiss Vision and the soon-to-be-released Vision Optimizer from Digital Vision Systems. DIGITAL PHOROPTERS If one is not ready to truly let go of the phoropter altogether, digital phoropters and computerized refracting systems are other alternatives to the traditional phoropter and they can help upgrade exam lanes into the 21st century. These digital phoropters often connect seamlessly with other diagnostic equipment and EMR. For example, auto-refractor measurements taken before the refraction can be automatically relayed into the phoropter, saving the doctor some time reading the auto-refractor results and then dialing them in. At the end of the exam, the subjective refraction results can be exported to EMR as well, and in some cases, the finalized numbers can be sent directly to the lab. These systems include the Epic 5100 workstation by Marco, the CV-5000S Automated Vision Tester from Topcon, the Huvitz HDR-7000 digital refractor, distributed by Coburn Technologies and the Ezer Digital Practice 7800, distributed by U.S. Ophthalmic. Whether the exam room of tomorrow will have a phoropter or not, one thing is for certain, the hulking metal measuring device of yesteryear that has hovered over exam chairs for decades is finally getting a much needed update. The subjective refraction also has now entered the 21st century and is being finely tuned to deliver a customized level of clarity that the elimination of higher order aberrations can provide. Patients now have the ability to receive a digitally derived prescription expertly tailored to their unique eyes and no longer have to settle for the “off-the-rack,” 0.25 diopter level of lower order aberration vision correction DIGITAL ‘ON-THE-GO’ EXAMS Many refraction systems help to increase efficiency and accuracy in the exam room. They may optimize a patient’s prescription, minimize exam room space or save optometrists time by eliminating the need to enter information into computers manually or write out prescriptions. However, there is a realm of digitized refractions that takes place outside of the exam room entirely. Here are some devices designed for “on the go” refractions: EYENETRA EyeNetra’s Netra-G consists of a smartphone that snaps into the back of a special binocular device. Used in conjunction with a proprietary app, the low cost system can generate accurate sphere, cylinder, axis and PD measurements, according to EyeNetra. PEEK Peek (Portable Eye Examination Kit) is a smartphone-based system that can be used to conduct comprehensive eye examinations, even in remote settings. Easy to use, affordable and portable, Peek allows general health workers and eyecare practitioners to diagnose eye diseases and provide a means for managing and monitoring the treatment of patients, anywhere in the world. PEDIAVISION Spot is a handheld binocular autorefractor from PediaVision that is being used by a growing number of ophthalmology and optometry practices. A portable, lightweight, Wi-Fi-enabled device, Spot measures monocular or binocular refractions, eye alignment, pupillary distance and pupil size. The device’s combination of patent-pending optics and processing algorithms makes these procedures as simple as using a camera, providing a comprehensive, reliable analysis in seconds. SMART VISION LABS Smart Vision Labs has developed a pocket-sized autorefraction device called the Smart Autorefractor. The device consists of an aberrometer with a wavefront sensor that can convert wavefront measurements into a prescription. Local measurements are used to create an image of the wavefront which is divided into quadrants, which are then used to reconstruct a full picture of the eye and produce a prescription. 2WIN The 2Win Refractometer is a point-and-shoot instrument for eye care and wellness professionals. It produces more complete reports of a patient’s visual system than traditional vision measurement equipment, according to Italian company Adaptica, which developed the device. The 2Win Refractometer is particularly helpful for use with infants, children, the elderly and patients who cannot cooperate because it is less invasive and requires a shorter use time than conventional equipment. In addition to checking all parameters of every visual function, the 2Win enables early detection of refractive errors. The 2Win is available in the U.S. through M31USA, Adaptica’s San Jose-based accelerator, and worldwide through Adaptica’s international distribution network. ON-LINE REFRACTION Self-administered online refractions represent another new development in eyecare. Although they have yet to be commercially introduced, online refractions would create a new avenue through which consumers could engage remotely with eyecare professionals.