Article Date: 7/1/2010

Give Yourself a Hand

Give Yourself a Hand

Here are five reasons you should consider adding hand-held devices to your diagnostic instrument armamentarium

Scottsdale, Ariz.

In the last 10 to 20 years, in particular, society has learned that some of the best things really do come in small packages. After all, cell phones, MP3 players and portable video game devices — just to name a few — have provided us with the benefits of convenient and fast communication and have facilitated media access. Along these same lines, the availability of several hand-held diagnostic ophthalmic devices has provided optometrists and ophthalmologists with several benefits. (See "Hand-held Ophthalmic Devices".)

Here, I explain these benefits:

Hand-Held Ophthalmic Devices

● Genesis-D digital retinal camera (Kowa Optimed Inc.)
● Retinal Acuity Meter (RAM) (AMA Optics Inc.)
● Palm AR autorefractor (Marco)
● Palm ARK autorefractor/keratometer (Marco)
● ARK 30 autorefractor/keratometer (Marco)
● Retinomax 3 autorefractor (Right Medical)
● Retinomax 3 K-Plus autorefractor (Right Medical)
● SureSight autorefractor (Welch Allyn)
● PachPen pachymeter (Accutome)
● DGH-55 Pachmate pachymeter (DGH Technology)
● PalmScan P2000 pachymeter (Micro Medical Devices)
● PalmScan P2000 FastPach pachymeter (Micro Medical Devices)
● PalmScan AP2000 A-scan/pachymeter (Micro Medical Devices)
● PalmScan AP2000E A-scan/pachymeter (Micro Medical Devices)
● IOPac standard pachymeter (Reichert Technologies)
● IOPac advanced pachymeter (Reichert Technologies)
● SP-100 pachymeter (Tomey USA)
● HSL-150 2.5v slit lamp (Heine)
● HSL-150 3.5v slit lamp (Heine)
● 510L slit lamp (Eidolon Optical LLC)
● SL-15 slit lamp (Kowa Optimed, Inc.)
● Perkins applanation tonometer (Haag-Streit USA)
● Transpalpebral diaton tonometer (BiCOM, Inc.)
● Diaton non-corneal tonometer (BiCOM, Inc.)
● Tono-Pen AVIA applanation tonometer (Reichert Technologies)
● Tono-Pen XL applanation tonometer (Reichert Technologies)
● PT100 non-contact tonometer (Reichert Technologies)
● iCARE tonometer (Designs for Vision)
● Scout portable topographer (Eye Quip)

A case of space

Although several full-size diagnostic devices offer accuracy, reliability and excellent features, regrettably, every diagnostic testing room is limited in space and accessibility. In fact, take a minute or two, and write down the number of instances you can recall when you and a patient have been "too close for comfort" in your diagnostic testing room as a result of the abundance of devices stored there, the actual footprint of the chosen device and/or a patient's physical limitation, such as obesity.

Now, think of the number of times you've attempted to relocate the patient from your exam chair to your testing room, only to find it's already filled to capacity with other patients — a potential Health Insurance Portability and Accountability Act issue — or that a fellow colleague and his patient is already using the device you need to use.

I would bet many of you find these circumstances occur daily. Further, I would wager that some of you are even considering relocating your entire practice to a larger building just so you can accommodate all your diagnostic equipment. This is a temporary fix to be sure, however, as technology will continue to evolve and with it the development of more must-have regular-size ophthalmic diagnostic devices.

Today's hand-held diagnostic ophthalmic devices can enable you to avoid these issues, and I've found that they're very analogous to the larger versions, so as not to require any special training or instruction.


Many of the patients who present to us have physical limitations that prevent them from positioning themselves within the footprint of a regularsized diagnostic device. As a result, this often precludes us from obtaining a complete exam.

In addition, some of the currently available fullsized diagnostic devices aren't ergonomically friendly to either the patient or the operator's body, causing shoulder-, back- and head-aches, among other physical issues.

Hand-held diagnostic ophthalmic devices, however, enable you to provide all your patients with thorough examinations, and they prevent the patient discomfort and work-related musculoskeletal disorders that can result from some of the full-sized diagnostic devices. Also, showing patients you have the ability to work around their physical limitation(s) creates a great deal of appreciation on their part, which can lead to several patient referrals.

Time is on your side

One of the most challenging aspects of running an optometric practice is sticking to scheduled appointments. When this doesn't happen — a common occurrence — it's not only frustrating for us, but also for those patients who must wait in the reception room far longer than they initially thought. This isn't good public relations for one's practice.

One of the main causes of falling behind scheduled appointments: the appearance of unexpected data or pathology during a routine eye exam, which requires us to relocate the patient from our exam chair to our diagnostic testing room.

For example, if we see a suspicious cup-to-disc ratio, a corneal thickness measurement is warranted, requiring us to transfer the patent from the exam chair to the diagnostic testing room. Considering both the space and ergonomic issues outlined above, however, relocating the patient can take up a great deal of time.

By having a hand-held pachymeter at your disposal, you can bring the device to the patient and obtain a reliable measurement in a matter of minutes. The result: You're able to stick to your schedule, and keep patients happy. Further, using such devices may allow you to increase your practice revenue, as the time you save from relocating patients may enable you to schedule even more patients.

Exam lane portability

The concept of exam lane portability means you're not limited to performing comprehensive eye exams and/or diagnostic tests in your diagnostic testing room or even in your practice — the latter of which can become a new source of practice revenue and referrals. After all, making house calls is a unique service. In fact, the ability to conduct a thorough evaluation in any setting enables you to bill for an exam at a higher level than when you do so in your practice.

With hand-held devices, you can roll much like the primarycare practitioner. Instead of a stethoscope, blood pressure cuff, otoscope, thermometer, mallet and tongue depressor, however, you have your hand-held slit lamp, hand-held tonometer and a portable light box — all the trappings of a great exam lane in the size of a back pack.

A colleague of mine recently marketed his ability to provide eye exams and care outside of his practice with hand-held devices, and he's now become the go-to eyecare practitioner for nursing homes and assisted-living complexes in his area.

Technogeek chic

Because much of today's best technology comes in a small package — as mentioned above — society has adopted the notion that if a device, gadget, etc., is smaller, it, therefore, must be more technologically evolved than the larger item. So, when you, the O.D. approach a patient with a hand-held diagnostic ophthalmic device, this translates to the patient viewing you as a technologically evolved practitioner. Also, I've found the "wow" factor the patient experiences in seeing the device can lead to several patient referrals.

Because hand-held diagnostic ophthalmic devices save space and time, are ergonomically friendly, provide portability and enhance a practitioner's reputation, they, like cell phones, MP3 players and portable video game devices also show that some of the best things really do come in small packages. OM

Dr. Bloomenstein is director of optometric services at Schwartz Laser Eye Center in Scottsdale, Ariz. E-mail him at

Optometric Management, Issue: July 2010