Article Date: 7/1/2013

The Thrill (of Refracting) is Back

The Thrill (of Refracting) is Back

Flipping lenses is now a joy. Learn why.


The Thrill is Gone,” sang by the legendary B.B. King, with the assistance of his ablebodied guitar, Lucille, obviously isn’t about traditional refraction, but that phrase represents exactly how I felt about refracting after 30 some years. I know it must be shocking to hear that “which is better?” lost its pizazz, but, trust me, it had.

Now, however, I’m having a blast refracting. In addition, patients tell me they’re “amazed” and “impressed” by the refracting technology we currently use.

The story behind my newfound love for refracting started with the purchase of an automated refraction system.

The beginning

My practice partners and I are always evaluating our patient flow for opportunities to enhance our patient care and practice efficiency.

Several years ago, we successfully increased our patient volume with the addition of a combination automatic refractor, keratometer and non-contact tonometer, which provides all three results in less than three minutes. In addition, we acquired an auto-lensometer that links with the combination device, allowing for a single printout of all the data.

As a result of adding these technologies (operated by a staff member), we were able to add one additional patient per hour, so the devices quickly paid for themselves in professional service fee revenue, not to mention the increase in optical revenue. I ran a few pro-forma spreadsheets, and they were very convincing. More importantly, patients loved the modern technology combined with the less in-office wait time.


Dr. Edlow enjoys the fun, comfort, convenience and patient “wow” factor of operating an automated refraction system.

Investigating EHR

Recently, we were developing our strategy for EHR implementation and how to enhance patient care and practice efficiency with its addition. At the top of our list: ensuring the refraction combination device and linked auto-lensometer would interface with the EHR system.

We contacted the device’s manufacturer for guidance. The manufacturer introduced us to a different automated refraction system that could integrate and interface with the combination system and a reputable EHR system. In addition, the EHR system was compatible with our other already-purchased devices. The data collected from the combination device and auto-lensometer is captured on a card reader (essentially a memory card), and the card follows the patient into the exam lane where it is then loaded into the different automated refraction system.

Putting it all together

Today, the entire refraction occurs electronically, manipulated from an intuitive control panel while I relax on my exam stool changing lenses, acuity chart letters, flipping JCC lenses, measuring prism (okay, I’ll admit, not too frequently) with the press of a button or twist of the central dial. Translation: The thrill is back.

Also, the “wow” factor for patients is awesome. With the simple push of a button, they can look through their old prescription and compare it with the new prescription without me, the O.D., having to adjust sphere, cylinder and axis left and right. In addition, the automated refraction system reveals subtle refractive changes, enabling an increase in spectacle sales.

With the EHR interface, all the refractive and acuity data is imported into the patient record with a simple press of a button (no more errors copying down numbers or, for that matter, struggling to actually see the numbers at the presbyopic age of 58).

Finally, the ergonomics and comfort of refracting without reaching saves hundreds of dollars in ibuprofen expenses.

Making the switch

If you are feeling somewhat less than excited with each refraction you perform, are looking to add some fun into your daily routine, have accepted that EHR is here to stay and want to “wow” patients, you owe it to yourself to test drive an automated refraction system. OM

Dr. Edlow is chief executive officer at Katzen Eye Group in Towson, Md. He is a frequent author and lecturer on practice management and technology implementation and an optometric advisor to Marco. Send comments to

Optometric Management, Volume: 48 , Issue: July 2013, page(s): 22 23