Article Date: 4/1/2002

Computer Vision
Caring For Patients in the Information Age
Your practice can reap benefits by specializing in computer vision care.
BY RICHARD S. KATTOUF, O.D., F.A.A.O., Warren, Ohio

The outlook for independent optometry isn't glowing. And unless we seriously consider a field of specialization, we might not survive as a profession.

Pretty harsh? Perhaps, but based on my 20 years of consulting, it's also a realistic appraisal drawn from the result of two seismic events that have occurred in recent years. The first event is the shift from indemnity insurance to fixed fee that has cut our net revenues virtually in half. The second is the aggressive marketing efforts (e.g., pricing) of corporate chains that have eroded our patient base. Together, these events have made specialization not just pragmatic, but necessary.

Specialize and work less

As a management consultant, I maximize a client's existing profit centers and create new ones. Many of my clients come to me with the same story: "I'm working harder than ever, seeing more patients and while my gross may be going up a little, my net keeps going down."

I tell these O.D.s that the only way they'll recoup their losses without seeing 50% more patients is through specialization. Specialization offers private pay outside of the managed care contract. Where with managed care, O.D.s today are lucky to net 20% of gross, with specialization the net-to-gross ratio is 50%.

Specialization is not a priority with the chain stores, which are more interested in practicing general optometry (putting "fannies" into seats, refracting and selling eyeglasses). And with 100 million Americans using computers daily, there's no better specialization in the 21st century than computer vision care.

The syndrome at large

The reason for the specific symptoms seen with computer usage is that the user is viewing a Gaussian Image, which has a bright center and fades toward the periphery, making accurate focusing impossible and creating a significant lag of accommodation. You can't focus on an image that's inherently out of focus. The lag of accommodation can manifest as great as 2.00D. Therefore, consider phoria and vergence findings in the final calculation of the computer prescription, which is calculated by reading pixels on a computer simulator. Charge an additional fee for the professional services that lead to the computer prescription because this special testing isn't part of the standard comprehensive visual analysis.

Optometrists are notorious for performing additional testing and not charging patients for it. That's why it's vital to pay attention to the concept of fee for service. You can't gather this CVS data by performing momentary estimate method (MEM) retinoscopy. A computer simulator near point testing device is the key to the proper prescription to alleviate the patient's symptoms.

Many combinations of prescriptions are available depending on the patient's vision condition. The basic treatment options for CVS are in the form of eyeglass lenses, which may involve many different types of lens designs (progressive, specialty progressive) and could involve a variety of lens powers or prisms.

Computer vision demographics

An estimated 100 million Americans work daily on computers -- a number that hasn't yet approached its pinnacle. The investment for specializing in this area is small and the learning curve isn't particularly steep.

Adults aren't the only patients who need computer vision care. Today's youth spend hours every day surfing the Internet or playing computer games even though their visual systems haven't yet matured. As a result, we see many victims of environmental myopia. These are children, some of early school age, whose myopia is far worse than their parents'. We also see college students showing premature signs of myopia because of all the near work they do. If we put them in distance lenses, their eyesight will only get progressively worse.

Incorporating this specialty into your office

A computer vision care specialty offers the O.D. three opportunities to generate income:

1. computer vision testing

2. the sale of a second pair of glasses and other peripherals, such as clips

3. punctal occlusion if the patient has dry eye.

My experience has been that many symptomatic patients don't know the reason for their headaches; dry, sore eyes; blurred vision; and general fatigue. It's up to you to educate them. Here are some helpful tips to get you to do just that.

Step one. Proper history taking is key to eliciting the subjective response that you can use to teach the patient about the syndrome.

Have patients fill out a questionnaire about their computer history so you can incorporate this into their medical history. Patients won't always volunteer information about computer vision problems on their own because they won't necessarily associate their discomfort with computer use.

Symptoms of Computer Vision Syndrome

Progressive Research in Optics (PRIO) has performed extensive studies on the symptoms and cure of this syndrome.

  • eye fatigue
  • eye irritation
  • difficulty focusing
  • headaches
  • burning
  • itching
  • dry eyes
  • loss of focus
  • shadows
  • double vision
  • neck and shoulder pain

Step two. Involve the technician during the pre-testing and data entry phase. Here, the technician can draw more information from the patient to expand on the patient's history.

Step three. You have to create the want and the need, letting the patient know about the importance of a separate computer vision exam (that you'll need to charge her for) and the possible requirement for multiple eye wear. It's up to you to order, direct and prescribe to the patient in the exam chair. If you don't, the patient probably won't do anything about her symptoms. You have the power of being the doctor, so use it.

Additionally, your practice can market internally by identifying those patients whose jobs indicate heavy computer use. This includes editors, writers, graphic designers, computer programmers, office workers, teachers, engineers, architects and advertising/public relations executives. Send a newsletter to these individuals to educate them on the problem and the solution.

You can also bolster your computer vision practice by lecturing to organizations (including parent groups and corporations, where computer vision care has been shown to enhance worker productivity). Because many members of the media (e.g., editors, reporters and producers) know the problem first hand, there's also the chance to pitch to local newspapers and TV and radio stations. This can give you additional exposure, at no cost.

Return on investment

I tell my clients that if they make even a minimal effort to market their computer vision specialty internally, they'll realize an immediate return on investment. Of course, if the tester sits in the corner of the room and the display is never demonstrated, you'll waste the investment.

Some doctors believe that they can offer a computer vision specialty and resist making any purchase, instead using the Snellen test and MEM retinoscopy to determine the proper computer prescription. This doesn't consider the difference between pixels, computer images, and the printed word, and could lead to the wrong prescription. If you're a quarter of a diopter off, the patient won't be comfortable.

Instead, do it right and you'll be responsible for what I call the "wow syndrome." In my practice, once we've arrived at the prescription, we have the patient read aloud with his distance vision. We then have him close his eyes while he's in the phoropter and, with the computer prescription now added, have him read the pixels. The patient invariably says, "Wow, do I feel better."

That's exactly the same response I get from my clients who've added a computer vision care specialty to their practice.

Dr. Kattouf practices optometry with his son in Warren, Ohio. He also works as a management consultant with thousands of optometry and ophthalmology practices around the country.


Optometric Management, Issue: April 2002