Article Date: 8/1/2004

Six Telltale Signs of Equipment Replacement
Is it time for you to pull the plug?
BY GARY GERBER, O.D., Hawthorne, N.J.

If it ain't broken don't fix it."

That sentiment is costing the average O.D. thousands if not hundreds of thousands of dollars in net income each year -- and patients are suffering because of it. Conventional wisdom says that if your current equipment is working and patients aren't complaining, then nothing is broken -- so don't fix it.


Let's redefine the terms

Conventional wisdom is correct -- we're wrong. In reality, much of our equipment is indeed "broken," albeit not in the usual sense of the word. Sure, your keratometer dials are worn and wobbly. But they still turn and continue to take accurate K readings. Your PD ruler is missing some numbers, but it works as well as the first time you ever used it. Your Goldmann performs tonometry and your phones still ring. So what's the problem? What's broken?

The practice-building consultants at our company spend countless hours assessing and exploring new technologies. Clients count on us to assist them in their due diligence and research so we can advise them when it's the right time to add, replace or upgrade their equipment.

Based on this experience and our visits to hundreds of offices, we can tell you unequivocally: Optometry's equipment really is broken and it's time to replace it!

Be on the lookout for these

Here are the six telltale signs for which you need to be on the lookout. Some are obvious, some are not so obvious.

1 Let's start with the least obvious sign first: "Trade Show Envy." You're walking around a trade show and you hear a faint voice in the distance calling out to you, "Look at me!" It's not a person, it's just a thin voice lingering in the air.

Following the voice, an invisible retractor beam pulls you to the latest piece of optometric technology. It's love at first sight -- you know it's better than what it will replace. So what does this telltale sign distill to? How do you know it's time to replace something? You just know. Your heart and your intellect both know it's time for an upgrade. You only need to see the new technology first hand to know it should have a home in your office.

2 Your equipment is worn, frayed and overall cosmetically out of sync with the technology gestalt of the new millennium. We all deal with patients whose cell phones ring during exams. Like the rest of us, these patients are functioning in a high-technology world. Before and after their exam, they check their e-mail and voice mail. They drive in a high-technology car. However, once they cross the threshold of your exam room, they're confronted by the same pink chair and stand and the same, "which is better, number one or number two" machine you've been using for 30 years.

Doc, it's time to cut the cord. Patients notice that your facility and equipment are outdated. They might not tell you, but they certainly tell our consultants; worse yet, they tell their friends.

3 Your patients have memorized their eye exam. When your patients tell you, "I remember the letters on the chart from last year" they're telling you something much more meaningful than that they probably scored a 1600 on their SATs. Beyond the letters, they've also memorized the sequence and routine of your "routine" exam. They know when to put their chin in the chin rest, they know when the drops are coming and they know they'll sting. Time to put some excitement back into your and your patients' lives.


Putting it Into practice


Let's say you've recognized your affliction with Trade Show Envy and decide to act on it. Here's how some actual numbers might shake out if you replaced your current retinal camera, which you know needs replacing.

If you're open about 20 days each month and routinely take pictures of all your patients, then consider this: A moderately sized practice could spend about $600 each month in Polaroid film taking images of about 10 patients each day. The same practice could lease a complete digital imaging system for less and start saving money the day it installs the camera. It would also profit by selling its current camera.

Additionally, factor in the easier use of a digital system for comparing images and the shorter after-image time that translates to happier patients and staff. All of this adds up to a practice that is immediately on the plus side both clinically and financially.

4 Clinical nightmares frequently wake you. "The IOP was 22 mmHg, the fields were fair and the C/D was 0.3. If only I had an NFL analyzer, I'd be sleeping right now!"

Few of us would argue that older technology is clinically inferior to new technology. We know it intellectually and emotionally. We are reticent to change even though we know our technology is clinically "broken." Our only obstacle is the cost (see "Putting it Into Practice" at left and "Choosing Equipment That Works for You," on page 40). Like point number one above, our optometric experience and knowledge base tell us it's time to replace older "guessing" technology with new "it is" technology.

5 " Doctor Dinosaur, can we please get a new Opto-whatever?" asks your trusted staff member. If your staff is asking, then pay attention. They're probably hearing from patients that something needs replacing.

6 Put it out of its misery. There comes a point of diminishing returns with maintaining faulty older equipment. Just like newer cars, newer optometric technology requires less maintenance and is more easily upgraded. Cut your losses with technology that continues to break down.

How to pay for it?

While we all would like to drive a Lamborghini, most of us don't because of the cost. The problem with replacing our equipment is that we view it the same way as we would the Lamborghini. The same "What I'm driving is fine; I don't need anything as extravagant as a Lamborghini" emotions come into play. But unlike the car, our equipment, when correctly chosen and used, actually makes us money instead of costing us money. New technology isn't a luxury -- it's a necessity.

Think about when you bought your original equipment. Sure, the absolute cost was a significant consideration. But you still bought your equipment and started practicing. Your thought was, "I need this equipment to practice. I need it so I can do two things: Take care of my patients and run a profitable business."

Start saving

Fast forward to today. I'm asking you to once again do the exact same thing: Buy equipment just like you originally did -- but this time with the reassurance that it will take better care of your patients and be more profitable almost immediately.

Unlike the car, it won't use a lot of gas and require much maintenance. And certainly unlike the car, it's better for your patients, staff and bottom line. So get over the cost and move on. The longer you wait, the more money you're losing instead of saving.


Dr. Gerber's Top 10 Equipment "Replacers"

New Technology  Why New is Better
Virtual Try On Technology Get ready to toss your PD Ruler and thousands of frames in your inventory. What you save in inventory carrying costs will more than pay for the technology. The ability to streamline the frame selection process and sell multiple pairs is the icing on the cake.
Nerve fiber layer analyzer We all know tonometry and visual fields are not the best tests for glaucoma. While NFL analyzers can be used as a great diagnostic tool, some also have the ability to screen for glaucoma and to then generate additional revenue with the glaucoma cases it picks up.
Aberrometers Your current auto-refractor might work, but it is not telling you the complete story about how your patients are seeing. On the horizon are aberrometers that will allow fast and accurate refractions and allow you to replace the oldest technology in your practice - the conventional eye- glass lenses you've been prescribing for years.
Second-generation corneal topographer  Topography should already be a staple in your practice (Let's hope the  keratometer is already gone). This new paradigm in state of the art topography adds pupillography at a very affordable price.
Digital Eye Chart As mentioned above, your patients have already memorized the letters on your projector. These new "charts" are the inexpensive way to not only deal with that problem but offer lots of other great features.
Updated Web site technology Your current web site is probably nothing more than an electronic  brochure (that is probably out-dated). Newest offerings allow you to make changes to your content on the fly with no web design experience. They also integrate with your office computer offering you thousands of dollars in cost savings.
New refraction systems So, which is better -- one or two? There is now technology that not only asks the questions for you, but records the answers in a very easy to use and accurate way.
Communication technology Ask your staff if they like confirming appointments. Okay, you don't have to ask because you already know the answer. Your current appointment booking system and an unhappy staff will love you for adding this technology
High Tech point of purchase displays Dusty and outdated brochures and other ineffective point of purchase materials set the wrong tone in your office. Step up to a 42" plasma TV that delivers the right message to patients at exactly the right time -- when they're in your office and in "eye exam" mode.
Integrated refraction system Most of your exam lane can be condensed into a few feet of high technology with this complete refraction solution. Your aching shoulders will love you for looking at this technology.


Choosing Equipment That Works for You
By Richard S. Kattouf, O.D., D.O.S., Warren, Ohio

Before purchasing any piece of equipment, assess whether it meets some or all of the following criteria. It should:

  • Increase income
  • Increase patient flow
  • Enable you to delegate greater duties to technicians
  • Reduce doctor time with patients while maintaining a high level of care. This is a critical issue in a managed care environment
  • Act as a public relations tool. Make sure you teach proper scripting to maximize the affect of internal marketing. You must teach the patient that each instrument has unique characteristics. You must communicate three points to the patient when performing a test:

1. What you're doing to him.

2. Why you're doing it to him.

3. Why you must perform this procedure every year.

Assessing equipment

Let's take a closer look at the criterion we mentioned above.

1) Shift exam time to highly-skilled techs. The following instruments will help you do just that:

► An autorefractor (stationary or hand-held) gives the doctor a tremendous starting point. In essence, this is an automated retinoscope. Don't let your techs become robotic in repeatedly performing the same procedure. This instrument meets all the criteria above. Could save the doctor several minutes per patient.

► Retinal imaging such as Optos's Optomap. Some offices use this technology in lieu of dilation. Patients are happy because they dislike being dilated. When patients are sent to the optical department, they aren't blurred. Results are unique and impressive. The device can be accessed by any exam room computer. This is an "informed consent" procedure. The office makes additional income when the patient consents to have the procedure and pay the additional fee. Saves the doctor five to ten minutes per patient.

2) Increase income. Adding tests such as those listed above, plus such things as retinal photography, glucometry and sphygmomanometry are examples of expanding your medical imagery. All of these can add income through "informed consent." Such instruments and tests, combined with proper scripting, educate the patient that the exam is an eye health evaluation, not simply a spectacle exam.

3) Non-verbal messages. Hand-held autorefractometers by Welch Allyn, hand-held slit lamps by Haag-Streit and automated projectors (STIMULI) by Haag-Streit all exhibit the doctor's attention to disabled and pediatric patients. Patients and observers are impressed when they see that you've invested in specialty instrumentation for specific groups. Patients don't care how much you know until they know how much you care.

4) Staying on the cutting edge. You should have a goal to add some new instrument or procedure annually. This sends a tremendous image to your patients. Infant vision testers by Stereo Optical uses the "preferential looking" concept to evaluate acuity of infants. Potential Acuity Meter (PAM) enables a tech to establish the end point acuity of amblyopic and cataract patients.

5) Making your practice more sellable. We're presently in a buyers' market for the sale of optometric practices. Modern and plentiful equipment increase both the hard asset and goodwill value.

Don't rely on the machine

Keep in mind that without the proper internal marketing, you will not reap the benefit of your equipment investment.

Dr. Kattouf is president and founder of two management and consulting companies. for information, call (800) 745-eyes or e-mail him at


Dr. Gerber is president of The Power Practice, a company specializing in making doctors more profitable. You can reach him at (800) 867-9303 or at



Optometric Management, Issue: August 2004