Article Date: 9/1/2005

Update Your Refraction System
Technology has moved far beyond your old phoroptor and your patients know it.
BY GARY GERBER, O.D., Hawthorne, N.J.

In order to concentrate on my consulting business, I recently retired from private practice. So, after 22 years in the field, I thought I deserved the answer to optometry's longest unsolved mystery — which is better, one or two? Well, I can tell you: Even when you leave practice, you still won't know. But I did learn that the ways we ask that question are changing.

A new standard

What was once thought of as little more than a toy for the wealthiest opto-techno-geeks, electronic refraction systems are becoming mainstream and with good reason. I admit, while practicing I, too, was hesitant to take the plunge into this new technology. But the recent precipitous drop in pricing for these systems made the plunge a much smaller step. Many of the "fully-loaded" systems are now available for less than $30,000, putting them in reach for almost any practice.

The complete systems I'm referring to typically include an auto-refractor/keratometer, auto-lensometer, electronic phoroptor and electronic chart. The data from the auto-refractor/keratometer and auto lensometer is "dumped" into the phoroptor. The final refraction data can then be further dumped into your practice management software. Beyond the instant elimination of transcription errors, let's look at the other benefits to these systems and how they can help your patients and practice.

For your patients

We have many clients who call us on the verge of burnout. Indeed after years of spinning the dials on their phoroptors and never finding out which really is better, one or two, can you blame them? Even with optometry's expansion into medical eye care, a thorough refraction — with a phoroptor — remains the symbol of optometric care. But even in the most high-tech practices that have yet to use these systems, it's common to hear patients say, "Doc, I don't get it. With all of these gadgets and computers, my eyeglass prescription still comes down to me guessing at letters with the one or two machine. Why is that the one thing you haven't updated?"

Yes, one reason to consider a refraction system is that patients do notice that you are still using the same phoroptor you've had since the day you opened your practice. While waiting for you to enter the examination room, they are checking e-mail from handheld PDAs and talking on cell phones — and staring at your phoroptor. See a technology disconnect here? Patients think refraction systems are cutting-edge, and that's a compelling reason to add them to your practice!

Make life easier

This article is about refraction systems and isn't intended to once again open a debate about delegating refraction. Suffice it to say that with these systems, if you choose to delegate, it's easier than delegating refraction without them. For example, your sequence of refracting can be pre-programmed for different patient populations. Want to use a 0.25D cross cylinder most of the time, but a 0.50D for seniors? On most systems you can easily set-up these two different scenarios.

Should you choose not to delegate your refraction, you can still gain some speed in the exam room because you won't have to load in the data from your pre-test room. Also, showing patients the difference between their habitual Rx and their new Rx is a fast, one-button process instead of utilizing multiple, slower lens changes. The targets on your chart can be programmed to change simultaneously with each phase of your refraction sequence. This enables you to avoid this embarrassing phenomenon that has happened to all veteran OD.s . . .

Doctor: "Is that line of letters blurry?"

Patient: "Uh, Doc — there isn't a line of letters up there. There's only one letter."

. . . And for yourself

Many clients have told us that a major benefit of these refraction systems is that the doctor is now practicing "pain-free." While optometry isn't historically thought of as a physically taxing profession, reaching for that phoroptor patient after patient, year after year, has caused many a sore shoulder and back. Now, you can sit down, face your patient and spin the dials from the comfort of your desk. No more leaning, no more reaching, no more pain.

With some of the newest refraction systems, it's now possible to eliminate a conventional refraction entirely. They talk to the patient and self-direct them to complete the refraction. Newer wavefront refraction systems allow data to go directly from the instrument to the eyeglass lab with the push of a button. The prescription, as well as the correction of higher- order aberrations, is recorded with a bar code that is transmitted to the lab via the Internet. There are no transcription errors and should you choose to do so, it's easy to delegate.

This one's a no-brainer

Which is better, one or two? I still don't know. But I do know that these new refraction systems are better than the manual ones.

Refraction Systems

Marco  EPIC, TRS, Evolution
Ophthonix RH Burton Z-View Aberrometer 
VELO Refraction System,
VELO Refraction System w/ slit lamp
Topcon CV-3000 Refraction System,
BV-100 Automated Subjective Refraction
Veatch  DRS-3100 Digital Refraction System,
DRS-3100 Lite Digital Refraction System,
Futura Digital Refraction System

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: September 2005