For decades, a manual keratometer, slit lamp, and the ophthalmoscope were the main instruments used by optometrists to examine their patients. As technologies advanced, analog film cameras and beam splitters were added to slit lamps and retinal film cameras became affordable.
My first experience with an automated instrument was the Dioptron autorefractor in 1979. It was amazing technology for its time. The size of a small refrigerator, it took about a minute per eye to perform its magic as internal motors moved and whirled internal lenses. At the end of the process, a thick paper card was ejected with your patient’s refraction.
My second experience was installing the original Humphrey Visual Field Analyzer (HFA-1) in my primary care practice. It had motors, solenoids, and a video monitor to follow the progress of each test. It made lots of noise as it presented each new stimulus for testing, but it did provide repeatable 30-2 threshold visual fields. For the first time, an automated instrument gave optometry the same diagnostic capability as ophthalmology. This technology provided accurate information to diagnose and manage glaucoma suspects and the ability to co-manage patients referred to a subspecialist.
Over time, additional automated instruments were installed in the practice: autorefractor/keratometer, corneal topographer, digital retinal camera, frequency doubling technology perimeter, HFA-2, OCT, and ERG diagnostics. Many have since been upgraded with software or replaced with newer, more capable models for increased diagnostic capability.
What I’ve learned: the best diagnostic instruments are a great equalizer in patient care. Your practice is defined by the instruments in your office. If you don’t have adequate instrumentation to diagnose and manage ocular disease, it’s nearly impossible to grow. My recommendation for 2016 is to carefully assess the latest generation of diagnostic instruments and implement them when appropriate to expand your practice.
Richard Clompus, OD, FAAO | Professional Editor