G. Timothy Petito, OD, FAAO, DNAP, is director of professional relations for Marco Ophthalmics. He obtained his BS degree from Michigan State University and his Doctorate of Optometry from Ferris State University. In addition to 20-plus years in private practice, his extensive experience includes a residency in pediatric vision and vision training, academic positions at the State University of New York and a research scientist role at Columbia University. He is also an internationally known author and lecturer.
Richard Clompus, OD, FAAO: In 2017, Marco will be celebrating 50 years of innovation that began with Seymour Marco, an optometrist who had previously founded Frontier Contact Lenses prior to founding Marco. How did you become the first OD in the “executive ranks” since Dr. Marco retired?
G. Timothy Petito, OD, FAAO, DNAP: Four years ago, I began using the OPD Scan from Marco, which completely changed the way I practice. It greatly improved my diagnostic efficiency, and it allowed me to diagnose optical conditions that previously eluded (or just plain baffled) me and cost me a lot of time and money over the years.
Then, about two years ago, I got a call from a former colleague who was working for Marco at the time. Marco was considering adding a professional relations position to its administrative team, and he asked if I would be interested. I thought about how the technology had changed my practice, improved the outcomes for my patients and rejuvenated my excitement for the cases I used to dread. I thought I should do my part to help my colleagues learn about these great benefits, especially since at that time HIPAA, Meaningful Use, ICD-10 and PQRS were forming to be the perfect storm to sink a lot of practices. (Not to mention the uncertain effects of telemedicine, online retailers and the ACA with its alternative payment models that were not specifically defined then.) It was clear to me those who were not efficient or could not take care of complex cases””which may be one of the few profitable niches left””would have hard times ahead. I thought the position would give me a great platform to spread the message that we all need to improve our diagnostic and operational efficiency if we were going to survive the sweeping changes coming our way.
RC: How does the Xfraction Process improve efficiency and accuracy with eye exams?
GTP: Xfraction, the examination process that combines the use of the OPD-Scan III for optical path diagnostics, and the RT-5100 digital refractor for wavefront-guided refraction allow one to rapidly diagnose the condition of the patient’s optics, understand their likely endpoint acuity and adjust the examination routine as needed for maximum efficiency and best outcomes. These instruments and the automated lensometer share their data digitally and transfer it all to the EMR, tremendously increasing documentation speed and accuracy. This system can be implemented in a standard office design, with the OPD-Scan III in a “pre-test” room and the RT-5100 on a traditional stand next to a chair in an examination room elsewhere in the office. Or, the system can be configured on the EPIC workstation, which allows the OPD-Scan III, RT-5100, automated lensometer and a specialized acuity chart to fit in a 6 ft. x 6 ft. area.
RC: Marco is taking advantage of gains in smartphone technology with its new ION imaging device for biomicroscopes. How does the device work?
GTP: The ION Imaging system has three components. The first is a device that fits into the optical pathway of a biomicroscope between the oculars and the turret that contains the objective optics (the same location where the beam splitter for other imaging systems or observation tubes have traditionally been placed). The beam splitter and optical system divert light from the left ocular and transmit it to the camera of the iPhone 6 Plus (the second component of the system), which the ION body holds in the specific location and orientation needed to capture the image. The third component is the ION app for the iPhone. The app stores and transmits the images with appropriate HIPAA-compliant safeguards in place.
RC: As devices become more connected with the internet of things (IoT), how do you see instruments of the future used by optometrists for patient care?
GTP: This is a very interesting question because it touches on the topic of telemedicine and all the potential good and bad that it conjures. Certainly, we can gather data in various settings, remotely from the physician who is analyzing the collected data and formulating the treatment plans for a patient. There are situations and data types for which this arrangement is perfectly acceptable and will not impact the quality of care at all. In those applications, the improved access and patient convenience argue for broad acceptance of telemedicine as part of the delivery system.
But, there are also scenarios where quality is very likely to be sacrificed with potentially disastrous consequences by the use of telemedicine to replace face-to-face care, and the dilemma right now is to decide which scenarios fall into which category. Right now, we (society) get great benefits from the comprehensive nature of primary eyecare as it is provided by optometrists. In my opinion, we need to carefully consider the effects of segmentation of that care as currently described by the proponents of telemedicine in eyecare. Separating refractions from the history and physical examination of the eye and adnexa, or replacing actual examination of the eye with images of parts of it, will likely have costs in terms of quality. On the diagnostic side, every day in my practice I discover a serious health problem in a patient who presents with something unrelated to the condition I discover. It is very likely that without the comprehensive face-to-face examination currently utilized most of those people would not be diagnosed until much later in their disease course. On the therapeutic side, we know that long-term compliance with treatment for chronic conditions, whether it is dry eye, glaucoma or diabetic care, is not great. The longer between clinical visits, the worse the compliance becomes. It is yet to be seen whether telemedicine can improve that compliance or not. I suspect it will be better than nothing, but not as good as a face-to-face visit in this regard.
In short, the instruments of the future depend on how we and our patients accept the trade-offs and benefits of remote data capture.