My name is Dr. Benny Peña, and I switched to the ZEISS digital refraction system. If you didn’t know that ZEISS makes a subjective refraction system, let me tell you about my experience. It does a lot of things very well.
The core of the system has three components: a digital phoropter called VISUPHOR®, a digital display called the VISUSCREEN®, and the i•Com mobile user interface. The first thing that struck me when I first saw the system is how totally modern it looks. Instead of a plastic-covered phoropter shaped like an everyday phoropter, the VISUPHOR looks like a pair of flat panels. The VISUSCREEN is very flat, very sharp and very bright. The user interface is on an iPad, and you can tell that it was made for touch because the layout is very simple. Everything looks like it was designed to fit together as a complete system, right from the beginning. But it was only after I started using it that I could really sense how much attention ZEISS paid to details.
THE VISUPHOR PHOROPTER
The phoropter allows me to set corneal vertex distance using illuminated viewing ports on the front of the phoropter, by viewing a side profile of each eye. There is no need to crane my neck or peer behind the phoropter. Although the patient’s PD can be automatically uploaded and set from pre-test data or patient records, the VISUPHOR has another nice touch: cross-hair reticles to adjust the monocular PD.
Other phoropters have an indicator light to show if the patient is in contact with the forehead rest, but ZEISS provides an indicator both on the phoropter and on the iPads user interface. The forehead rest is broad and fairly flat making it very comfortable for the patient and very easy to clean. In fact, the entire phoropter housing is so simple that cleaning it is a breeze compared to other phoropters I’ve used. And today’s patients really pay attention to cleanliness!
IPAD USER INTERFACE
I really enjoy the user interface. The iPad lets me change position easily while maintaining control at all times. The other digital phoropters I looked at all had control panels that looked gimmicky with lots of buttons and controls. I thought they could be difficult to operate. A great feature about a software-defined touch interface is that controls can be upgraded, and ZEISS has already provided new features and capabilities. I wouldn’t get that kind of upgrade capability with a user interface controlled by knobs and buttons on a hardware panel.
The ZEISS user interface only shows me controls for the test I’m doing at the moment. That’s because the software is based on workflows. I created my own workflow based on my needs, but it would be possible for another doctor to use his or her own customized workflow or a standard work flow. Basically a work flow is a sequence of a set of tests to be performed in every refraction, and you can have several defined workflows for different kinds of exams. ZEISS also provides a “Freestyle Mode” to switch away from a defined workflow in case a particular patient requires a different test. Of course the user interface allows the doctor to let the patient experience different refractions, but the ZEISS system’s total wireless integration makes it easy to compare values such as the power of the patient’s current glasses, i.Scription® wavefront refraction, or a previous refraction pulled from an EHR system. All refraction results that are available are displayed on a convenient list and can be shown to the patient at the touch of a button on the iPad.
I already mentioned that the VISUSCREEN is very bright and very sharp. It is fully integrated and wirelessly linked to the user interface and phoropter. Whatever is displayed on the screen is also displayed on the iPad’s user interface. That is a lot more natural than twisting around to see what the patient is looking at! I can do the whole refraction without ever turning my back on the patient. I like to randomize letter presentation to keep patients from memorizing charts or “locking in” on a single letter during cross cylinder testing, so it’s a great benefit to have a “what you see is what they see” display right in front of me! The display can show many kinds of targets, including pediatric pictures. Another feature I’d like to explore more is using inverted contrast or low contrast letters, especially for patients who have unique requirements or are especially sensitive to slight prescription changes.
The complete integrated system provides capabilities that advance the experience of refraction. One of those is split-prism monocular refraction that takes the cross-cylinder test to a next generation: instead of having to remember which view is better, the patient gets to compare both views at the same time. I find this easy for the patient to understand and makes this part of the refraction very efficient. Another useful feature is the artificial star built into the VISUSCREEN. With this you can directly simulate the effect of your refraction on night vision.
I use an iProfiler and use this feature to demonstrate the improvement of the i.Scription.
I also love the seamless wireless integration with our ExamWRITER software. We can automatically transfer data from pre-testing to the phoropter, and when I’ve finished the latest refraction, I just tap a button on the iPad and a button on the computer, and everything is sent directly to my EHR. Plus whenever another of our doctors has a visit with one of my patients, any of the patient’s previous refractions can be uploaded to the phoropter, making it easier to understand what’s going on.
Patients love the ZEISS refraction experience, and most of them comment on our state-of-the-art technology. They love that lenses in the phoropter change quickly and quietly and tests are set up to proceed quickly and efficiently to a conclusion. In fact, I appreciate that too because ZEISS has made it possible for me to spend less time on refractions so that I can spend more time evaluating patients’ ocular health and prescribing the best lenses and lens enhancements for their lifestyle.
Brought to you by Carl Zeiss Vision, Inc.