The Best Ancillary Testing Options to Boost Productivity in Your Office
By Keli O'Connor, COMT, ABOC October 20, 2020
Patients trust their optometrists and ophthalmologists with one of their most valued senses. They deserve high-quality care and treatment, but eye care practices do not need all of the biggest and most high-tech testing gadgets on the market. Finding the right machines that suit the needs of patients can be invaluable for their health and practice record keeping alike.
At a time when it seems like insurers are demanding more from providers for less reimbursement, imaging and special testing can provide additional revenue where it is desperately needed. In time, these testing devices pay for themselves and more. There are numerous perimeters, cameras, and OCTs available, but knowing what your office needs can help narrow down which ones are the best fit.
Confrontation fields are a benchmark for virtually all eye exams, but the results are subjective for the patient and the administrator alike. The use of equipment and machines for recording central and peripheral defects has been common in practices large and small for decades, but there is not one single perimeter that is best for every office. Goldmann Visual Fields and tangent screens have their place and are generally reserved for specialty clinics, but the Zeiss Humphrey Visual Field and the Haag-Streit Octopus Perimeter are two of the more common machines in use today.
Humphrey Visual Fields are standard throughout eyecare. The Humphrey has been a steadfast choice for physicians from private practice to hospital settings for decades, and the technology only improves with time. Newer models include a liquid lens and, therefore, no longer require loose lenses for best vision. These units come with several types of tests preloaded into them and can be customizable to include test patterns that are not commercially available.
One of the biggest competitors for the Humphrey is the Octopus. This perimeter touts an unheard-of two and a half minute screening as well as results that are generally quicker than the Humphrey. Octopus fields have a built-in tracker to monitor changes and progressions in field loss over time, which can come in handy when recording glaucomatous field loss.
Whereas a perimeter only performs a series of one type of assessment, many instruments for the anterior chamber have several roles. Certain machines, like the Zeiss IOLMaster, have one primary purpose but other modalities offer a full suite of anterior imaging and scanning.
Like Band-Aid and Kleenex, the IOLMaster has a name that has become almost interchangeable with the type of product it is. The IOLMaster may be useful for only one test, but it's worth looking into because it is good at what it does. Often referred to as the gold standard in intraocular lens calculations, the IOLMaster is customizable and can tabulate lenses using any of the standard IOL calculation formulas still in use today.
For corneal topography and OCT, however, some machines work as stand-alone or as a multifunctional piece of equipment. Corneal topographers like the Zeiss Atlas or the Oculus Easygraph both generate high-quality surface maps, but the Atlas is a stand-alone unit compared to the Easygraph, which attaches to the slit-lamp for portability.
Systems like the Bausch & Lomb Ace Diagnostic Platform or the Oculus Pentacam are multifunctional and can capture a number of different measurements. These tests can document the thickness of the cornea as well as the depth of the anterior chamber. While there are models that require topical anesthetics for imaging, these machines are all non-contact and can be performed on most patients, regardless of Ks.
Dilated fundus exams are an essential facet of the visit, but there are occasionally problems under the surface that we just cannot see with the naked eye. Having an OCT in the office is a wise decision for any eye care practitioner, but not all OCTs are built the same. When it comes to retinal imaging, the Heidelberg Spectralis is one of the best pieces of machinery an office could have. Alternatively, the Zeiss Cirrus offers outstanding detail of the optic nerve and is often favored for that reason. Both machines can test both the retina and the nerve, so usually deciding which OCT is best for the office comes down to personal preference.
For clear fundus photography where the layers of the retina are not needed, there is a multitude of ophthalmic cameras on the market. For basic, single shots, the Centervue Eidon is one of the most straightforward cameras to use. Once in the headrest, the machine will instruct the patient to open their eyes and take the image automatically. This option is a good one for offices with limited staffing because of its speed and ease of use. Zeiss makes a camera called the Clarus, which is almost as easy to use and has the added capability of stitching multiple images together.
Some of the most beloved cameras in modern eye care, the Optos line of products can photograph the retina without dilation and has options for fluorescein angiography and autofluorescence imaging. What sets Optos apart from everything else is that they offer the most expansive views currently available at an astounding 200° in a single image. With all of these benefits, however, comes a hefty price tag. Their California, Daytona, Monaco, and Silverstone can run over $85,000 with customizations, but basic models will be a little easier on the office budget.
Deciding which machines to purchase for an office can be a difficult task that requires substantial research.
Each machine is specialized and, in many cases, customizable to the needs of the practice. Often, one camera can do the job of many, freeing up space and thousands of dollars. Representatives from all of the manufacturers listed here will gladly consult for advice and assistance, but taking a full inventory of your practice needs and comparing it against your ancillary testing options is the best bet for your patients.