Have you reached the stage in your professional life where your practice is established, the leases on your initial equipment are substantially paid out and you are looking at making changes to your practice and your personal involvement in it? Most healthy practices start out with a modest equipment budget, allowing an optometrist to have minimal instrumentation with which to provide an adequate level of care for patients in its early years. However all practices reach a point where “minimum” is no longer enough.

Consider a consulting room with an old chair and stand, a refractorhead, slit lamp, keratometer and a set of hand-held instruments that were purchased back at university. Would this room meet the minimum requirements for an optometrist delivering an appropriate contemporary standard of care? Would today’s increasingly savvy patient recognize that an optometrist in a better-equipped room elsewhere could deliver a better standard of care? It constantly amazes us when we see practices that have outdated instruments and torn chair upholstery. All we can conclude is that some optometrists are so used to working with such conditions that they no longer notice these tell-tale signs of disrepair. Unfortunately for them, first impressions are extremely important to patients and the perception that a consulting room is shabby or old-fashioned will not inspire recommendation of the practice to others.

So what are the “minimum requirements” we need in our practices now and what would be “recommended”? The practice of optometry is constantly evolving, not only in respect to meeting the needs of patients, but also in the field of employment for young optometrists born in the computer age that have received their optometric education in an environment of high-tech instrumentation. A colleague of mine recently remarked that his search for an employee-optometrist was being hampered by the lack of a retinal camera and auto-refractor in his practice. Optometrists that have embraced technology with automated refraction and digital photography systems are rapidly becoming the norm rather than the exception, so where does that leave the consulting room described above? Unable to attract an employee in my colleague’s case! Furthermore, loyal patients that are unaware of alternatives may continue to accept care from a technologically backward practice, but patients expecting a better standard of technology from their optometrist will be lost forever and you have no way of knowing why.

Quite simply, keeping your diagnostic equipment up-to-date is a necessity. Today’s optometrist is increasingly perceived by the public and rightly so as the first person to see for a number of eye-related health issues. We have the training, but do we have the equipment to provide the best possible primary care in our environment of advanced technology and increasing prevalence of litigation? These are exciting times to be an optometrist, but with the extra elements of care that current legislation has authorized us to provide comes a responsibility to equip our practices to an appropriate scale. Whether or not a patient presents, for example, with symptoms that suggest problems at the back of the eye, we feel it is an optometrist’s responsibility not only to assess the retina but also to keep the best possible record of its condition for future comparison. It is an impossible task to adequately record the state of the fundus by means of sketching by hand. Now that the Topcon TRC-NW6, the indisputable benchmark in retinal cameras, has allowed us to capture and record digital images of the retina without mydriasis and without a blinding flash of light, can the responsible optometrist really be without one?

Not only does the NW6 provide unsurpassed retinal clarity, but its software compares two images of the retina simultaneously under high magnification. Consider the enhancement to our diagnostic toolbox that this affords us: firstly we can analyse a patient’s right and left optic nerve heads simultaneously, allowing us to detect asymmetries. Secondly images of the same patient taken on different dates can be compared, allowing identification and monitoring of even the subtlest changes in the retina. Thirdly images taken of a retina from different fixation angles can be viewed stereoscopically making possible assessment of optic cup-depth or any retinal lesion protruding into the vitreous.

Photographs of the anterior eye are also certain to enhance your practice and the Topcon range of digital slit lamps provide superb imaging without the need to sacrifice one of the eyepieces to a camera or to install a cumbersome beam-splitter. Patients respond positively to magnified images of the front of their eye and appreciate computerized record-keeping of such conditions as a pterygium for future comparison. A groundswell of recognition now exists of the benefits of this technology to optometrists that are serious about fitting contact lenses, especially now that Topcon has designed the photographics to neatly wrap around the eyepiece stem which permits unhindered access to the patient for lid eversion or digital manipulation of a lens. Furthermore, demonstration of images of soiled contact lenses or adverse ocular conditions will improve patient compliance.

The barriers that prevented optometrists from upgrading their practices have now gone. Topcon have augmented their autorefractors’ unquestionable reputation of being the most accurate with a range of digital cameras that clearly set the standards for optometric photography. Optical Manufacturers configure these instruments to interface with practice management software seamlessly and now that the associated lease expense is affordable for all practices, the opportunity to upgrade your practice has never been greater.

Lee Pepper
March 2005