SPOT On: AOANews March 2013


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This is a story I wrote about the SPOT autorefractor for the AOANews. It features the staff at Lyons Family Eye Care and several others who are involved in its use and development.

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SPOT On: AOANews March 2013

  1. 1. TOMORROW’S PRACTICE TODAY Spot on!By Dominick M. Maino, O.D., called the Spot. an incredibly efficient way toand Geoffrey Goodfellow, The Spot is relatively screen children” and “it isO.D. small, lightweight (2.5 lbs.) much easier to obtain a read- and easily transportable ing on children because itA OA members are (slightly bigger than one of doesn’t scare them by forcing constantly trying to those more expensive digital their head into an instrument.” use technology to SLR cameras with a fairly Simpson also said it is anserve their patients at the high- large zoom lens attached). The efficient way to assess refrac-est level and at the same time testing sequence is straight tive error and is often moreimprove overall efficiency of forward. You turn it on, enter accurate for children andtheir office procedures. The the appropriate data, reduce patients with special needsmany tools used include those the room illumination, have than other auto-refractorsthat assess ocular health and the patient look at the camera available in the office. Evenan electronic health record (the patient fixates lights that more telling is that she would(EHR) system that not only can be associated with various suggest to her employer,meets the requirements of sounds), and then within about Stephanie Lyons, O.D., that ifthird-party payers and govern- a second or so, obtain the she had to buy the Spot again, Rachel, an optometric technician/optician atment regulations, but also desired results. that the investment was well Lyons Family Eye Care, conducts a pre-examina-improves office communica- The Spot is WiFi-enabled worth the cost. tion sequence using the Spot on smiling patienttion and efficiency. and has a battery life of about Audrey Reed, director of Carie Zaas, whie her mom, Alina, looks on. Frequently, when it four hours. With it, you can National Programs, Essilorcomes to refractive care, measure a range of refractive Foundation, has been using be obtained. The Spot is a part may be using this and similaroptometrists tend to rely more errors from -7.50 to +7.50 and the Spot for some time as of the pre-examination devices within their office visiton retinoscopy and the stan- up to 3D of cylinder. The well. She and her volunteers sequence that our AOA certi- sequence. This is not necessar-dard “which is better, one or patient’s pupil size can be as conduct vision screenings that, fied paraoptometrics routinely ily inappropriate unless thetwo?” subjective refraction small as 4mm and as large as when needed, lead to an use prior to my conducting a patient or parents of theand less upon technology. This 9mm with a pupillary distance immediate eye examination by comprehensive examination. patient interprets the findingsmay be changing in the near from 35-80mm. The device an optometrist. She notes how As new advances are in such a way that they believefuture as many new choices can be mounted on a tripod easy it is to teach her volun- made in this area and the next- a full, comprehensive eyeare becoming available in the and also has a neck strap and teers to use the Spot. generation Spot appears on the examination was completed.area of auto-refraction. safety wrist strap mounts. Reed also said they used this horizon, our wish list includes This can often result in a false Although auto-refraction Once the data is captured, auto-refractor with 200 chil- an expanded range of refrac- sense of security by the par-technology has been around the screen displays the dren over a two-day period tive error determination (+/- ents and devastating, unintend-for decades, there did not patient’s PD, pupil size, eye and only had four children 7.50 is just not adequate when ed consequences for theappear to be any one device alignment, the refractive error with whom the screener did you work with special-needs patient if a serious eye disease,that could work with all popu- spherical equivalent and the not appear to function well. patients), voice input of data, binocular vision dysfunctionlations typically evaluated by complete refractive error Both Simpson and Reed an even faster capture time, or refractive error is missed.optometrists. Various auto- (sphere, cylinder, axis) in commented on how the need and the ability to work in a We would also caution thoserefractive instruments worked either “+” or “–“ cylinder for a darkened room and fairly wide range of ambient light conducting vision screeningswell with adults but not chil- form. You can also print a hard large pupils sometimes including normal room illumi- that if the screening does notdren, while others did not copy of the findings that can detracted from the Spot’s use- nation. lead to better outcomes, a cur-seem to work with those be included in your patients’ fulness, but its overall usabili- Although Jeff Mortensen, rent review of the literaturepatients with special needs at files or scanned as a PDF and ty, ability to save data on a vice president Business suggests a comprehensive eyeall. Some early refractive error attached to your EHR patient jump drive, and wireless con- Development of PediaVision, and vision evaluation be con-screening technology initially database. When used as a nectivity far outweigh any lim- couldn’t comment on future ducted by a doctor of optome-required one to send in pic- vision screening device, the itations. Another possible limi- incarnations of the Spot, he did try as soon as possible.tures to be evaluated by an printout also offers a severity tation to the device noted by say the SPOT does not replace More information aboutoutside source before you index and call to action rec- some is that using a finger to the comprehensive eye exami- the Spot can be found atcould tell the individual what ommendation. Any finding input data can be difficult, but nation and that it “is an appro- of refractive error was printed in red suggests prob- that if you use the rubber end priate tool for use as a part ofpresent. lem areas to be investigated, of a pencil data input becomes the doctor’s pre-examination Dr. Maino is a professor at the This is changing, and the and at the top of the page (also much easier and reliable. sequence” and can be used to Illinois College of Optometrychange may lead to conse- printed in red) will be a call After using the Spot in “build awareness of various (ICO) and a Distinguishedquences yet not imagined (see for action such as “Complete my (Dr. Maino’s) private prac- vision issues including not only Practitioner of the National Eye Exam Recommended.” tice (Lyons Family Eye Care) refractive error but also binocu- Academies of Practice. He can9/13/diy-refractions-disrup- for several months, I find it lar vision dysfunction.” be contacted attive-innovation-that-affects- Firsthand does what it is supposed to do experience pretty well. I also found it A few caveats Goodfellow is an associatemy/). There may be one fairly easy to use, and even the professor of optometry at ICOnew device, however, that AOA certified paraopto- youngest child and more diffi- and unintended and the colleges assistantcould change how we practice metric Katherine Simpson of cult patient with special needs consequences dean for curriculum andright now. This device is Lyons Family Eye Care in will often respond in such a It is our understanding assessment. He can be con-offered by PediaVision and is Chicago notes that the Spot “is way that a reliable reading can that pediatricians and others tacted at ggoodfel@ MARCH 2013 29