Anything that improves customer experience will benefit brick and mortar opticians and ODs interested in selling eyewear. Separating medical and optical is one the most powerful ways to do just that. New refraction technologies could be the savior of our profession and even our industry. Refraction technology could, in time, allow a high percentage of opticians to become, once again, truly independent. The resulting separation of optical and medical would make the eyewear experience more palpable to consumers and would benefit everyone involved. How exactly might this happen?

Dr. Shui Lai, PhD, CEO of Vmax Vision, read my earlier article on how one optician used Smart Vision Lab’s autorefractor to obtain eyewear prescriptions. Dr. Lai contacted me and introduced me to his refraction technology technique developed under Vmax Vision, Inc. We discussed an integrated model based on an optician lead - OD relationship rather than the traditional OD lead – optician one. Here is our conversation.

John: If I understand it correctly, you have an auto-refractor which has added technological features that incorporate both objective and subjective measures?

Dr. Lai: Correct. Vmax had introduced several refractor models. The one you refer to is either the Lotus or the Perfectus. Both these models have a built in wavefront aberrometry-based auto refractor. Therefore, in one sitting, without moving a patient from auto-refraction to a phoropter exam room, both objective and subjective refraction are done.

John: Would you briefly explain wave-front abberometry, please? I know many opticians are only familiar with the lower order aberrations.

Dr. Lai: Traditional autorefractor looks at the retina image based on a single data point. Wavefront aberrometry uses hundreds of data points to assess the refractive errors of an eye. It is obviously much more accurate. On top of that, it provides high order aberrations beyond the sphere, cylinder and axis in a traditional Rx. The high order errors represent halos, glare, and order distortions not addressed by the low order ones, in the sphere, cylinder and axis numbers.

John: How does the combination of a subjective and objective measure change the way we can implement the use of technology like this?

Dr. Lai: You could place such station in the optical area if you like. It is for the first time that a refractor talks to the patient, and walks the patient through the entire objective and subjective refraction! An unskilled person can be trained to run the VASR (Voice Active Subjective Refractor) in a matter of hours. Certainly, a trained optician can learn it quickly. No need for a phoropter or the long training curve of a phoropter.  A novice can be up and running to provide good scripts within days.

John: That almost sounds like a dream come true for opticians who want to return to true independence. But, we still have the “dispensing a prescription” legality issue to deal with. Without going to jail, how do we get around it?

Dr. Lai: Legally, that script still needs to be validated by a licensed physician. However, there is no law that I am aware of that forbids a patient to self-refract. It is not a question of the accuracy of the script. Believe me, that is an easy one. We have collected hundreds of patient data points showing the results are over 90% equal to or better than those performed by an OD using a phoropter. Only time will allow us to fight for the ability to design lenses from the findings of this kind of technology.

John: (laughs) So much for my dream come true then. You made several valid points about how your model might, in time, bring about the changes I would like to see. Or at least a little bit closer to it anyway.

Dr. Lai: You may think we are back to square one, because we still need a doctor to validate. But there is a big difference here. If you have a VASR in your optical, you can catch all walk-ins, all hours, whether a doctor is in or not, since patients can do self refraction with VASR. Yes, you still need an OD or an MD, but, you only need them for a fraction of the time. Let’s say you have them on Tuesday and Thursday afternoons or two half days. You have three to five days to collect patients with VASR measurements already done and glasses made and ready for delivery. The doctor is there to do the medical part, validate the script, and dispense the glasses. All legal, and improves doctor utility by 300%. Think about it in terms of efficiency and cost cutting here.  

John: That sounds great in theory and is close to what I would like to see happen. But flipping the coin around is not going to be easy. I’m going to put you on the spot here. Give me your “elevator speech” and convince me, a recent optometry grad, to try this. Convince me that I might be better off working for an optician part-time rather than the other way around.

Dr. Lai: If you are a recent graduate from an optometry school, really you have mostly one choice, working for a chain store, for an entry level salary. They work you 8 hours with 4, 5, 6 or more patients per hour, and almost no upside. On the other hand, if you work with an optician or a group of opticians, you get referrals to fill your entire schedule. You earn a fee for each validated script, and collect medical exam fees. Best of all, you are building your own practice and very quickly!

John: Just to be clear. You are suggesting that an independent optician would add this technology to their store. They would run their customers through the system, help them through the usual steps of buying frames, choosing lenses etc. They would have the glasses made and then the glasses would be presented by an OD or MD.

Dr. Lai: Correct. As I said, the scripts are 90%+ in terms of accuracy. The prescription validation is expected to be completed in matter of seconds. Doctor hands the glasses to the patient, and then immediately begins a complete medical eye exam. This business model satisfies the state laws, in that; patient eye health is well taken care of. And nobody is issuing any illegal scripts.

John: Thank you, and thank you for contacting me. Between our emails, phone calls and this interview, it is clear our vision of the future is very closely aligned. I hope we both get to see it happen.

Is there anything you would like to add?

Dr. Lai: Health care costs must come down. Whoever can deliver cost-effective products without any compromise should get himself/ herself a lot of business. Our VASR technology is a big step approaching the direction of making quality eye care more affordable.

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