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When Their Tech Lets them Down, These ECPs Have Things Covered

And their patients appreciate the human touch.

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TECHNOLOGY: IN OPTOMETRIC terms it means unparalleled accuracy, speed and convenience. But real life has a way of throwing up cases that just won’t cooperate with the latest equipment. And blackouts can strike anywhere. This is an industry whose gear continually evolves, but it’s also one of accumulated knowledge and, occasionally, improvised solutions. We asked around to see what kinds of tricks opticians and ODs have up their sleeves. If the lights go out while you’re in the chair or at the dispensing table of any of these eight ECPs, you’ll be in good hands.

Carissa Dunphy, Lake Stevens Vision Clinic Lake Stevens, WA

Optician Carissa Dunphy believes it’s important to take both digital and manual measurements from every free-form progressive wearer because she sees differences in patients’ body language towards a camera/iPad versus a person doing a manual measurement. Tech doesn’t always accommodate for specifics noted by the optician, such as someone who is really tall or short, she says. “A fitter of free-form progressives should know how to measure for each position of wear (POW) value manually and should measure both ways, comparing the values and critically thinking about the right solution for that particular patient.”

Bridgett Fredrickson, Whelan Eye Care
Bemidji, MN

Low-tech solutions have a special place in the heart of a veteran administrator like Bridgett Fredrickson at Whelan Eye Care. She and her doc are probably the only ones in her office who know how to handle an exam on paper. “About once a year we have to pull out a form … while our computer software is down.” She knows of older ODs who never came to grips with electronic records, and younger docs who would stare blankly at a paper form. “Those of us [from] that bridge era have a unique perspective and appreciate the old way and the new.”

Adam Ramsey, OD,Iconic Eye Care
Palm Beach Gardens, FL

An old-fashioned technique Dr. Adam Ramsey uses regularly is trial frame refraction, which he finds spares him headaches with patients that are particular. Ramsey says it’s a “great way to move the phoropter out of the way and deal directly with the patient.” If he finds prism in the patient’s previous glasses, he will “usually skip the fancy toys and go straight to the trial frame to refract that patient. Using fixed PD trial frames gives … the best comfort.” Most patients appreciate the extra care, he says, especially when they can visualize the improvement right away.

Mike Davis, OD, Opti-Care
Eldersburg, MD

Dr. Mike Davis is nothing if not prepared. We’re confident his patients could enter his practice in a blizzard-induced blackout and come out seeing perfectly. He keeps a paper acuity chart around, along with a hand-held retinoscope and ophthalmoscope, and trial frame and lens sets. His iCare tonometer is battery powered, and with a PD stick at hand he’s “ready to roll.” The hand-held equipment Davis uses was primarily brought in to save space, but “by happy coincidence” it’s mostly battery-driven, so he’s confident he could get by for a day or so without power. “The art of hand neutralization, figuring out the prescription … with a lensometer, is helpful on house calls and nursing home visits, but mostly a good party trick.”

Marc Ullman, OD, Academy Vision
Pine Beach, NJ

“I … have inserted punctal plugs outside in the sunlight with a jeweler’s headset when the power is out,” proclaims Dr. Marc Ullman with justifiable pride. Magnification is weaker with the headset than behind the slit lamp, Ullman says, but he feels most doctors should be able to insert punctal plugs with a headset if necessary. He has most brands and sizes of collagen and silicon plugs on hand and has lately been using the six-month extended plugs more often. “Punctal occlusion generates a lot of referrals and happy patients at my office,” he says.

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Jen Heller, Pend Oreille Vision Care
Sandpoint, ID

“It may be silly,” says Jen Heller — a champion of the humble PD stick — “but I can prep a pair of glasses anywhere, anytime, with all the lights out and just a dinky little flashlight, and so can all our staff.” Some facilities might sniff at the idea as “backwards,” but Pend Oreille Vision Care still does hand-measured PDs on all orders, because they found that it was easy for rookie staff to lose track of where they’re placing a traditional pupilometer on squirmy kids, or adults with broken noses. “With a hand ruler, everyone can see exactly where that crook in the nose is — or, better yet, take a relaxed PD over the top of a patient’s previous prescription to rule out that plunging eye turn in high hyperopes.” Rulers are cheap and plentiful, and all staff are trained to take manual PDs. This way, Heller says, “patients never have to wait around because someone else is using a piece of equipment or because all dispensing tables are full. Get the needed measurement, and go!”

Pablo E. Mercado, LensCrafters
Alpharetta, GA

Alpharetta, GA-based optician Pablo Mercado told us that outside of screwdrivers and pliers, the PD stick is the one tool he cannot work without. “With it, I can forgo most of the technology at the office and still feel confident I can deliver quality eyewear.” While his workplace has a sophisticated digital system, “for some cases it is a complete dud” and Mercado reaches for the stick. It comes in especially handy when taking measurements from children. But he also uses it to measure the thickness of a frame when edging — and he’s just getting started: “I use my PD stick to show patients how a couple of millimeters can make the difference between being able to wear a particular frame or not,” and to train coworkers. He also finds it indispensable when inspecting eyewear for quality control.

Sarah Bureau, sbspecs
St. Catharines, ON, Canada

Now here’s a really old-fashioned idea: Repair, don’t replace. According to sbspecs owner Sarah Bureau, a modern mobile business based in St. Catharines, ON, Canada. “The general consensus when we, as an industry, are presented with a broken or wear-worn frame is to recommend it be replaced.” But Bureau insists that an acetate frame that has been well loved and has now turned white can be brought back to its original lustre by sanding and polishing the acetate by hand. Using a clavulus or hot fingers to replace a hinge, whether riveted or hidden, can save your client from having to replace a temple or frame front, she says, while cracked acetate rims or broken bridges can be repaired by fusing the material back together and filing and polishing by hand. These are especially valuable options for frames that are no longer in production. The approach does more than just demonstrate Bureau’s concern for the environment; giving your client the option of a repair, she says, is a great way to build a strong and long-lasting relationship with them. “Offering these services results in their confidence in you as a professional and the retention of them as a loyal client.”

After years covering some of the farther flung corners of the world of business journalism, Heath has more recently focused on covering the efforts of independent eyecare professionals to negotiate a fast-changing industry landscape. Contact him at [email protected]

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