Technological updates in the office and exam room may not be proof of an optometrist’s ability to manage ocular surface disease or accurately provide refractive error correction, but streamlined communication, modernized instruments, and applications using virtual reality and artificial intelligence have the potential to enhance patient experience and add an element of credibility to an optometric practice. In this second installment of Optometry Advisor’s Best Management Practices series, Miriam Korik, OD, of Park Slope Eye Optical Boutique in Brooklyn, discusses the importance of using updated technology to improve operational efficiency, save time, and impress patients.
The past decade, particularly the post pandemic years, has created an exponential boom in technological advances in health care.1 This technological evolution has found its way into eye care and exists among a variety of practice modalities. From optical boutiques to high-volume pediatric practices to dry eye centers of excellence, the integration of state-of-the-art advancements has not only elevated the diagnosis and treatment of various eye conditions, it has also enriched the overall patient journey. Implementing new technologies in the exam room, which may include ultra-widefield optical coherence tomography (OCT) or rebound tonometry, or outside of the exam room, which may include streamlined office-to-patient communication, patient portals, and virtual assistants, can broaden the scope of practice, significantly improve efficiency, and have a positive influence on patient encounters.2,3
Optimizing the patient’s journey starts with improving the way they book an appointment. Does the patient need to call the office during limited operating hours to speak with a live person, who may ultimately put them on hold? Do they have to call to ask if their insurance is accepted? Or, can the patient book online through a website or use automated texting to make the appointment and view doctor availability on their own time? Does the practice’s website provide a list of covered insurances to eliminate coverage surprises at the front desk? By offering multiple ways to book an appointment at any time of day, patients can enjoy the convenience of making an appointment on their own terms, while office staff can use that time to address other concerns.
Automated texting can also provide timely reminders to patients, resulting in less missed appointments and improved patient compliance with follow up.4 Some texting and instant messaging programs can keep patients updated with their appointment status and provide other important office updates.
Virtual front desk assistants can help with administrative tasks that can be handled without a face to face interaction, including manual data input, checking insurance, and scribing. These remote employees can also schedule appointments, answer emails, and post on social media pages, which improves office efficiency by removing some tasks of the in-office team.3
Patient portals can provide a secure, efficient, and user-friendly method for patients to access their health records, view the status of their glasses or contact lens orders, and communicate with their optometrist. This document-viewing portal enhances the patient experience by making it easier to view their prescriptions and treatment plans.
A Technological Makeover for the Exam Room
After making an appointment on their own terms and enjoying the hassle-free experience of using a website to answer insurance-related questions, patients may be happy to see that their doctor is using the latest technology to aid in their clinical decision-making.2 During pretesting, wide-field fundus screening and an optic nerve and macula OCT wellness scan can allow the doctor to detect retinal disease, identify macular changes, and screen for glaucoma before performing biomicroscopy and refraction. It also allows the optometrist to triage their focus during the exam. For example, if a patient presents with a macular hole during OCT evaluation, the doctor can presume the patient may not be able to see the 20/20 line during refraction.
Adding in a slit lamp camera and infrared imaging of the meibomian glands can provide a visually-enhancing experience for the patient — one that has the potential to inspire lifestyle changes or improve treatment compliance.5 When describing meibomian gland dropout to a patient, clinicians with this technology can show the patient side-by-side comparisons of their meibomian glands, an image of normal glands, and glands with severe dropout. Having an imaging system that allows patients to see their own glands can inspire them to try evidence-based treatments for meibomian gland dysfunction or simply improve their eyelid hygiene and dry eye management routines.
Investing in technological updates for the practice can lead to a wider scope of practice and enable optometrists to offer their patients more services. For example, integrating amplitude scan (A-scan) ultrasonography and corneal topography allows optometrists to provide more accurate, efficient, and comprehensive myopia management services.6,7 By regularly monitoring eye length with an A-scan, optometrists can track myopia progression in their patients, compare them with age-matched individuals without myopia, and adapt management strategies accordingly. Corneal topography can reveal corneal thinning or warparge, and is essential for any practice that fits orthokeratology lenses.
Replacing non contact or applanation tonometers with a handheld, rebound tonometer can improve patient comfort and cooperation, which will ultimately reduce chair time and enhance the overall patient experience. Instruments that produce visually-stimulating images, an ability to provide more specialized services, and a more comfortable exam experience can really increase the “wow factor” for patients who are accustomed to inconvenient, long-lasting dilation or uncomfortable puffs of air to the eye.
Expanding Technological Updates Beyond the Exam Room
Telemedicine, the delivery of health care services through digital platforms, has significantly affected the way optometrists provide care during and after the pandemic.8 Incorporating telemedicine into clinical practice can offer flexible scheduling for doctors and their patients and can be performed synchronously or asynchronously. A synchronous telehealth exam involves optometric evaluation from a remote location in real time, while an asynchronous exam is not performed in real time. Offices that implement a cloud-based storage system can provide asynchronous care, and technicians can upload refraction, lensometry, widefield retinal imaging, slit lamp, and tonometry data for the optometrist to review and discuss at an agreed-upon time frame. Both types of exams are advantageous in terms of enabling scheduling flexibility and reducing patient wait times, and clinicians can remotely service multiple locations and expand their patient base.8
Telemedicine cannot always replace traditional, in-person care, but it can serve as a convenient supplementary tool. With a balanced integration of telemedicine and in-office visits, optometrists can offer a hybrid model of care to better accommodate their patients’ and doctors’ schedules, enhance their practice’s efficiency, and maintain patient satisfaction.8
Using Interactive Virtual Reality and Artificial Intelligence Applications
Virtual reality applications can provide a more immersive, engaging, and enjoyable experience for patients treated with vision therapy.9 This technology includes a wide array of interactive games and exercises designed to improve depth perception, eye coordination, and visual processing speed. The exercises, which are more akin to playing in a virtual playground than undergoing traditional vision therapy, make the experience fun for patients.
Mixed reality technology can blend the physical and digital worlds, allowing patients to interact with holographic objects in their real-world surroundings. The doctor can also personalize patients’ treatment plans and adjust the difficulty and variety of games. Patients can see their progress in real-time, which can be encouraging and rewarding.9
Artificial intelligence (AI) can reduce time spent performing routine tasks in optometry practices, which translates to more time spent with patients.10 One AI-powered platform can perform automated medical transcription. After recording conversations between the optometrist and patient during a clinical encounter, the technology automatically transcribes relevant information into the patient’s electronic health record, which the doctor can later edit. Other AI applications may include testing analysis, appointment scheduling, writing summary reports to primary care providers, and automated billing and coding.
Bringing the Technologies Together to Enhance Patient Experience
Advancements in eye care technology, which include integrating the latest diagnostic and treatment equipment, using automated texting for appointments and doctor communication, and implementing virtual reality and AI, have all collectively transformed the patient eye exam experience. These technologies have improved accuracy, efficiency, and overall patient satisfaction. By embracing these innovations, eye care professionals can create comprehensive and personalized solutions to meet the visual needs and expectations of their patients. As technology continues to evolve, new advancements will further enhance the patient experience, promote better eye health outcomes, boost practice efficiency, and improve the overall quality of eye care services.
- Stuermer L, Martin L. Characterization of technologies in digital health applied in vision care. J Optom. 2022;15(Suppl 1):S70–S81. doi:10.1016/j.optom.2022.09.005
- Miller L, Derbyshire L. Clarity and precision: a new generation of imaging. Optometry Today. Published January 15, 2022. Accessed July 25, 2023. https://www.aop.org.uk/ot/industry/equipment-and-suppliers/2022/01/15/clarity-and-precision-a-new-generation-of-imaging
- Malamas N, Papangelou K, Symeonidis AL. Upon improving the performance of localized healthcare virtual assistants. Healthcare (Basel). 2022;10(1):99. doi:10.3390/healthcare10010099
- Robotham D, Satkunanathan S, Reynolds J, Stahl D, Wykes T. Using digital notifications to improve attendance in clinic: systematic review and meta-analysis. BMJ Open. 2016;6(10):e012116. doi:10.1136/bmjopen-2016-012116
- Llorens-Quintana C, Rico-del-Viejo L, Syga P, Madrid-Costa D, Iskander DR. A novel automated approach for infrared-based assessment of meibomian gland morphology. Transl Vis Sci Technol. 2019;8(4):17. doi:10.1167/tvst.8.4.17
- Iqbal F, Khan HA. Comparative analysis of axial length measurement using partial coherence interferometry and clinical ultrasound. Adv Ophthalmol Vis Syst. 2019;9(1):11-13. doi:10.15406/aovs.2019.09.00334
- Fan R, Chan TC, Prakash G, Jhanji V. Applications of corneal topography and tomography: a review. Clin Exp Ophthalmol. 2018;46(2):133-146. doi:10.1111/ceo.13136
- Massie J, Block SS, Morjaria P. The role of optometry in the delivery of eye care via telehealth: a systematic literature review. Telemed J E Health. 2022;28(12):1753-1763. doi:10.1089/tmj.2021.0537
- The VTS 4–HoloLens computer orthoptics holographic vergence exercise system. Accessed July 25, 2023. https://htsvision.com/vts4-hololens/
- Scanzera AC, Shorter E, Kinnaird C, et al. Optometrist’s perspectives of artificial intelligence in eye care. J Optom. 2022;15(Suppl 1):S91–S97. doi:10.1016/j.optom.2022.06.006