The latest AL-Scan M biometer from Nidek can be characterised by unprecedented speed, accuracy, and reliability. But for optometrist Susan Walton, it was the ability to offer myopia management with greater confidence that cemented her decision.
In preparation for a myopia epidemic, optometrists across the country are re-evaluating their current practice scope and ensuring they are equipped with the latest technology and treatments to optimise management of this progressive condition.
Mrs Susan Walton OAM, principal optometrist at Specialeyes Newcastle, decided to expand her suite of diagnostic instruments to include the new Nidek AL-Scan M Biometer so she can offer her patients premium, all-inclusive eyecare.
Walton is a behavioural optometrist, and fellow of the Australasian College of Behavioural Optometry and Australasian director of the Opening Eyes program for Special Olympics. With two vision therapists in the practice, the team see a large volume of paediatric patients.
With an estimated 25% of children diagnosed with myopia in Australia, Walton wanted to ensure her practice’s diagnostic and management capabilities catered to the needs of the population.
“I thought: ‘I should be looking more closely at the increasing numbers of younger children becoming myopic coming through the practice’,” Walton says. “The biometer was a means of tracking myopic change in an objective way that I didn’t have within the scope of the practice before.”
Previously, she had relied on a topographer to fit orthokeratology (orthoK) lenses as a means of myopia control, and ensured the children had full scope binocular vision assessment. Now, AL-Scan, distributed by BOC Instruments in Australia, is set to transform myopia management within Walton’s practice, as well as practices across the country, with biometry considered the gold standard in tracking progression.
According to its manufacturer, Nidek, the AL-Scan boasts unprecedented speed and accuracy and can measure axial length with accuracy to within 0.01mm.
Due to its 3D auto tracking and auto shot features, Walton says the AL-Scan does most of the work for the operator.
“With the focusing auto measurement the operator roughly locks on the child’s eye and the machine takes over and does everything itself. It’s super easy,” she says.
One pivotal feature, according to Walton, is its speed. Often working with children, she finds it can be difficult for them to maintain composure for an extended period while having a measurement taken at various pieces of equipment.
Therefore, she says the speed at which the AL-Scan takes the measurement is a game-changer. It is also supported by good reproducibility and repeatability, which is independent of the operator.
Additionally, because the biometer has automatic capabilities, Walton can alleviate some workload off herself.
“Trying to get kids on devices and have them sit still can be really difficult sometimes,” she says.
“This one is so fast and I’m quite pleased to say I can happily allow a technician to take the measures because I feel like there’s almost no room for error – since the machine is so easy to utilise.”
Other features that stood out, which consolidated Walton’s decision to make the purchase, was its high accuracy and excellent software platform that provides information about trends for future measures post-baseline.
“The beautifully arranged report comes out from the device and software platform that’s attached to it, which allows us to both print the information and give to the patient and then store it within the practice,” Walton says.
The biometer can be integrated with optional Myopia Viewer MV-1 software for myopia management or as standalone. If a Nidek autorefractor is connected, the MV-1 can receive the refraction data. Otherwise, refraction data can be manually entered.
The software integration is said to allow for evaluation of the progression of myopia, with comparisons to age-matched populations. Myopia progression is extrapolated based on growth curves.
The accuracy of progression and estimates of the risk of high myopia in adulthood is supported by robust research. In fact, a multicentre study by Tideman et al., 2018, published in Acta Ophthalmologica showed that the biometer was accurate in predicting trends post-baseline measurement.
So, Walton is eager to implement longer-term myopia measurements in her own patients, in order to optimise management protocols and offer tailored eyecare.
“The system offers graded scales of what’s expected for normal length for both Caucasian and Asian eyes and then deviation from that which indicates the possibility of myopia,” she says.
Walton is using the AL-Scan as standalone and – as a new addition to her suite of diagnostics – is currently obtaining baseline measures until she can gather enough data for myopia progression among her patients over time.
“My plan is to take measurements three or four times a year for each patient to monitor any progression,” she says.
“If there is a trend of faster elongation of an eye, then I would have to consider if I have offered that patient the best myopia management protocol, and perhaps consider atropine, since I am not therapeutically endorsed.”
Above and beyond
Beyond the capabilities of the device, Walton says the after-sales service and ongoing support offered by BOC Instruments has been impressive, and her previous positive experiences with the company influenced her decision to purchase the AL-Scan.
The company’s national sales and service consultant Mr Carl DuToit installed the biometer and trained Walton’s staff. This means four practice staff, in addition to Walton, can operate it.
“I have no hesitation in saying anything I’ve bought from BOC has support – you know they’re always a phone call away,” Walton says.
“Anytime I have any questions regarding my equipment – especially when new – including the autorefractor, mechanised refractor head, slit lamp, OCT, AL-Scan and new virtual reality visual field measuring device, BOC are just wonderful to deal with in terms of support, both technical and then physically coming to organise anything that might need attention.”
She wasn’t initially in the market for a biometer, instead looking to replace her visual field analyser. As an earlier adopter of the OCT, and among the first in the Newcastle area to offer the imaging capability, Walton has always seen the value in investing in a comprehensive equipment portfolio – as it allows her to deliver the best possible care while differentiating her practice.
“I’ve always felt equipment that has become increasingly available to us allows me to do the most comprehensive exam, ensuring there is no aspect of ocular health being overlooked,” Walton says.
For her patients, greater diagnostic capabilities entails a small add-on to the cost of the consultation. This acts as a feedback loop, which again allows her to invest in the practice. And in the case of myopia management, it allows the practice to better communicate the need for an intervention beyond single vision lenses, reaping clinical and commercial benefits.
“It is important to have the structures in place for our additional measures without being onerous to patients,” Walton says.
“People understand that in delivering that level of care, there’s a cost to the equipment, and people do have some expectation that it’s okay to charge for these specialty services. On the other hand, as a practitioner, it continues to allow you to be able to implement best quality equipment within the practice and remain at the forefront,” she says.
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