Devices, Feature, Report, Technology

Optimising workflow for precise results

Heron Eyecare

Independent optometrists discuss their decision to harmonise the end-to-end patient journey with the latest ophthalmic lens technology from a single manufacturer, and the value it’s creating for their businesses and patients.

When Heron Eyecare embarked on a practice renovation in 2019, it presented a double-edged opportunity. The 32-year-old independent practice, which operates out of a Queenslander-style building in Toowoomba, could create much-needed space for a third consulting room. But, more importantly, it presented the chance to completely rethink its equipment configuration.

It was an opportunity director and senior optometrist Dr Hugh Bradshaw couldn’t afford to squander. He joined the practice in 2009 when it was owned by husband-and-wife Henry and Miriam Heron, before later taking over and continuing their legacy as a leader in technology and optometry innovation.

“With a long-standing practice like this, which was established by the Herons in 1989, often technology and equipment is added and doesn’t always perfectly fit with all other current equipment and software,” he says.

Dr Hugh Bradshaw
Dr Hugh Bradshaw, Heron Eyecare in Toowoomba, Queensland.

“When we did a small renovation two years ago it was the ideal moment for us to upgrade to the Zeiss suite of equipment so the whole workflow matched from end-to-end to greatly improve the patient experience.”

Heron Eyecare’s relationship with Zeiss Vision Care began around eight years earlier when it switched from its original lens supplier due to ongoing quality issues. Over the years, it incorporated Zeiss equipment like the i.Terminal mobile centration system, but it still used existing refraction systems from another manufacturer. A major advocate for Zeiss lenses, Bradshaw felt he could do more to get the best out of them.

Heron Eyecare director and principal optometrist Dr Hugh Bradshaw using a Zeiss Visuphor 500 digital phoropter in his practice.

In 2019, the practice became the first in Australia to install the Zeiss Visufit 1000 digital 3D centration system. It also invested in an i.Profiler plus wavefront aberrometer, Visulens 550 digital lensmeter, and three Visuphor 500 digital phoropters and accompanying Visuscreen 500 digital charts for each consulting room.

As the optometrist, Bradshaw can now manage the entire patient journey using the Visuconsult 500 software platform, which displays all test results and measurements on a single iPad screen in real time. As well as connecting to each device, it integrates with the practice’s Optomate system, which automatically populates the patient’s information into each device and stores the prescription in their records.

The practice has also benefitted from technology called i.Scription, which, according to Zeiss, uses the wavefront measurement to determine the exact “fingerprint” of the eyes, taking into account the effects of low and high order aberrations on retinal image quality by measuring up to 1,500 points. As a result, Bradshaw says he’s able to fine-tune the refraction to 1/100th of a diopter, offering precise individualised lenses.

“We then take the patient to the final step, which is dispensing of the frames,” he explains.

“We’re very fortunate to be the first practice in Australia to use the Visufit 1000, which is the most high-tech digital dispensing tool on the market. Most use a single camera that takes a front and side shot, but this has nine cameras in a semi-circle which takes a simultaneous shot and creates a 3D avatar of your face. Using 45 million reference points, we’re able to create the most accurate measurements to effectively customise each pair of lenses for the particular frame for our patients.”

Differentiation and loyalty

Bradshaw believes the future prosperity of independent optometry lies in delivering first-class service. It’s a mantra he adopts in order to build and maintain his patient base, knowing he probably won’t compete on price with his corporate contemporaries.

“If you’re producing a product for the lowest possible price people aren’t going to be loyal to your service, they will be loyal to the lowest price, and they’ll continually seek it,” he explains.

“The more we have increased and improved our services, whether this be through technology, our sales training or conducting more procedures and treatments in areas like dry eye and myopia, the more our patients appreciate they are getting the best care they possibly can, meaning they’re more likely to return.”

By adopting the full suite of Zeiss technology, Bradshaw says the practice can now exploit the full potential of the company’s lenses. Patients are happier, and it’s also allowed the business to become more efficient due to a reduction in dispensing errors.

There are several reasons for this, with the first being consistency. Because Heron Eyecare is using a single platform that automatically links with all measurement devices and its patient management system, it is eliminating basic transcription errors during the patient journey, including for processes like lens ordering.

And when issues do occur, it has allowed them to get to the root much faster.

“Every month we generate a report on each remake and pull them to pieces to find the reasons behind them,” he says.

“It’s shown us that very few are non-adapts now, the lens quality is excellent, so it may be that someone – for whatever reason – needs an adjustment. But we’re now far more intuitive as to why patients are having problems so we can fix them. It’s also allowed us to accumulate additional knowledge with each lens design so we can fit them better each time.”

What’s the ROI?

Like many independent optometry practices, Heron Eyecare is a small business, so large investments require due diligence.

For Bradshaw, he says the return on investment could easily be justified by taking a long-term view. He implemented a modest 5-10% price increase on premium individualised multifocal, vocational and single vision lenses.

“Because you’re offering better lens solutions, you can therefore calculate what the increase needs to be to compensate for the investment,” he says, adding that patients haven’t found the small increase unreasonable.

“If you break the investment down over a five-year period it makes it seem more affordable. Working out how many lenses you’re doing each year within that period, and the cost per patient, it actually works out to be very little, it’s a good way of itemising it,” he says.

State-of-the-art technology that is upgradable via software improvements also helps justify the investment. This means practices can purchase the equipment for the next five to 10 years without the fear of it quickly becoming outdated.

An example is a new virtual try on tool feature that will soon be released for the Visufit 1000. Bradshaw is excited by this development, which will allow patients access to a catalogue of frames beyond what’s available in the practice.

“When the Visufit takes an image of the patient’s face, they will have thousands and thousands of frames they can try on digitally,” he says.

“This will open up the potential for not necessarily having fewer frames stocked, but getting around issues such as requests for different colours, or patients who need larger frames. And for frames you don’t have in stock, the patient can still order it through your practice – this is the way of the future.”

Showcasing technology to patients

Fitzgerald Optometry is a medium-sized practice with two consulting rooms, three optometrists and five support staff. It also considers itself an early adopter of technology.

For principal optometrist Mr John Fitzgerald – who has owned the business in the Melbourne suburb of Williamstown for 25 years – a practice refit meant they were able to bring their Zeiss equipment out of hiding and proudly display it.

Mr John Fitzgerald
Mr John Fitzgerald, Fitzgerald Optometry in Williamstown, Melbourne.

“The use of Zeiss equipment was a natural fit for us. Their focus on product, innovative technology and customisation to create a memorable patient experience mirrors with our values,” he says.

Since 2015, Fitzgerald Optometry has introduced the Visuphor 500, Visuscreen, i.Profiler and Visulens 500. This is in addition to diagnostic equipment such as the Cirrus 6000 OCT system and a reconditioned IOL Master. Last year, it purchased the Visufit 1000, which has created several benefits, including the ability to social distance from patients during COVID-19.

“In the past we would discuss lens design and recent advancements in technology only then to grab a texta and put a dot on the patient’s lens to mark it up – a very low-tech solution for a high-tech lens,” he says.

“Patients see the Visufit as a positive experience and are impressed with the technology. But importantly the measurement is performed without the need of a clip-frame, which previous digital centration devices require. These clips invariably altered the fit of the frame.”

With the i.Profiler autorefractor, Fitzgerald has found it useful for explaining why some patients are seeing well during the day but less so at night or in poor contrast. The practitioner can also look at Rx as function of pupil size.

“With the Visuphor, we’ve found it creates a ‘wow factor’ – patients are impressed with technology. Preconfigured workflows make it easier and faster to determine subjective results, and it’s easy to operate from an iPad,” he says.

“Another great benefit is the ability to operate away from the patient to maintain social distancing. We can then switch between prescriptions easily highlighting differences between current and new Rx. As it interfaces with the Zeiss focimeter as well as i.Profiler it can directly import and load the data from each device.”

As for the future of independent optometry, Fitzgerald says it will require greater collaboration and co-management, and increased need to specialise.

“Rapid change in technology is making it more critical to keep up-to-date and develop long-term partnerships with equipment suppliers,” he adds.

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