Significant growth in patient numbers at DR DAVID O’NEILL’s independently-owned optometry practice on the Sunshine Coast has created a bottleneck when conducting visual field testing, leading him to find a speedier solution.
At Looking Smart Optometrists in Pelican Waters on Queensland’s Sunshine Coast, patients undergo a comprehensive pre-test before being seen by one of the practice’s three optometrists. It’s helped build the practice’s reputation as an adopter of modern technology, but for optometrist and director Dr David O’Neill the process was creating a problem.
“We provide a full pre-test which involves a Topcon TRK-2P 4-in-1, OCT, widefield imaging with a DRSMini, and visual field test. This is done before the patients see our optometrists,” O’Neill says.
“But now that we have grown to three optometrists and 75 patients daily, the field test was creating a bottleneck. We have been using two existing visual field devices – but their testing time is 12 minutes for a threshold and six minutes for a screening.”
They were minutes he couldn’t spare.
O’Neill knew he needed to resolve this workflow issue, and upgrading the equipment to speed up the visual field testing process seemed the obvious solution. He purchased the VF2000 Neo from a US medical equipment manufacturer, exclusively distributed in Australia by BOC Instruments.
While he acknowledges it is unconventional to perform visual fields on all patients, he says Looking Smart Optometrists is “always on the precipice of the future”.
“We only do ‘screening’ field tests on patients over 50 which we do not charge to Medicare. We pick up one patient every one to two months who is having or has had a stroke or brain tumour,” he says.
“We believe in testing to see what is wrong rather than test when you see what is wrong. We do not charge the patient for this.”
The same philosophy applies to OCT imaging.
“I would personally pick up two to four patients with a sight threatening condition that would have been missed by conventual testing. We have provided OCT for free since 2012, one of the first in the country. We have only just replaced our machine after 11 years and a total of more than 500,000 scans,” O’Neill says.
But testing takes time. While he concedes that six minutes of field tests is excessive, he argues it saves six to 12 patient lives a year per optometrist, meaning 18 to 36 patients per year for the practice.
“Those six minutes are invaluable to those we diagnose. I would say to each patient, ‘Is six minutes – or one minute on the VR goggles – worth the potential of saving your life?’.
“This week alone I have picked up a cystoid macular oedema treated with Acular, which saved the patient’s vision 10 weeks post cataract surgery, a glaucoma with completely normal eyes, and a case of wet macular degeneration which had no visible symptoms, but I got the patient into anti-VEGF injections on the same day, avoiding long term vision loss.”
O’Neill says this adds up to hundreds of patients yearly whose vision or life he is saving.
“The $60.00 per consultation Medicare rebate we receive is hardly sufficient for this task, but I can sleep at night knowing that I have done the best for my patients and in the fact that I am unlikely to receive a phone call because I missed something,” O’Neill says.
“I could not afford to do this in an individual practice, with staffing costs, but when the independent optometrists can band together to provide excellent healthcare, we can excel.”
When it came to deciding about which visual fields device to purchase, one model stood out.
“We could have purchased a more advanced field tester from our existing supplier, which has faster test times, but requires annual maintenance which I think is around $1,100 per year. Instead we opted for the VF2000 Neo,” he says.
“A full threshold takes five minutes, and the machine gives full verbal instructions to the patient. For a screening, it takes under a minute and does an Easterman for driving assessments.”
Built on cutting-edge virtual reality
Mr Robin Lanesman, national sales executive at BOC Instruments, says the company only recently started supplying the VF2000 Neo to its Australian customers. O’Neill is one of the first to receive it.
The new compact, sophisticated, Bluetooth-connected portable visual field analyser has been designed to replace bulky conventional devices.
An innovation from Micro Medical Devices in the US, the VF2000 Neo broadens the clinical scope beyond offering reliable visual field testing.
According to the manufacturer, the VF2000 Neo virtual reality visual field device incorporates complete visual field analysis and progression, with versatile and efficient vision screening technology in a compact portable device.
Equipped with the latest internal optics, the VF2000 Neo can quickly run visual field protocols and a variety of added self-guided vision tests in full-colour 4K-resolution.
“It is designed to improve every aspect of patient testing from patient experience and clinical results to practice efficiency without compromising the accuracy of results,” Lanesman says.
“AI virtual assistance guides the patient and enables communication in multiple languages. Active eye tracking ensures enhanced accuracy, and testing pauses when a patient loses fixation or closes their eyes, and alerts the patient.”
The VF2000 Neo provides multiple visual field tests including full and fast threshold visual fields, Frequency doubling technology (FDT) perimetry, neuro, kinetic, ptosis and Esterman tests.
The the device also includes an option to select bilateral fixation, meaning a non-fixating eye can be tested without issues.
“This technology provides the same reliable standard of visual field analysis and is Gold Standard Visual Field compliant with identical report format,” Lanesman says.
“Furthermore, it offers a broad range of additional tests such as visual acuity, contrast sensitivity, colour testing – including Ishihara, D15 and advanced colour tests – stereopsis testing, eye mobility and strabismus, with more in development.”
The VF2000 Neo is supplied with a tablet PC and uses Bluetooth interface between tablet and device, and does not require WiFi for testing.
Test results are stored and accessed from the tablet and automatically uploaded to the cloud, and can therefore be retrieved on any PC through Micro Medical Devices online portal (micromedinc.com).
“Compact, space saving and extremely portable, the VF2000 Neo can be used anywhere. It provides a far more comfortable and relaxed experience, an eye patch is not required as occlusion is done
digitally, and no dedicated space nor a darkened room is needed,” Lanesman says.
Using settings now – and in future
O’Neill, who began training as an optical dispenser in 1996 at OPSM, went on to study optometry at Queensland University of Technology, graduating in 2001.
He gained experience working in locations ranging from Cairns to Southport, including at Precision Eyewear in Wynnum and Premier Optique (now Specsavers) in Maleny before opening his own practice in 2006.
At the time of writing, O’Neill had only been using the VF2000 Neo for a few short weeks, and had yet to discover if it held all the answers to his problems.
“Questions remain, such as how is the battery life of the machine? We will know more when we can run it with more patients. It can operate plugged in, but I would prefer wireless if it can last the 60 tests daily,” he says.
A few weeks later, he had an answer:
“The tester goes several days without needing a recharge, now we have used it continuously.”
He says the ease-of-use was one of the features that drew him to the VF2000 Neo.
“When the patient is doing the test, it monitors eye position and warns them to look in the centre rather than relying on an operator or the blind spot analysis,” O’Neill says. “You just need to start and stop the machine.”
“The web interface allows easy viewing in any consultation room, and we have thought of sharing this with ophthalmologists when we co-manage glaucoma to save them from repeating fields. It is also easier for entry of patient data with a regular keyboard.”
O’Neill has also used the device’s strabismus settings, which have been useful, he says, in calculating prism in patients, similar to a synoptophore.
“This does it in a fraction of the time. The VF2000 Neo can also be utilised in other areas, like acuity and visual training, but we are not using it for this.”
The reason for this, he says, is simply because the practice is operating at maximum capacity.
“To be honest, we are too busy doing what we do. I really need another two optometrists, as we are severely short staffed. I keep taking on other optometrist’s client lists as they retire. We already serve up to 50,000 patients and will possibly double that number in the future. Our practice is 30% larger than 12 months ago, and the growth of business is causing a problem of having too many patients to look after,” O’Neill says.
“I do my best to only hire the best optometrists. I want those who want to continue their career. My goal is to teach them what I can, but for them to go forth as better optometrists than myself and to strive to greater heights in the community. I am proud of the people who have worked here, and they are incredible optometrists who are a credit to the profession.”
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