This is a story I wrote about the SPOT autorefractor for the AOANews. It features the staff at Lyons Family Eye Care and several others who are involved in its use and development.

1. TOMORROW’S PRACTICE TODAY
Spot on!
By Dominick M. Maino, O.D., called the Spot. an incredibly efficient way to
and Geoffrey Goodfellow, The Spot is relatively screen children” and “it is
O.D. small, lightweight (2.5 lbs.) much easier to obtain a read-
and easily transportable ing on children because it
A
OA members are (slightly bigger than one of doesn’t scare them by forcing
constantly trying to those more expensive digital their head into an instrument.”
use technology to SLR cameras with a fairly Simpson also said it is an
serve their patients at the high- large zoom lens attached). The efficient way to assess refrac-
est level and at the same time testing sequence is straight tive error and is often more
improve overall efficiency of forward. You turn it on, enter accurate for children and
their office procedures. The the appropriate data, reduce patients with special needs
many tools used include those the room illumination, have than other auto-refractors
that assess ocular health and the patient look at the camera available in the office. Even
an electronic health record (the patient fixates lights that more telling is that she would
(EHR) system that not only can be associated with various suggest to her employer,
meets the requirements of sounds), and then within about Stephanie Lyons, O.D., that if
third-party payers and govern- a second or so, obtain the she had to buy the Spot again, Rachel, an optometric technician/optician at
ment regulations, but also desired results. that the investment was well Lyons Family Eye Care, conducts a pre-examina-
improves office communica- The Spot is WiFi-enabled worth the cost. tion sequence using the Spot on smiling patient
tion and efficiency. and has a battery life of about Audrey Reed, director of Carie Zaas, whie her mom, Alina, looks on.
Frequently, when it four hours. With it, you can National Programs, Essilor
comes to refractive care, measure a range of refractive Foundation, has been using be obtained. The Spot is a part may be using this and similar
optometrists tend to rely more errors from -7.50 to +7.50 and the Spot for some time as of the pre-examination devices within their office visit
on retinoscopy and the stan- up to 3D of cylinder. The well. She and her volunteers sequence that our AOA certi- sequence. This is not necessar-
dard “which is better, one or patient’s pupil size can be as conduct vision screenings that, fied paraoptometrics routinely ily inappropriate unless the
two?” subjective refraction small as 4mm and as large as when needed, lead to an use prior to my conducting a patient or parents of the
and less upon technology. This 9mm with a pupillary distance immediate eye examination by comprehensive examination. patient interprets the findings
may be changing in the near from 35-80mm. The device an optometrist. She notes how As new advances are in such a way that they believe
future as many new choices can be mounted on a tripod easy it is to teach her volun- made in this area and the next- a full, comprehensive eye
are becoming available in the and also has a neck strap and teers to use the Spot. generation Spot appears on the examination was completed.
area of auto-refraction. safety wrist strap mounts. Reed also said they used this horizon, our wish list includes This can often result in a false
Although auto-refraction Once the data is captured, auto-refractor with 200 chil- an expanded range of refrac- sense of security by the par-
technology has been around the screen displays the dren over a two-day period tive error determination (+/- ents and devastating, unintend-
for decades, there did not patient’s PD, pupil size, eye and only had four children 7.50 is just not adequate when ed consequences for the
appear to be any one device alignment, the refractive error with whom the screener did you work with special-needs patient if a serious eye disease,
that could work with all popu- spherical equivalent and the not appear to function well. patients), voice input of data, binocular vision dysfunction
lations typically evaluated by complete refractive error Both Simpson and Reed an even faster capture time, or refractive error is missed.
optometrists. Various auto- (sphere, cylinder, axis) in commented on how the need and the ability to work in a We would also caution those
refractive instruments worked either “+” or “–“ cylinder for a darkened room and fairly wide range of ambient light conducting vision screenings
well with adults but not chil- form. You can also print a hard large pupils sometimes including normal room illumi- that if the screening does not
dren, while others did not copy of the findings that can detracted from the Spot’s use- nation. lead to better outcomes, a cur-
seem to work with those be included in your patients’ fulness, but its overall usabili- Although Jeff Mortensen, rent review of the literature
patients with special needs at files or scanned as a PDF and ty, ability to save data on a vice president Business suggests a comprehensive eye
all. Some early refractive error attached to your EHR patient jump drive, and wireless con- Development of PediaVision, and vision evaluation be con-
screening technology initially database. When used as a nectivity far outweigh any lim- couldn’t comment on future ducted by a doctor of optome-
required one to send in pic- vision screening device, the itations. Another possible limi- incarnations of the Spot, he did try as soon as possible.
tures to be evaluated by an printout also offers a severity tation to the device noted by say the SPOT does not replace More information about
outside source before you index and call to action rec- some is that using a finger to the comprehensive eye exami- the Spot can be found at
could tell the individual what ommendation. Any finding input data can be difficult, but nation and that it “is an appro- www.spotvisionscreening.com.
type of refractive error was printed in red suggests prob- that if you use the rubber end priate tool for use as a part of
present. lem areas to be investigated, of a pencil data input becomes the doctor’s pre-examination Dr. Maino is a professor at the
This is changing, and the and at the top of the page (also much easier and reliable. sequence” and can be used to Illinois College of Optometry
change may lead to conse- printed in red) will be a call After using the Spot in “build awareness of various (ICO) and a Distinguished
quences yet not imagined (see for action such as “Complete my (Dr. Maino’s) private prac- vision issues including not only Practitioner of the National
http://newsfromaoa.org/2012/0 Eye Exam Recommended.” tice (Lyons Family Eye Care) refractive error but also binocu- Academies of Practice. He can
9/13/diy-refractions-disrup- for several months, I find it lar vision dysfunction.” be contacted at
tive-innovation-that-affects- Firsthand does what it is supposed to do dmaino@ico.edu. Dr.
science-people-and-the-econo-
experience pretty well. I also found it A few caveats Goodfellow is an associate
my/). There may be one fairly easy to use, and even the professor of optometry at ICO
new device, however, that AOA certified paraopto- youngest child and more diffi-
and unintended and the college's assistant
could change how we practice metric Katherine Simpson of cult patient with special needs consequences dean for curriculum and
right now. This device is Lyons Family Eye Care in will often respond in such a It is our understanding assessment. He can be con-
offered by PediaVision and is Chicago notes that the Spot “is way that a reliable reading can that pediatricians and others tacted at ggoodfel@ ico.edu.
MARCH 2013 29