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We have set up a small practice whose main purpose is to maximise our philosophy of 'less is more'. We can be just as profitable spending more time with a few people. This is much more satisfying and we particularly enjoy giving the client an appointment to have their new eyewear fitted. We often do this in the consulting room with our test chart 2000, but we also have software on a laptop in the dispensing area to show car number plates and road signs. It seems more professional and justifies the expense of modern eyewear better. We also have fewer non-tolerance cases through lack of confidence or misunderstandings. As the dispenser as well as eye examiner, we are well placed to advise the patient on tints and coatings as we are familiar with their general and eye health.
Discovering the Anyview Pro
Several months ago, we wrote an article for Optician on how a phoropter head can make life easier and reduce back strain for optometrists (Optician, January 25, 2008).
We do all our own dispensing and when we met Professor Jeff Kwon at Silmo in Paris in 2006 we were pleased to encounter equipment that would do for dispensing what the phoropter has done for refraction. Professor Kwon is the managing director of Viewitech in Korea and we have acquired his top of the range product 'Anyview Pro' (UK distribution via BIB Ophthalmic Instruments).
We see such advanced dispensing systems as extending the high-tech aspect of our eye test out to the front of shop. Too often in previous practices we have heard comments of how the eye test is very high-tech but why do the dispensers use a ruler and marking pen? The real forte of this system is to dispense more high-end products (which we really believe do deliver maximal vision and as such are certainly worth recommending) and especially 'individualised' progressive power lenses (PPLs). This is really a practice builder that allows you to justify the premium prices of such lenses. More and more of these PPLs (for example, the Essilor Physio 360) need extra fitting information and this machine can acquire all of that and more as well as store it all safely for future reference.
One of the measurements required is the face form (di-hedral) angle of the frame. 'Anyview' comes with an innovative mirror mount tool that is worn on the client's head and that allows the camera to take a 'bird's eye view'. By having the client look to the side, an accurate measurement of both back vertex distance and pantoscopic tilt can be achieved. It has a tilt facility that effectively 'peeks under' a thick frame side that would otherwise obscure this measurement. There is even an update imminent to allow measurement of the close vision point to allow highly accurate positioning of the reading area for bespoke/free-form progressive lenses.
BIB Ophthalmic Instruments installs the system and provides all the product training. In addition, the people at BIB were able to talk me through how to incorporate the Anyview Pro into the networked IT system I currently operate, which now allows them remote accessing, for ongoing training, trouble shooting and any software updates as they become available.
The instrument
Anyview is essentially a tall mirror that can be mounted either on a floor stand or (as we have done) placed on the desk. Behind the mirror is a 10 megapixel camera that the client cannot see. It has a built-in flash that helps to detect the visual axis of the pupils and delivers truly astonishing quality images. The camera is a Canon unit with auto-focus and 16X optical zoom. The unit has a robust industrial touch-screen with a flat-embedded PC on the back. It is also available with mouse and keyboard for practices that wish to use their existing computer and monitor.
The distance between the client and the camera is important (ideally 1m), so there is a mat supplied on which to ensure the distance is correct. My clients are seated and I ensure the chair is the correct distance. When in 'measurement mode', as opposed to choosing frame mode, a precisely calibrated lightweight jig is centred on the chosen, adjusted frame and the client is instructed to look directly into the mirror. They are then imaged with a gentle flash.
All the measurements one could possibly require can be taken, including vertical and horizontal centration as well as the frame's measurements precisely. These are displayed on the screen and this impresses the client enormously. I have never lost anyone to the internet traders once they have seen the capability of our dispensing systems. It would just appear too risky to them to chance the remote dispensing of the internet.
The camera can move up and down silently and discreetly and when at the right level, it corrects for unusual or incorrect head posture such as a tilt or turn. Crucially, this all helps to avoid any parallax errors. I always used a Y-stick (available from Norville) to reduce parallax error when dispensing but that still involved leaning forward (bad for the back) and dotting the lenses with a marking pen (bad for one's high-tech image). We dispense coated varifocals more than anything else and to have such an aid that effectively de-skills the job (saving on employing a DO) and reduces the cost and hassle of non-tols and remakes has been useful. I would argue that non-tols are more to do with lack of confidence than actual false measurements.
There is always the option to have ancillary staff use the equipment, especially for 'frames on faces' selection. One can set the speed at which the camera captures images and the number of them displayed at once. There are excellent on-screen images that prompt the client on which way to look (frontal and oblique). We then either email or print out the pictures so friends or relatives can assist in the choice. This is invaluable, especially for those people with high refractive errors that hamper their choosing spectacles unaided. One can demonstrate the effects of photochromic lenses, tints and coatings on the person's frame on their face. I particularly like the demo of aspheric lenses and how that improves the person's cosmetic appearance.
Having the Anyview Pro system sitting on my desk not only enhances the look of my practice but I no longer have the need for all the clutter of the various dispensing paraphernalia, such as tint sets, glazed samples, aspheric demonstrators, coating examples, and so on. It literally covers all dispensing scenarios.
As the system is totally generic you are not tied to only one lens manufacturer, which truly allows the patient to be dispensed the ultimate lens selection, based upon their prescription and final frame choice. In our practice we specialise in fitting Hoya ID lenses to Silhouette rimless frames. We can get all the measurements easily to ensure a good fit and enjoy the ability to drag cursors and lines around the screen to alter the lens size to best accommodate the lens. When a person collects their new varifocals there are some excellent suggestions in video clip format on how best to use them (going down stairs, aim with the nose, focus with the chin and so on).
Providing options
On the subject of giving people options, after having dispensed using Anyview Pro, I am confident that all the options have been presented.
I think this is a vital aspect of being a good practitioner and we are often surprised that we are the first to really explain, for example, how photochromics work even to long-established photochromic wearers. I tend to explain as I tick my recommendations on the (about to be issued) prescription. Being the eye examiner gives my recommendations extra weight and this is borne out by the almost universal acceptance of having AR coatings. If one really goes through all the options one can invariably end up dispensing new eyewear even in a no change Rx situation.
We are all risk averse having the necessary information reduces the chance and indeed the fear of making the wrong choice. This feeling of confidence extends to what the client then spends and is proof of our philosophy that 'less is more'. We would rather see a few clients who dispense well than be busier with diminishing returns.
There is also a full contact lens module included. This allows the demonstration of various types of contact lenses and the benefits compared to spectacles. One can then give excellent tuition on their handling and care. For those who wish to have cosmetic tints to alter the eye appearance one can demonstrate that virtually on an image of the client so they can best choose.
To conclude, the Anyview Pro system should be and will be a dispenser's best friend as it has quickly become ours. I have seen too many systems quickly become dust-gathering white elephants cluttering up the practice. Utilising the technology and features of the Anyview Pro really brings dispensing into the 21st century and I believe that one day (soon, I hope) all dispensing will be done this way.
David and Elizabeth Baddeley run their own practice in Harefield. For further information on Viewitech, contact BIB on 01438 740823