Spotlight ON TECHNOLOGY & TECHNIQUE

Xfraction System Aids Convenience, Condenses Multiple Testing Functions

Two multi-purpose devices in one platform save significant time.

By Bill Kekevian, Associate Editor

Two companies, Nidek and Marco, began collaborating 15 years ago on the use of wavefront technology as a diagnostic tool. They wanted to develop a precise, clinically relevant diagnostic aberrometer. What they ended up with is a process that combines wavefront technology with automated refraction.

The Xfraction System platform involves a partnership between two physical technologies: the multi-functional OPD-Scan III aberrometer/corneal analyzer and the TRS-5100 digital refractor, merged into one work station known as the Marco Epic. Marco calls the system “a comprehensive understanding of the total visual system.”

Overall, the process is more expedient than manually performing the two devices’ series of tests, which makes for happier patients and more room in the doctor’s schedule, according to one doctor who uses it.

Patient Comfort

“If you have a child, adult, or handicapped patient, you can measure them all on this system,” says Mitchell A. Jackson, MD, the founder and director of Jacksoneye in Lake Villa, Ill. Jacksoneye is a private practice specializing in cataract and refractive surgery, with one ophthalmologist and one optometrist on staff.

Because ophthalmologists have a large elderly population, wheelchairs are not uncommon in their offices. Moving wheelchair patients in and out of exam chairs and up and down hallways can eat up valuable time and create an uncomfortable situation for the patient, Dr. Jackson explains. By the end of the day, all the time-saving measures of the Xfraction system can enable him to see about 10 more patients a day by eliminating “counterproductive labor,” in his words. “It’s more efficient,” Dr. Jackson says. “Patient’s aren’t waiting as long.”

OPD-Scan III

The Xfraction System begins with the use of the multi-modality OPDScan III. It’s a space-saving device, Dr. Jackson says. “It’s very small. You don’t need a lot of space. We could fit a second OPD Scan III Epic station into a free exam room better than a second lane with a phoropter.” The OPD-Scan III performs at least five important clinical functions:

• Automated refraction.

• Automated keratometry.

• Corneal topography.

• Pupillometry.

• Wavefront aberrometry.

The TRS-5100 is designed to replace a manual phoropter. The operator remains seated using a portable keyboard and color touch-screen.

“Technicians can take the patient’s information and run five tests at once,” he says. “The technician takes the eye pressure and dilates the patient before I walk into the room. That gives me a lot of information.”

Altogether, this device gathers more than 20 diagnostic metrics and maps 2,520 points across a 9.5 mm pupil. The OPD-Scan III then helps the physician make a variety of decisions. In seconds, the OPD-Scan III distinguishes between patients who require minimal refinements and patients who will require full refractions to achieve 20/20 vision. The auto-select feature can also discern the best refraction starting point. It can identify which patients are likely to have night-driving issues and may require a second prescription. It will also identify which patients have a higher order aberration that may not be correctable.

“It separates corneal from lenticular astigmatism very well,” he says. “It gives you the quantitative value of the spherical aberration so you can determine the type of lens needed. It can also mark patients preoperatively as an aid to toric IOL placement. And postoperatively, it has a retro-illumination feature so on day one [postoperatively] you can see the placement of the toric IOL without having to dilate the patient.”

TRS-5100

At this point, the OPD-Scan III transfers the wavefront-optimized refraction to the TRS-5100 digital refractor. The OPD-Scan III measures the integrity of a patient’s optical pathway, but the TRS-5100 rapidly completes all refractions and allows immediate patient verification of old vs. new prescriptions. This device employs a split-prism method, which translates to no longer flipping through trial lenses while asking patients “which is better, one or two?” This new technology instantly compares old and new prescriptions.

The TRS-5100 is designed to be used by technicians of any level and can replace the manual phoropter. The operator can remain seated throughout the exam using a portable keyboard and an 8.4-inch color LCD touch-screen. Next, the user verifies the information. According to Dr. Jackson, this includes checking the placido rings, photopic and mesopic pupils, the OPD map and retro-illumination. The automation between the two devices can save between five and seven minutes per exam, according to the company.

EHR Compatibility

“Our technicians complete the initial workup with the Xfraction system, measure IOP with a Tono-pen (Reichert Technologies) and dilate the patient with all OPD-Scan III information integrated into our EHR prior to my seeing the patient,” Dr. Jackson says. “With instantaneous EHR connectivity with the OPD-Scan III, transcription errors are essentially eliminated.”

He adds that the system’s EHR capabilities are a benefit for the patient as well as the doctor.

“It’s great with EHR. If I am in front of the patient, I can demonstrate the difference between corneal and lenticular astigmatism visually and explain why, for example, I might recommend a toric lens implant, “Dr. Jackson says. “These pictures are worth a thousand words.”

IOL Calculations

Together, the two technologies gathers important data for calculating IOL powers. They measure spherical aberrations, angle kappa, pupil size and lenticular astigmatism. Dr. Jackson has been using versions of these devices for 15 years. In fact, he says, he trusts their capabilities so much that, when he underwent LASIK surgery himself, he used them to gather data about his own eyes. He says he then brought his surgeon all the relevant information the devices produced.

Staff Reviews

Dr. Jackson adds that he is not the only one at Jacksoneye touting the system. Although he employs only one certified ophthalmic technician, he says, his other, non-certified technicians are just as capable at performing refraction tests thanks to the Xfraction system.

In fact, he says, his technicians gripe when the Epic station is in use and they’re forced to perform manual tests using traditional equipment. “My staff’s always begging me to get a second one,” he says. The more he talks about it, the more it sounds like his staff’s pressure is working. “As there are a lot of practices with multiple stations, we probably will get a second one to further enhance efficiency,” he says.

“We’re trying to spend less money now because of reimbursement cuts, but buying a second station is one thing I’m willing to spend more money on as it will allow us to see more patients in a single day,” he says. OM