Diagnostic Instrumentation

Removing Roadblocks to Change: Advanced Instrumentation

By Brian Linde, OD

Investing in high-level instrumentation, such as digital retinal imaging, provides enhanced eyecare to patients, and it differentiates your practice from competitors.

Successful practices with high revenues and a loyal patient base can become set in their ways. It’s easy to rest on your laurels and feel that you are set and have no need to search for additional paths to improvement. One of the ways we stay ahead of the optometric curve and differentiate ourselves from competitors is by investing in advanced instrumentation such as Optomap digital retinal imaging, OCT and visual field instrumentation.

Offering higher-level instrumentation sends a message to our patients and the community that we offer cutting-edge eyecare. More importantly, this provides our patients with the best possible eye and vision care. Investment in the most modern instrumentation also aligns well with the practice philosophy we have borrowed from our consultancy, The Williams Group: “If it’s good for the patient, it’s good for the practice. If it’s good for the practice, it’s good for the patient.” This means that a practice needs to be profitable and successful to be able to reinvest in equipment and upgrade technology, which benefits patient care.

Brian Linde, OD

Heights EyeCare
Billings, Mont.

Southern California College of Optometry
Class of 1987

Practice opened cold in 1989



Five doctors (3 full-time; two part-time)

22 support staff

Comprehensive examinations

8,800 annually



Gross Revenues

$3.3 million

An Investment that
Pays for Itself

Ten years ago, we saw Optomap technology as an opportunity to further educate our patients. We leased the instrument for the first eight years paying a sliding scale for each Optomap based on our monthly usage. We were able to buy it two years ago for $75,000. Its usage paid for itself in seven months. We continue to have nearly 65 percent of all of our patients electing this as part of their vision and eye health exam. We have performed 41,000 Optomaps over the 10 years that we have had the instrument, including 11,000 over the past two years. It has generated nearly $1.3 million dollars in gross revenues. Our staff takes an Optomap image on every patient so there is no bottleneck. That way, the patient does not have to be sent back to the pre-testing area once in the exam room if they decide they would like one of these images on file for them.

The clinical staffers understand the technology and are able to relay to patients its importance including the ability it gives me to diagnose potential dangers to vision and eye health, creating a baseline for me to monitor their eyes. As doctors it has allowed us to talk with patients about their eye health, their family medical history, and have a dialogue beyond their refractive needs.

We take Optomap images of every patient who visits our practice for a comprehensive exam. Once in the exam room, we ask the patient if they would like us to use the image. If they agree, then we explain that there is a $30 fee for the use of Optomap photos. If the file is opened in the exam room, then the charge applies. Most of our patients agree that it is worth $30 for their doctor to get an in-depth look at the inside of their eyes.

Greater Instrumentation, Greater Patient Education

The Optomap has been a tool that allows me to discuss eye health concerns. We have large-screen computer monitors that are networked to our Optomap, our Cirrus OCT and our visual field instruments in each exam room. Dilation continues to give me views of the retina, but when a patient can see their retina and understand what I am looking at and looking for, the process helps them understand the importance of vision and eye health exams. The margins beyond the lease payment or mortgage for this technology add to the revenue-per-patient equation. This is also true when multifunctional recommendations are made regarding eyeglasses and contact lenses.

Instrumentation Investment:
Practice-Building Resources

The Williams Group, the consultancy that has helped Dr. Linde grow his practice, offers the following resources on the value of instrumentation to the growth of your practice.

Dangerous Road #3 on Keeping Technology Current by Williams Group consultant Bill Nolan

Williams Group blog post on today’s consumers and their appreciation of cutting edge technology

A video introducing The Williams Group and some of its clients.

When we talk about the Optomap, we are careful not to talk about it like it’s a photo. I explain that it is a digital imaging technology that allows us the opportunity to visualize up to 200 degrees of the retina. The red-free filter helps me see the subtle signs of hypertension or diabetes. The technology allows me the chance to compare images and see changes that can occur over time.

Make Advanced Instrumentation Part of Regular Patient Flow

Incorporating the Optomap is just part of the patient flow through the practice. We have eight exam rooms networked with the Marco Automated 5100 Refracting System. These refracting systems allow us to press a button at the end of the refraction and show a patient if or how their refraction has changed. We are always looking for new technology that improves our collection of information. We replaced the NCT with the handheld I-care tonometers for glaucoma screening. We have two separate pre-testing stations where we auto-refract, do screening via a Matrix visual field and tonometry. Patients then move to the Optomap and from there to the exam rooms. We have four clinical staff members who collect this information before a doctor sees a patient.

The Marco refracting systems, doubling and upgrading our pre-testing equipment for our two stations, cost another $220,000. This investment has allowed our staff to move patients through the practice more efficiently.

Related ROB Articles

Explain Your Instrumentation…and Send a High-Tech Message

Intelligent Investing: Crunch the Numbers–and Analyze Your Patient Base

Buying Instruments: New Toy or Valuable New Treatment Tool?

Brian Linde, OD, is a partner of Heights EyeCare in Billings, Mont. To contact him: BrLinde@Bresnan.net.

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