Electronic Dispensing Aids: Friend or Foe?

Preface: In full disclosure I must state, I am not an optician. In my line of work I focus on regulations, policy and political research. However, I do stay informed about the eye care industry by working on projects for the Opticians Association of America who I have partnered with for over five years. I give this brief bio, so the reader understands whom and where this article comes from.

Two years ago Vision Monday published an article titled “Dispensing Goes Digital” by Andrew Karp that first brought attention to the EDA’s. Back then it was an emerging technology relocated to upscale independent optical shops that paired with some of the larger national lens vendors to deliver this new device. EDA’s were seen by some as a technological advancement eye care practitioners could make use of to better fit eyewear to the customer. Some of the EDA’s use 3D imaging, digital measuring and have playback modes that display how different styles of frames look on the customer. There is a healthcare and an aesthetic component to these machines. In VM Barry Santini, an optician and writer who owns Long Island Opticians in Seaford, N.Y. stated he believes that “taking eyewear measurements with digital photographs offers distinct advantages over older technologies such as pupilometers.” While the new technology is not for everybody, in 2010 the digital dispensing aids were filling a niche in the market.

The article closes out by Jim Voss, who is a dispensing optician at the John Boys Smith Vision Center in Ellensburg, WA arguing that “Whether dispensers take a high tech or low tech approach to fitting eyewear doesn’t seem to matter, as long as it reduces the number of redos.” Jean Sabre of the Uptown Vision Clinic continued with, “The more accurate your measurements are, the more success you’ll have in fitting lenses. We have less redos and patients are happier. And if they’re happy, we’re happy.”

At this point in the history of EDA’s they are scarce and somewhat expensive at $8,000 apiece. It also appears they are predominantly utilized in the correct fashion by experienced opticians. Fast forward a couple of years, April 16, 2012 to another article in VM titled “Enhancing the Digital Experience,” and the potential for legal ambiguity become apparent. By 2012, thousands of the new dev ices are being placed in chain retailers as well as independent shops across the nation. Essilor has installed about 1,200 of their Vissioffice systems and LensCrafters has their Accufit dispensers in almost all of its 950 stores.

As most of our members are fully aware of, not all opticians are created equal in the eyes of the law; many states have defined regulatory requirements while some do not have any. I argue the new technology has the potential to disproportionately harm opticianry in states where there is a legal requirement to be an optician. States like Arizona, Hawaii, Kentucky, Massachusetts and Nevada to name just a few. These are places where statute explicitly defines the act of dispensing as someone who interprets, measures, adapts, fits or adjusts the lenses, spectacles, eyeglasses, or appurtenances to the human face. Many of the processes the new EDA’s help facilitate.

It has become apparent the expanded usage of the EDA’s has the potential for unlawful dispensing to take place if not closely monitored. Reports from licensing boards have detailed how “frame stylists” are being used in lieu of opticians to operate the EDA’s and in some instances the licensed opticians are then asked to “sign off” on the work of multiple technicians or frame stylists serving patients, forming assembly line health care practices. In Nevada this has caused the Board of dispensing opticians at their August 15, 2012 meeting to debate whether to clarify what dispensing means, either by FAQ or by re-definition and open the topic for public comment. The debate was needed in order to clarify the difference between helping a customer use a machine to pick out a stylish frame and making professional judgments regarding a patient’s eye health. The EDA’s at least in Nevada are blurring the definition of what it means to dispense.

It is worth noting to remember technology is not the enemy of the optician and the use of EDA’s should be accepted if they provide a better end product for the consumer. What worries me however, is the over-reliance on technology leading to a faÇade of improved care by unqualified ECP’s. Cyndy Dinius, senior director of product innovation and commercialization at LensCrafters stated in the VM article that “customers are delighted and engaged by the system, and are more confident of their eyewear choices. They view our associates as more skilled and knowledgeable.” I may be wrong, but I believe most opticians do not want technical jargon and 3D imagery to manipulate the patient into believing their ECP is more skilled and knowledgeable, they want improved education, experience and higher qualifications to do that. And here is why…

Filling an eyeglass Rx is more complex than the average consumer is aware of. There are a multitude of lenses, lens coatings and frame sizes that affect vision outcome. The one on one encounter is invaluable in filling the particular needs of the patient. Having a qualified professional from the onset is a vital service according to Master Optician Matt Morookian of Anchorage, Alaska who has been refining his craft for over 30 yrs. Mr. Morookian who after researching the EDA’s stated “a frame stylist could input all the correct data, use the EDA as it was designed, have a licensed optician sign off on the work, and still not meet the patients needs as a professional should. There isn’t a replacement for qualified care.” Troubleshooting the individual needs of the patient and navigating the variants of lens and frame selection has a dramatic effect on the overall experience and most importantly vision. The profession as a whole could be damaged if the EDA’s (or any device) are not used by experienced opticians. Pupilometers, compression pliers and even the new EDA’s are only as competent as the hand that holds them.

Publishing this article might bring criticism and that is ok, but what I hope it does more than anything is encourage opticians to examine all aspects of their profession, where it’s been, where it is and especially where they are going to take it.

by Kris Pickford

Mr. Pickford was educated at the University of Illinois with a graduate degree in Political Studies in the College of Public Administration. He has partnered with Opticians Association of America for over 5 years on numerous issues relating to the healthcare field. He is also employed as an auditor/policy regulator in state government.