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Diagnosis Total Visual System Assessment— Integrating Wavefront Technology in Refractive Examinations Cynthia Matossian, MD, FACS 1 and Joseph C Noreika, MD 2 1. Matossian Eye Associates, Pennington, New Jersey, US; 2. Excellence In Eyecare Inc., Medina, Ohio, US Abstract Current trends and recent legislative changes have increased the pressure to control healthcare costs, especially those associated with running ophthalmic practices. These factors have driven practice consolidation, reduced consultation times, increased use of electronic health record systems, and encouraged more meaningful use of technology. At the same time, patient expectations and standards of clinical care are both rising. This climate could discourage investment in new technology and encourage increased intensity of service, with higher patient throughput at the risk of decreased quality of care. This situation emphasizes the traditional value proposition model in which quality, time, and cost are closely interrelated; decreasing time and/or cost negatively affects quality. The use of wavefront technology and the development of the XFractionSM process, however, have challenged this model. Using the Optical Path Difference III (OPD-III) and Total Refractive System-5100 (TRS-5100), substantially greater amounts of higher-quality data are derived from ophthalmologic patients in shorter examination times than with other refraction instruments. Their use provides an improved patient experience, greater patient throughput, and more time for the physician to precisely tailor the treatment to match the condition. In practices that have acquired the OPD-III, it has become indispensable in vetting patients for intraocular lenses (IOLs), advanced corneal refractive surgery, and preoperative identification of various optical issues. Experience at an example practice shows that optional use of OPD-III examination is high and it is increasing, despite patients incurring out-of-pocket fees. XFraction technology, therefore, is a route to more satisfied patients, greater efficiency, and profitability; and it can help ophthalmic practices thrive amid increasingly adverse commercial and medical pressures. Keywords Optical path diagnostics, wavefront optimized refraction, total visual assessment, intraocular lens selection, sustainability, value proposition, return on investment Disclosure: Cynthia Matossian, MD, FACS, and Joseph C Noreika, MD, have nothing to disclose in relation to this article. Acknowledgements: Medical writing assistance was provided by James Gilbart at Touch Medical Media, London, and funded by Marco. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: February 22, 2016 Accepted: March 16, 2016 Citation: US Ophthalmic Review, 2016;9(1):41–5 Correspondence: Joseph C Noreika, MD, Excellence In Eyecare, Inc., 3609 Medina Road, Medina, OH 44256, US. E: jcnmd@aol.com; Cynthia Matossian, MD, FACS, Two Capital Way, Suite 326, Pennington, NJ 08534. E: cmatossian@matossianeye.com Support: The publication of this article was supported by Marco. The views and opinions expressed are those of the authors and not necessarily those of Marco. This review examines how the adoption of refractive wavefront technology can help address the challenges, and promote the success of practices competing in an increasingly demanding regulatory and economic environment. In ophthalmology there is an increased need for efficiency and productivity, beginning with the collection of meaningful patient data. A new value proposition has evolved to meet the demands of changing market conditions. This proposition helps define and protect the value of the practice, drives the decision to acquire new technology and illuminates the procedural changes that add value for the patient, the ophthalmologist, and the business. Devices acquired by a practice need to meet this new paradigm. The metrics proposed below delineate this purchase decision process. Increased spending mandated by the Affordable Care Act has enhanced access to medical care for people who previously had no medical insurance. 1 TOU CH MED ICA L MEDIA Significant consolidation of the insurance industry has resulted. The cost of insurance policies and out-of-pocket costs to the patient have increased. As a consequence, there is increasing pressure to control these outlays. Practices may respond to the downward pressure on reimbursement by reducing investment. Recent legislation, including the repeal of the Medicare Sustainable Growth Rate (SGR) has shifted the payment model from fee-for-service to value and quality. 2–5 Medicare payments are now determined by the quality and efficiency of rendered care. In all areas of medicine, including eye care, there is an impetus to utilize electronic medical record technology in ‘meaningful’ ways. 6–8 The meaningful use of electronic health record (EHR) systems aims to engage patients in their healthcare, improve coordination among caregivers and enhance public health. Diagnostic instruments that functionally integrate 41