24 | SEPTEMBER 2021

� COVER FOCUS WILL TODAY’S INNOVATIONS BECOME TOMORROW’S TRENDS?

There’s no denying that optomet-ric practice has changed since the onset of the COVID-19 pan-demic. In fact, it was changing even before the pandemic. The

quantities of data we deal with have multiplied, our storage and process-ing have been increasingly moving to the cloud, and patients expect to be able to be seen or managed remotely through telemedicine for interactions that would previously have brought them to our offices. Many practitioners took notice, got in front of this trend, and have invested in new technologies to ensure that their practices were able to adapt to the changing times.

The pandemic rewarded those who invested, allowing them to survive and even grow. However, this scenario has also heightened patient expectations.

Many patients who come to our offices for the first time (aside from our established patient base) do so

because they have heard or read about the technology we use. This can be a good thing, but beware. Investment in technology is not an end in itself. Technology must improve care, and hopefully pay for itself, in order to be a worthwhile acquisition. A technology that looks cool but does not drive outcomes can be a drag on income or profitability, rather than a practice booster.

TECHNOLOGY BENEFITS A new technology can benefit a prac-

tice in several ways. One is by improv-ing patients’ interest in their own care. Consider our clinical trial patients who come to us from all over the region. When I demonstrate some of our advanced imaging technologies—an OCT angiogram (OCTA) or an ultra-widefield image, for example—they’re blown away because they’ve never seen the manifestation of their condition in

their eyes before. Being able to visual-ize the impact of their health on their eyes at each follow-up visit helps them remain invested in their eye health and in the trial results, and willing to make the long trips needed to stay compliant with trial schedules.

Another benefit of some advanced diagnostic technologies is their ability to acquire data remotely and to store and process that data in a cloud environ-ment rather than on the device itself. These capabilities have stepped up tele-health services by leaps and bounds. The ongoing COVID-19 pandemic has dem-onstrated this. Diagnostic technologies that allow us to screen patients without risky exposure, upload the results to the cloud, review them remotely, and discuss the findings without the require-ment of traditional office appointments, have all helped to increase patient con-fidence in our services—and potentially limited unnecessary exposure.

WHY IT’S IMPORTANT TO STAY AT THE FOREFRONT OF EYE CARE TECHNOLOGY

Patients demand it, and it looks good, but be sure to think carefully about every potential investment.

BY AARON LECH, OD, FAAO

SEPTEMBER 2021 | 25

COVER FOCUS WILL TODAY’S INNOVATIONS BECOME TOMORROW’S TRENDS? �

It is also vital that the information we acquire can be shared and integrated with findings across different modalities, by different software platforms. The days of siloed technologies and propri-etary platforms are, we hope, behind us, and many companies have made signifi-cant moves in this direction.

It is helpful, for example, to see how a visual field and an OCT tie into one another. Similarly, overlaying a retinal photo with OCTA can give us insights about the relationship between pathology and blood flow.

SURVEYING YOUR TECHNOLOGYHow do you know when it’s time to

update your technology or bring in new technology? Ask yourself two questions.

What does your current patient population look like?

If you see, let’s say, roughly 3,000 patients a year, and you know that 30% of them are over age 60 (roughly 1,000 patients over age 60), that’s useful infor-mation. You could then further tally the percentage of patients with diabetes, macular degeneration, and dry eye for a good, round estimate of what condi-tions you’re treating and how frequently.

Now, say you have an OCT unit that’s 10 years old, that does not have angiography capabilities. You know that OCTA can give us a real leg up in managing patients with diabetic reti-nopathy or age-related macular degen-eration (AMD), particularly in terms of understanding when a patient might be converting from dry to wet AMD. With patients’ best interest at heart, technol-ogy available today compels us to invest.

These kinds of data, even if they are back-of-the-napkin calculations, can help you figure out whether your patient base justifies updating the technology in question.

What specialty do you wish to develop?Given the patient base analysis that

you just performed, think about a specialty you might want to develop that you already have a decent base-line for. This allows you to consider

making an investment or technology upgrade. If it’s an upgrade, consider whether the device will allow data to be exported for deeper analysis or will trap that data on that machine.

KEEP THE MIND ON FINANCESDemographics aside, decisions

made about technology upgrades should always consider the return on investment.

Let’s say you’re building your practice and you’re about to hit a sweet spot where you will have really consistent revenue. This is when you have to start thinking about tax implications such as depreciation and amortization, because that depreciation acts as an indicator of the real value of the technology asset.

Suppose you’ve made a purchase that allows you to write off $30,000 in depreciation. You were either going to pay a portion of that money in tax to the government, or you could use it to purchase a device that gives you a deduction and potentially boosts revenue. That’s where having that conversation with your financial advi-sor is so important. That device and its depreciation essentially can become an asset management account against tax liability. The best clinicians who are also businesspeople do a really effective job of understanding how much their esti-mated tax liability is, and when to turn that into a compelling reason to buy something that will benefit the income of the practice. Keeping in mind the 1,000 patient estimate above, a tech-nology that nets ~$30 per patient would essentially produce $30,000 in profits in year 2.

You really want to do your tax and purchasing planning in July and August. If you’ve maintained your financials, by July or August you should know what September through December will generally look like, give or take. You might consider aligning your purchases with the fiscal behavior of the manufacturers. If you know when different companies will have specials or will be pushing sales based on their fiscal calendars, you can plan ahead for

purchasing and strike some great deals.When it comes to staying on the cut-

ting edge and embracing new technol-ogy, affordability is crucial. You don’t want to break the bank and put yourself into a $1,500 or $2,000 monthly lease if you won’t have the money to spend. But if you can generate enough revenue in the first year to perhaps break even, and you have the potential to do the same next year and hopefully grow the practice through the new functionality provided by this new instrument, then it’s a zero-sum no-brainer.

QUALITY OVER QUANTITYIt’s vital to our practices that we

stay at the forefront of technology. It’s what our patients want and what trends indicate. However, it’s imperative that we exercise caution about the kinds of technological investments that we make.

Case in point: Digital refractors are pretty cool. They come with lots of bells and whistles and can make us faster in clinic—if our goal is to fly through as many vision examinations as possible each day. On the other hand, digital refractors do nothing to drive addition-al revenues, unless you’re strictly talking about seeing more patients. But higher volume doesn’t necessarily translate into more dollars per hour because it tends to erode the patient experience. So we have to think long and hard about whether a particular technology is a good investment.

During the pandemic, our practice had the same financial performance in 2020 that it did in 2019, even though we saw fewer patients. So yes, invest in technology, but consider the pros and cons for your own particular situation before you invest. n

AARON LECH, OD, FAAOn Optometrist and Owner, ClearVue Eye Care,

Roseville, Californian Member, Modern Optometry Editorial Advisory Boardn drlech@clearvue.orgn Financial disclosure: Advisory Board and Consultant

(Allergan/AbbVie, Zeiss Meditec, Avellino)