This is a review of the Essilor Vision-R800 phoropter, a revolutionary piece of optometric equipment. I’ve written it for eye care practitioners and also for (potential) patients. It describes the Vision-R800’s groundbreaking precision and the benefits to patient and optometrist alike, with regard to comfort, precision and social distancing.
Currently, there are just 24 Vision-R800 phoropters in use in the UK. I work at Benjamins Opticians, a forward-thinking, high-end practice, and we have three of them. I’ve been using one since mid-June when I returned to practice from being furloughed during Coronavirus lockdown.
What is a phoropter?
A phoropter is a machine that some optometrists use in place of the traditional trial frame, seen here modelled here by my dad.
Trial frames and phoropters are both used to determine the refractive error, a process called refraction. It’s how we quantify a patient’s long/short-sightedness and astigmatism. Most phoropters have a rack of lenses inside. The patient sits behind and looks towards a screen while the optometrist asks a series of questions. The optometrist changes the lenses according to the patient’s answers. They do so by rotating dials on the phoropter itself or, depending on the model, via a remote control or console. Generally speaking, they are bulky and, can be quite noisy when the lenses whirl round. Despite that, I’ve always preferred a phoropter to a trial frame.
Why is the Essilor Vision-R800 different?
The Vision-R800 is a state-of-the-art phoropter that contains a patented, automated optical module powered by digitally controlled motors. The module replaces the rack of lenses, so makes for a much smaller and less cumbersome phoropter head. It is also very quiet, slick and smooth. The neat head allows the patient a wide field of view and makes it easy for the optometrist to see and read patient facial expressions and cues. This is especially useful if they are wearing a mask. This phoropter will fit into the most bijou consulting room.
In traditional refraction, and with both trial frame and phoropter, the refractive error is rounded to one-quarter dioptre, (0.25D) at every stage. (Occasionally to 0.12D). Consequently, small inaccuracies can accumulate.
Five years of research by Essilor showed that 95% of people are sensitive to increments of less than 0.25D. The Essilor Vision-R800 measures to a precision of one hundredth of a dioptre, because the value of the sphere, (amount of long/short-sightedness) and cylinder, (amount of astigmatism), can be changed in 0.01D increments. This is unprecedented precision. To go hand-in-hand with that, Essilor offers premium lenses integrating this precise prescription in most of their spectacle lens options. It enables the patient to reach their full visual potential.
The Vision-R800 offers a choice of automated refractions and several other “SMART” options. The optometrist can tailor-make their own programme too. The SMART tests and programs use algorithms which guide the refraction to make the whole process very quick and easy. The practitioner displays the various tests, records the patient’s answers and follows the algorithm progression. The programme automatically ends when the value has been reached.
I use the automated AVA programme on most patients. So far, every one could see the improvement in their vision between a prescription precise to 0.01D compared to that accurate to the traditional 0.25D. 100% of patients so far prefer the phoropter to the trial frame, regardless of which programme I used.
The phoropter is operated from a console which helps maintain social distance between practitioner and patient. The smooth power changes and the wide field of vision make for a very comfortable refraction process for the patient. There is no heavy trial frame and no whirring of lenses in a rack. The procedure is shorter than a traditional refraction, so there is less fatigue. Throughout the process, each step is adjusted to patient sensitivity so differences are easier to perceive. It’s easier for the patient to respond and the response “I don’t know” is a valid one.
At the end of the test, there is an option to show the patient a comparison of their previous prescription with the new one by watching an animation. The animation simulates real-life conditions and is excellent. It demonstrates to the patient the improvement they can expect from their new prescription. They are genuinely amazed at the difference and that in itself is rewarding all round.
Optometrist comfort and ease of operation
Speed and precision are the greatest benefits to the optometrist, thanks to the continuous and simultaneous changes of sphere power, cylinder axis and cylinder power. It’s much kinder to the back too because there is no leaning in and out to change lenses or turn dials. The programmes are intuitive and easy to understand. My colleagues and I had training with the brilliant Emily Mascall via video call. (Emily has experience of working in practice and is now a member of the Essilor Instruments team). There are also downloadable quick guides, so we soon got to grips with the new kit.
The AVA and SMART automatic programmes are suitable for most patients. However, there will always be a few exceptions. Patients with amblyopia, (a lazy eye) will struggle because of the algorithm, so a manual route through the test is better. And the manual route is still quicker, more precise and more comfortable than using a trial frame.
When the Essilor technical team came to the practice to set the Vision-R800 up, they calculated the working distance of the consulting room to incorporate it into the software. The end refraction can be converted for a distance of infinity. This is especially useful in a short-form test room. Our test room is 2.5m long. The mirror means patients are looking at a chart at an equivalent distance of 5m. Some people accommodate (focus) slightly when viewing at this distance so the end result might be slightly inaccurate. Converting to infinity eliminates this. The final results are presented in several ways, including to the 0.01D and rounded to the 0.25D, which is very useful.
What do I think of the Essilor Vision-R800?
I think the Essilor Vision-R800 is brilliant.
I’d seen it demonstrated several times and was hopeful our practice owner would invest. She was going to wait until the end of the year, but brought it forward because of Covid-19. The fact it’s a quicker refraction means the patient and practitioner are in contact for a shorter time and there is much-reduced physical proximity between the two. It’s easier to clean and sanitise the phoropter head between patients than it is to wash a trial frame and lenses after every patient The phoropter fogs up a lot less than trial lenses too, something which is especially useful now that so many wear face masks.
It’s user friendly. I got used to it very quickly; it’s now second nature. When we had our training with Emily, she made the clear distinction between refraction and prescription. The Vision-R800 finds the refraction. It is up to the optometrist to interpret the results and issue the patient with the best prescription. I can tell early on whether the automated AVA programme will be the best or whether a manual programme will work better. It’s easy to swap to the manual programme from the automated during the test.
It sets our practice apart. I’m proud to tell our patients that there are only 24 in the UK and Ireland, and that we have three. It’s innovative, forward thinking and future proof. This system has changed the way we refract. The precision is unparalleled and it’s incredibly rewarding to give our patients the best possible vision, to enable them to reach their full visual potential. The AVA spectacle lenses don’t cost much more and most are happy to pay that little bit extra to reach their full visual potential.
The Essilor Vision-R800 phoropter:
- Measures to 0.01D
- Sets the practice apart
- Is quick, slick and quiet
- Offers fully automated as well as bespoke and manual programmes
- Is comfortable for the patient
- Is comfortable for the optometrist
- Looks impressive
- Helps maintain social distance
- Is easy to sanitise between patients
- Fogs less than trial lenses, (especially when the patient is wearing a mask)
- Is innovative and forward-thinking
- Has got excellent support from both Essilor and Emily Mascall
- Is intuitive and easy to operate
- Has revolutionised refraction
This post is sponsored by Essilor. All opinions are 100% honest. Thank you to my friend and work colleague Julian Hotchkiss for taking the photographs of me with the phoropter.