Practice Management Channel

The Innovation that Exponentially Improved My Pandemic Exam Room

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By Gregory Moore, OD

Jan. 6, 2021

When your phoropter gets fogged as you are doing an exam, the quality of the exam is compromised, and the patient experience is impacted. Fortunately, there is a new product that solves this problem in a simple way that transforms the pandemic exam room experience.

That product, the VisibleBliss™ Phoropter Mask, is designed to provide an extra layer of protection for patients and doctors during exams. Each single-use, recyclable non-gas permeable breath shield attaches to the phoropter to prevent patient contact, shield you from your patient’s breath, and trap contaminants, all without fogging the phoropter lenses.

Easy to Implement, Big Improvement
VisibleBliss takes only seconds to change in between patients. You simply attach it to the phoropter, so that when the patient is in place, it helps to secure their face mask so that exhaled air escaping its superior edges is minimized and so is fogging of the phoropter lenses. Installation is easy. The manual phoropter design slips into the clips along with the face guards that hold both securely to the phoropter. This takes far less time, and is more effective than the any other method I am aware of, to reduce phoropter fogging.

I have been using VisibleBliss for about three months. Prior to using it, every patient at some point in the refraction fogged the phoropter, usually at least two times. Sometimes we would clean the phoropter, and before we could restart the refraction, the phoropter would fog again. On average, VisibleBliss reduced our refraction time by about a third. That was amazing to me. Unless you closely track time, I don’t think most ODs realize how much time is spent clearing the lenses after they fog during the refraction.

More Efficient AND Offers an Extra Layer of Protection
Some professional organizations have recommended that patient and doctors hold their breath during a slit lamp examination, even with a slit lamp breath shield in place. That, of course, is not feasible for a refraction, and yet the doctor’s hands will be even closer to a patient’s nose and mouth during a refraction than during a slit lamp examination. VisibleBliss functions similar to a slit lamp breath shield, but it is specifically designed for the phoropter. Staff love that it is single-use so that they do not have to clean it like bulky, reusable phoropter breath shields, which can be difficult to keep in place during the refraction.

Once you’re within two feet of another person, the blue paper masks (which most people are using) offer protection from a cough or sneeze, but within minutes you both are still sharing the same air. Some studies suggest that reaching a viral load can happen in as little as 10 breaths each.

Considering the refraction is likely the longest diagnostic test being performed within that proximity, the VisibleBliss Phoropter Mask with its unique design significantly reduces our time with the patient during the refraction. That, in turn could, in my opinion, possibly assist in lowering the risk of transmission beyond your walls. As long as the COVID-19 pandemic is still a dangerous health threat, it is no understatement to say that anything you do to potentially reduce the transmission of contaminants between patients, staff and doctors is helpful in providing an extra layer of protection.

The most important thing any ECP or organization can do to be “safe” during the pandemic is to minimize the social interaction times with the patient and the time spent in our exam rooms. Here is the bottom line – time saves lives! Our goal should be to reduce our time spent in the exam while not compromising care. This is very difficult during refractions based on the challenges we are facing. Fogging by itself has created a major problem and VisibleBliss has helped me save ~30 percent less time just on the refraction. What was taking me six minutes is now only taking me four minutes. By eliminating fogging and having a disposable mask we install and toss after each exam, it has met our most important criteria and we are now using it as a new “standard of care” for all of our refractions.

Efficiency will be the key to practices surviving this disease. We may be turning the corner with vaccines and new FDA-approved treatments, but we have a long way to go. Until we get there, how will practices protect their patients and staff, and at the same time, survive financially? The answer to both questions is the same. You have to decrease your routine exam time as much as possible without decreasing the quality of care you offer. VisibleBliss is a cost-effective way of doing that. Reducing the time it takes to do a refraction, not only mitigates the risk of spreading diseases, it allows more patients to be seen per day. This goes a long way toward allowing the practice to return to pre-pandemic patient volumes and revenue.

The Best Option for a Pressing Problem
Other options that reduce phoropter fogging include taping the patient’s face mask down, which in and of itself, should require the use of more personal protective equipment. Fresh gloves should be put on anytime your fingers are that close to the patient’s face to prevent transference via fomites. Having the patient adjust their own mask or holding it against their face helps. However, the patient should wash their hands first or be given gloves. These methods actually increase the patient’s time in the office and there is still the increase transference risks via fomites.

Both of these methods take significantly longer than using VisibleBliss. Having the patient sit back from the phoropter works to a degree. However, most patients will automatically move into the head rest at some point, and that is not far enough away to prevent fogging. And that method requires you to account for the increased vertex distance, which you then have to calculate into your final Rx.

Win for Your Patients, Practice & Your Community
VisibleBliss is a win-win-win product. It offers an extra layer of protection in your office for patients, your staff, your families and then subsequently the general public. It is the ripple effect. If you help to slow, or stop, the spread of breath droplets and contaminants in your office, anyone who comes into contact with anyone who has been in your office will have less exposure as well. It’s a way to help, not just your patients and practice, but your whole community, to make it through the pandemic.

Gregory S. Moore, OD, is a co-founder of the International Academy for Safe Practice Standards and owner of the Greater Regional Eye Group PLLC in South Charleston, W.V. To contact him:

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