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Picture of a refractor

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Any optometric office has certain basic pieces of equipment that allow us to provide vision care. If these instruments are not in proper working order, then it becomes difficult to do our job.  Therefore, the maintenance of our instruments should be of the utmost importance.   


After graduation, I worked in a large clinical practice for twelve years. Then for nineteen years, I was in a two doctor partnership. But, in the twelve years since then, I have actually worked in many different settings.  This allows me to have a unique perspective on how different offices operate.

Every practice I have worked in has incorporated new technology at different rates. This is influenced by the priorities of the doctor/owner and the needs of the patients that practice serves.  Those decisions must be made by the doctors and I’m not here to advise, criticize or judge anyone on their choices.  However, I do have some observations to make on the state of repair, or disrepair, in some offices.


 I was lucky because my first job out of school was in the Cleveland Clinic Department of Ophthalmology. This was in 1975. There were twelve ophthalmologists on staff.  I was the first and only optometrist on staff.  At that time, there were very few optometrists and ophthalmologists working together. 

We had a residency training program that had twelve residents and also several fellows in different specialties.  As a result, we had a full complement of technicians, receptionists and all the other people necessary to run the department.  

In a department of this size, it stands to reason that we had a lot of examination rooms and even more equipment.  We had the best and most advanced technology available. Our equipment was well-maintained and checked on a routine basis.  

The leadership of the department had the wisdom to keep all our equipment in good working order.  Any time something was out of alignment or not working properly, it was placed on a list.  We had an excellent repair person who came in once a week and took care of everything on our list. After that, if there was time left over, he would start to do routine maintenance and calibration on all the equipment room by room.  In this way, every piece of equipment received routine care, calibration and maintenance.  I realize that this level of maintenance is the exception rather than the rule.

It’s not possible or practical to have someone on retainer for a regular sized office.  But, the lesson I learned about equipment maintenance has stayed with me throughout my career.  We are an equipment dependent profession.  We must not neglect its maintenance.  And yet, what I have seen in many offices has surprised me. 


When I do work for other doctors, I never know what I will encounter. Keep in mind, I don’t object to using old equipment. I’ve used old Greens refractors. Those refractors were built like tanks and I doubt they will ever wear out.  Old non-contact tonometers can be a challenge as well.  But, the point is that it’s not the age of the equipment that bothers me- it’s the state of repair. 


The sad state of repairs I have seen in some offices both amazes and frustrates me.  I know we all get good at jerry rigging equipment to make it through the day. I’ve been guilty of this too.  We all learn some basic repairs so we don’t have to shut down the office when something breaks.  But, working with equipment that is not functioning well is annoying and inefficient. 

When you have to fix equipment or move patients to a different room it reflects badly on you.  It makes you look cheap and/or inefficient. That’s not the way you want your patient to remember your office.  


Some problems I’ve encountered are: 

  • Binocular indirect ophthalmoscopes (BIO) that have shorts in the cords and flicker off and on.
  • Project-o-chart slide with a shadow over half the screen.
  • Slit lamp tables that don’t move easily or won’t stay in place and have to be held in the proper position. 
  • Phoropters that won’t lock in position.  When the patient leans against it, it moves.   
  • Stereopsis books that are unglued and falling apart and the glasses are missing a lens.  

True, these are minor problems, but they still look bad.  In the next room there may be a fundus camera, an OCT or an automated perimeter. These new technologies could impress your patient, but not if basic instruments are falling apart in your exam room. 

The patient may not say anything to you, but don’t believe for a second that they don’t notice.  What would you think if you went to a doctor who had instruments not working properly?  Patients do notice and believe me, it doesn’t leave a good impression.


We are all anxious to have the newest technology in our offices. It improves the care we offer to our patients.  But, we can’t ignore the stable utilitarian tools we have used for years or let them fall into disrepair. They have saved me on more than one occasion.

Everyone needs to establish a good relationship with a company that provides equipment maintenance and repair.  Then when you do need a repair done, you know who to call and know they will respond. Previous experiences with them means you know they are reputable and the job will be done well and promptly.

Make a checklist of all your equipment and the recommended intervals for maintenance.  Have someone train you, or your staff, in some of the basic repairs.  For example: eliminating shadows on manual projectors, calibrating your instruments and doing some basic cleaning and maintenance are all simple.  Learn to write down whenever something needs a repair and then when you do have to call someone in, you can have everything  repaired at once.  Having a list means you don’t have to rely on your memory when a repair person is called. You can tell them all repairs that need to be done at once. 


Do you have back-up equipment to allow you to continue to see patients if something goes wrong?  Do you have back-ups for bulbs, fuses, paper or anything else required for the proper functioning of all instruments? Make your life easier and your day go smoothly. Be prepared.

Look at your office through your patient’s eyes.  They notice the little details more than you think they do.  

How do you handle routine equipment maintenance in your office? Does your staff know how to troubleshoot minor repairs?  Is there a plan in place if a major malfunction occurs?  Let us know what you do in your office by writing in the comments below. 

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