TECHNOLOGY REVIEW
     See also:  Updates in Cyberspace

Taking it to the Max?

by Dominick M. Maino, O.D., M.Ed.

Have you ever tried a software program or piece of hardware and said, "I really like XYZ, but …?" That's how I feel about the AcuityMax program from Science20/20 (www.science2020.com, 1-877-436-9868). Since there's a lot to like about this program, however, that's where I'll start my first of two product reviews this month.

AcuityMax
AcuityMax is software that takes the place of an acuity projector in your office. To use it, you must have a 386SX or higher computer with MSWin98, MSDOS, 5MB free on your hard drive, and a 3.5-inch floppy disk drive. You should also have 4-8MB of RAM, a parallel port, VGA (16-color) monitor, and a keyboard and/or monitor extension cord. The manufacturer also suggests that you use this program on a dedicated computer (it does not guarantee support otherwise). AcuityMax is specifically not licensed to run on a network.

The folks at Science20/20 sent me two copies of this program to evaluate. I installed one copy in my private-practice office, the second in the pediatric clinic at Illinois College of Optometry/Illinois Eye Institute. I've used it most frequently at ICO, since I spend most of my time there.

• Installation. AcuityMax comes on a 3.5-inch disk with everything you need to install it. This includes a small copy protection device (more on this later) that you must attach to the parallel port before you can run the program. The installation took 15-20 minutes and went without any difficulties.

• Setup. The minimum test distance from the patient to the computer monitor must be no less than 8 feet (3.78m) nor more than 24 feet (10.39m). The first screen you see allows you to adjust the monitor for the program. You can use the program as a mirrored or direct-throw system.

You then input your patient's distance from the monitor, initial optotype selection and how each optotype line is presented. Following that, you choose optotype size and when the screen saver kicks in. Finally, it asks you to save the configuration, and you're ready to begin.

AcuityMax comes with a hard copy and on-line help manual. Most of the functions you need to run the program are easy to access through the function keys.

• Optotypes. One of the greatest advantages of this program is the numerous optotypes available at your fingertips (literally). You can easily switch between Snellen letters, tumbling E's and an HOTV chart. If your patient requires Landolt C's or shapes particularly well suited to children (a clover, square, circle and cross), you can instantly start to use those as well.

Want to change optotype size or the number of optotypes on the screen? No problem. Just hit the up/down arrow keys or the right/left arrow keys to alter size and optotype choices (respectively). You can also see the size of the optotype displayed in Snellen, metric or log MAR designations.

• Other features. AcuityMax has a mode that allows you to conduct an examination with a hearing-impaired patient. Also available: vertical presentation of optotypes and crowding bars for evaluating amblyopes. You can also use a red/green balance, Worth's four dot testing, astigmatism test targets and various fixation targets. I especially like that I can now test in light as opposed to dim illumination. The "scripting" function allows me to present the visual acuity testing sequence with which I'm most comfortable.

• What others say. Joan Ploem Miller, O.D., says, "I LOVE it! It makes refracting easier and fun. It impresses patients, especially my Intel engineer patients, which make up an unusually high percentage of my practice." The flat LCD screen she uses tends to impress patients.

Practice management guru Neil B. Gailmard, O.D., M.B.A., says the AcuityMax "presents a high-tech look good for practice building." Projected charts often provide dim and uneven illumination. Or, they get dust and smudges on the slides, sometimes have less-than-excellent contrast, and the bulbs burn out. "Using a computer monitor eliminates all that," Dr. Gailmard says.

But, let me add a caveat or two. I hate (notice I didn't just say "dislike") copy protection schemes. I particularly hate copy protection mechanisms that use a hardware key. All software companies (even the game makers) have come to realize that the time and effort it takes to come up with a copy protection scheme are just not worth it. I would prefer that Science20/20 charge a fair site license that allows me to use the program for up to six computers and then trust that most of us are basically honest.

Billy Cook, O.D., of Midland, Texas, says the cost can be prohibitive ($1,650) if you want to use it in more than one exam room, even with a 5 percent multiple copy discount. He would also like to use it on his network, but cannot do so.

Dr. Gailmard also has some concerns about AcuityMax. Specifically, children's acuity symbols may not be easy for children to recognize, and it lacks an optotype larger than 20/200. He also would like to see educational eye diagrams and photos, attention-grabbing fixation targets and a screen saver that the doctor can customize.
Dr. Gailmard also notes that it is fairly expensive. However, since you can use it with individuals who are hearing-impaired, AcuityMax qualifies for an ADA tax credit. (Check with your tax adviser before you take that one to the IRS.)

R. Anthony Hutchinson, O.D., president of Science20/20, answers some of these criticisms. He says AcuityMax offers an important advantage: It's easy to upgrade. The next update will include 20/400 optotype sizes, plus a set of recognizable pediatric symbols, and it's free. Updates will also be put on Science20/20's web site for downloading. The ability to upgrade is a great advantage over standard visual acuity projectors.

Dr. Hutchinson also addresses the copy protection issue. "First, I would like to talk about software prices," he says. "As you know, game software and many consumer software products cost under $100. Often these products are quickly out of date, and more money must be spent on upgrades."

He adds: "Professional software packages aimed at a smaller market segment cost more as well. Most of these programs do require a dongle or software protection key, which cost the manufacturer about $30 apiece. Our software is priced at $1,650 which is more than standard projectors, but less than automated projectors."

He says the upgradable technology (at no additional charge and without maintenance fees) makes AcuityMax a better value than other visual acuity testing devices.

My final verdict? I loved using AcuityMax. It's fast and easy to use. Patients respond well to it during the examination, but … Even with Dr. Hutchinson's excellent arguments, I still would have difficulty recommending it until the company removes the copy protection scheme and develops an equitable multi-machine use policy.

B&L MagniViewer
Rick Potvin, O.D., a researcher with Bausch and Lomb, called and asked if I had tried B&L's new PC MagniViewer. I told him that although my visual acuity is decreasing as a result of being chronologically enhanced, I wasn't quite ready for a low vision aid.

Dr. Potvin then informed me that this is not a low vision aid. Rather, it's a computer screen-enhancing device for anyone with computer vision syndrome. It's not indicated for anyone whose visual acuity is less than about 20/200.

I use the computer every day. Even now I'm typing this column on my new Sharp Actius Ultralightweight while flying to a computers in education conference in California (more on both these in a later column).

And, I'm presbyopic. Those of you who also have crossed this line know that we are automatically afflicted with computer vision syndrome. Our main symptom: the sore neck that results from trying to tilt our heads back to view the screen through our bifocals. What I wouldn't give to view the computer without a sore neck! The PC MagniViewer, a large magnifier, brings the screen right where you need it.

• Setup. The PC MagniViewer comes in a rather large box with plenty of packing. An enclosed CD-ROM teaches you how to set up and use the device. Setup requires you to place your monitor on a stand and then connect an arm-like device to the stand and the MagniViewer itself. Since positioning is critical, the device allows you to alter its position easily.

As with many large magnifying devices, the edges of the lens show some distortion. I don't find these to be bothersome, although several of my colleagues do.

• What others say. Computer ergonomic expert Jeffrey Anshel, O.D., says the MagniViewer "forces the user to stay in a pretty fixed position of posture to maintain the view through it." He suggests that spectacles prescribed just for computer use may work as well. Overall, he believes the PC MagniViewer is unnecessary. He usually recommends a software image enhancement first, then a larger monitor if necessary.

Shaun Coombs, O.D., disagrees: "I have used the PC MagniViewer for about six months, and I really enjoy the device." His only complaint: "peripheral distortion and reflections off of the front surface of the lens."

Before using the MagniViewer, Dr. Coombs says, he had all the symptoms of computer vision syndrome. He can now use the computer longer and still maintain clear and comfortable vision. He also recommends the device to post-op LASIK patients who have trouble at the computer, and they've been receptive.

• Bottom line. I love my B&L MagniViewer and use it constantly. I also recommend it to my patients. B&L's suggested patient price is $295. Your cost is $200, and you can purchase it directly from B&L's web site (www.bausch.com).

Dr. Maino is a professor at the Illinois College of Optometry and is in private practice in Harwood Heights, Ill. He has no financial interest in any of the products or services he mentions in this column.

top

Updates in Cyberspace 
Get free software. I'm always looking for the best sites to download freeware and shareware. Where do you start such a quest? Try these out:

How about free PCs? Want a new PC? Who doesn't? Of course, nothing in life is free, so be ready to pay for Internet access and to share lots of private information about yourself. Still interested? Go to: InterSquid (www.intersquid.com), Free-PC (www.free-pc.com), DirectWeb (www.directweb.com), and MyFreePC.Com ( www.myfreepc.com) for more information.

• Computer alarm. Can't get yourself up in the morning? Go to www.mrwakeup.com, enter when you want to get up and a brief message along with your phone number. When you hear your phone ringing in the a.m., it'll be your very own wakeup service!

• Windows CE. No, I'm not talking about continuing education for your computer, but rather where to find the latest Windows CE programs for your personal digital assistant running Win CE. Log on to:

• Optometric home pages. Want to see what your colleagues' WWW home pages on sports vision and vision therapy look like? Go to:

• Need a quick and inexpensive way to develop a web site for your office? Go to www.optometry.net and take a look!

top
| | | | | |