Robert Noecker, MD, MBA, focuses his blog on the positive impact diagnostics and imaging have on various disease states and conditions. 

BLOG: Integrating visual electrophysiology into a practice

One of the issues faced by ophthalmologists is knowing which new technology should be incorporated into our practices. Because technological advances happen quickly, it is not possible to implement everything that is currently on the market, so doctors need to think about what is important and will add the most value to their practice and fit into their workflow. For my practice, introducing electrophysiological testing such as visual evoked potential and electroretinography has been well worth the investment in time and resources.

Several years ago, it would have been necessary to send patients to a hospital or research facility in order to obtain these tests. Consequently, doctors tend to view them as intimidating and inaccessible, but office-based equipment such as the Diopsys Nova ERG and VEP vision testing system makes testing both convenient and user-friendly. The biggest practical consideration is whether an office has sufficient space to allow patients to be tested undisturbed. If space is available, integrating the testing is relatively simple.

In the beginning, there was a lot of reticence on the part of my technicians because the idea of electrophysiological testing can seem intimidating. However, once past the mild learning curve, we have found it is actually much easier than a visual field, which all technicians can perform. The electrodes are easy to use and comfortable for the patient, which has vastly reduced patient complaints and makes the job of the technicians much easier. The entire process is streamlined and only requires approximately 20 minutes to perform — from patient set-up to printed results.

On a practical level, we were able to integrate this testing into our workflow without difficulty by implementing a special testing day. Typically, we set up times when patients can come in and get their testing done on days when I am out of the office. We can give them their results the same day so there is no need for another appointment. The test does not take as long as a visual field test, but it is longer than a test such as an OCT, so it is necessary to limit how many patients you schedule in a day. With planning, every office should be able to find optimal times to integrate ERG and VEP vision tests, such as mornings before the office gets busy or on days the doctor is away.

Once the electrophysiology testing routine is fully integrated and the technicians are trained and comfortable, your practice will run very smoothly. With the benefits of these objective, functional tests, integrating them into your practice is well worth the effort.

Robert J. Noecker, MD, is a leading ophthalmologist with more than 15 years developing innovations in glaucoma surgery. He currently practices with Ophthalmic Consultants of Connecticut and is on the clinical faculty at Yale University. Noecker can be reached at email:

Disclosure: Noecker reports he is a consultant to Diopsys.