For almost 150 years, the two most important tools in optometry have hardly been modified and a start-up of engineers in Atlanta is trying to change that. Mike Vinson and Zane Coffin are helping design the machine that could disrupt the way we see in the future. You just can’t see it, yet.
By Wyatt Williams. Photography by Dustin Chambers.
Snellen’s Chart & the Phoropter
In 1862, a Dutch ophthalmologist named Hermann Snellen developed a tool that most people know today as the eye chart. It is a simple tool, a piece of paper with alphabetical characters printed in a pyramid of descending sizes. Snellen’s chart, as it is known, has a very large “E” at the top followed by rows of ever-smaller print. There have been variations – charts with pictures for the illiterate, charts with different characters for areas that do not use the roman alphabet, and so on – but the form has remained the same. Every time I’ve visited an ophthalmologist or optometrist to have my eyes checked, this hundred and fifty year old tool has been part of the process. By determining what row of characters the viewer can or cannot see clearly, the chart measures the viewer’s clearness of vision.
…that weird giant mask on a crane with all of the dials and lenses and stuff.
Along with the chart, my eye appointments have always included another tool called the phoropter, but you probably know it better as “that weird giant mask on a crane with all of the dials and lenses and stuff.” At the proper distance, I lean into the mask and look at the eye chart as the ophthalmologist spins the dials and clicks through lenses and asks a single question on repeat: “Better now? Or better now? Better now? Or better now?” From this process, a prescription for one’s vision can be written, lens for spectacles or contacts sold.
If the phoropter seems like it belongs in a Victorian apothecary, that’s because it very nearly is Victorian. Versions of the machine were used through the late 1800s. The improved version that set the basic standard we use today was patented as the “Ultramatic RX Master Phoropter” in the 1920s. Improvements have been made since, but like the Snellen chart, the phoropter remains essentially the same.
If the history of tools in the field of ophthalmology has never once crossed your mind, you are not alone. In my annual visits to the ophthalmologist for the past twenty years, never once in those two decades did I second guess or wonder about the eye chart or the phoropter. Both tools seem as essential and unchanging as the fact that I need glasses to see. Yet, I recently heard someone say that everything about that was about to change. This person told me that the eye chart and the phoropter were headed to the dustbin of history, that an entirely new tool was poised to change the industry, to completely reinvent the experience and bring it in to the digital precision of the twenty first century.
“This,” I said, “is something I’d like to see.”
As it happens, this promised vision industry revolution, or at least part of it, is happening down the hall from my office at the Goat Farm Arts Center. Beside a mural of a large cartoon cat wearing a sweater is the door to the office of FormHouse, a design firm founded by Mike Vinson. As of now, the firm consists of Vinson, another industrial designer named Zane Coffin, a couch, a coffee table, a coffee maker, a couple of laptops, and a white board.
After getting a degree in industrial design at Georgia Tech, Vinson began his career as an industrial designer for Coca-Cola working on designing vending machines and bottles, among other things. Last year, he was contacted by a start-up familiar with his work about a freelance project. Vinson says, “They approached me and said, ‘We’ve got something around the same size as a vending machine that has interactive qualities. Could you work on it?’”
What Vinson was shown was an essentially formless box of wires, processors, and mechanisms. In this way, it could have been anything with wires and processors, any sort of work of engineers. So, they explained to him what this particular tangle of wires is intended to do.
That’s it: no antiquated phoropter mask, no eyechart, and, perhaps controversially, no ophthalmologist asking even once, “Better now?”
A patient walks into a room and sits down in a chair. Across the room, an image is projected from a corresponding screen, not a Snellen Chart nor anything like it. Instead the image is something that the patient chooses: a football field in the distance and a street sign at an intersection. The patient then interacts with the machine and, after a little fine-tuning, arrives at a precisely focused vision, a prescription within one-hundredth of a diopter. That’s it: no antiquated phoropter mask, no eyechart, and, perhaps controversially, no ophthalmologist asking even once, “Better now?”
The start-up that developed this machine, called Digital Vision Systems, had spent the last five years developing and building the first prototype of a machine they’re calling the VisionOptimizer or “DVO.” The company had been founded by Dr. Keith Thompson, an early-adopter in the field of LASIK surgery. A team of engineers had built the machine to digitally measure a patient’s vision down to the one hundredth of a point without using an eyechart or a phoropter. What they needed now was to test the machine in clinical trials.
Vinson says they wanted him to, “Just cover the wires and processors so it’s not ugly, just for in-house testing purposes and not as a final product.”
At first, the engineers had considered covering it themselves with beige panels and soon realized that if they were building a digital tool of the future, it probably shouldn’t look like a Dell PC tower from 1994.
After six months, Vinson had fabricated something functional enough, cutting away the refrigerator box shape into a moderately pleasing shape of boxy white panels around the back of a chair. It wasn’t perfect, but at least it didn’t look decades old. During that time, though, Vinson realized that he had stumbled upon a much larger challenge as a designer.
The phoropter and Snellen chart are iconic designs, tools that we immediately understand and recognize. The DVO needed a form that anyone could relate to, if it was going to compete. As the work began on this design in earnest, Vinson left his job at Coca-Cola and brought Coffin into the firm. All of this to try to find a design that could be as iconic, as lasting as the tools the project would replace.
“This,” I said, “is something I’d like to see.”
That’s when I got the bad news.
“Well,” Vinson said. “We can’t actually show it to you.”
Apparently, as designers, both Vinson and Coffin are bound by a non-disclosure agreement that prevents them from sharing their current working design for the DVO. They can describe it, but only in vague terms. They said that they might be able to get me in to use the machine as part of the current trial, but then I’d have to sign a non-disclosure agreement and wouldn’t be able to talk about it either.
Out of curiosity, I started asking if I could see other things, like Vinson’s designs from his time at Coca-Cola. Not a chance, those are also bound by NDA. Vinson also told me that he couldn’t tell me what town in Georgia he was born in. I’m still not sure if that was a joke.
Vinson and Coffin wanted to help satisfy my curiosity. They sent me to a website that has illustrations of the earlier, prototype design. On that website, the engineers describe the machine with not exactly basic terms:
“Images are projected from the wavefront generator to the DVO’s concave viewport mirror where they are reflected to the patient’s eyes. This architecture causes the corrective optics of the CVPLs to be relayed to the patient’s spectacle plane, permitting a “phantom lens” or “virtual refraction” to be performed under natural viewing conditions free from obstructing instruments or head restraints.”
…the DVO creates the effect of a lens in front of a patient’s eyes without a physical lens being present.
Maybe you got as lost in that as I did the first ten times I read it. I tried to ask one of the engineers what it meant and he basically just read that paragraph back to me. As best as I can understand, the DVO creates the effect of a lens in front of a patient’s eyes without a physical lens being present. I believe that is a mostly correct way of saying it, but I can’t say that I’ve seen it, used it, or in any way verified that it works.
A month later, I was told that Digital Vision Systems would be releasing the first renderings of the design at a trade show called Vision Expo West and, if I was just patient, that I could get a peek at what they were showing their peers in the industry. The renderings they sent me are below. When they finally arrived in my inbox, I was struck by them, especially by the way the design feels completely different, entirely new from the clunky prototype I’d seen before.
This fall, that design will be fabricated into eight fully functional machines. In the first quarter of 2015, eight optical locations around the Atlanta area will have the first trial run. If you happen to get your eyes checked in the area, you may finally see it for yourself.