Revisiting the Humphrey Vision Analyzer

In the course of yesterday’s post on the prose and cons of proprietary lenses, I noted examples of companies bundling proprietary devices for visual analysis together with proprietary lenses generated through the data from these devices. To the extent that the marketing strategies of the companies are effective, the impetus for practitioners initially coming on board ranges from specific perceived benefits to FOMO. The iZon lens was a failed example of wavefront guided lenses generated from data through a proprietary aberrometer, whereas the Neurolens is a contoured mini-prism lens generated by data from a proprietary binocular vision device that appears to be gaining traction.

In the course of citing a roundtable discussion generated by Neurolens, I shared my intrigue at a highly accomplished primary care doctor intimating that he found binocular vision to be intimidating. Part of the genius of the company is that it has made the prescribing of a micro amount of contoured base-in prism in a lens (progressing from zero at pupillary center to 0.375^ in downgaze) much less daunting. It has also done a masterful job of generating groupthink and FOMO, all the more impressive given that there has not been a peer-reviewed study published in a journal to date showing that a traditional 0.5^ BI is inferior to contoured 0.375^ BI for comparable cases of binocular deficit. To their credit as a company, Neurolens is avoiding the debacle of the Humphrey Vision Analyzer.

Chances are if you graduated from a School or College of Optometry after 1982, you have never seen (or even heard of) the Humphrey Vision Analyzer (HVA). The only reason I saw it in action was that one of my instructors at PCO, Dr. Lorance Harwood, was involved in bringing it to market in the mid 1970s. Nathan Efron wrote a review of the system that was published in the Australian Journal of Optometry in 1981. It was a system well ahead its time, permitting subjective refraction in free space without a phoropter.

But as the name implies, the HVA was a vision analyzer rather than just a subjective refraction system. It incorporated binocular vision targets as well, including phoria, vergence, fixation disparity, global, and random dot stereopsis.

The HVA system, including the Humphrey Lens Analyzer that permitted over-refraction of the patient’s habitual Rx, was priced at $39,000, an astounding amount of money for the late 1970s and early 1980s. The HVA could be purchased as a stand-alone system for $31,500. It quickly became a white elephant, and Humphrey turned its attention to it automated lens analyzer which became a great commercial success.

The HVA failed for numerous reasons. Among them:

• It took up considerable space in the exam room
• It had a high learning curve of operation
• The binocular information was intimidating
• The price point was too high for the perceived return on investment