“On average, every fifth child in Germany suffers from a congenital visual disorder,” says Johannes Huber, an ophthalmologist from Oberkirch in Baden-Württemberg. “Seeing is a learning process and develops in the first years of life. If this visual development is disturbed by a congenital, untreated visual defect, lifelong weak vision (amblyopia) develops in many cases, which cannot be corrected later.” It is therefore important to recognize and treat visual disorders at an early stage. Since babies and toddlers are often difficult to examine due to their age, many ametropia have so far remained undetected. Plusoptix GmbH has found a solution to this problem.
The Nuremberg company, which employs 30 people, has been selling hand-held, binocular photorefractometers since 2001 under the management of Jürgen and Christian Schmidt. According to the company, it is the world market leader in this area. Plusoptix sells the devices in more than 60 countries. A binocular photorefractometer measures the refractive power of both eyes simultaneously in a matter of seconds. The most successful are the vision screening devices. They made it possible to “recognize any existing visual impairments very early, namely at the age of six months, quickly and without strain,” says Christian Schmidt.
The handy mobile device is intended for first responders such as paediatricians. It attracts the child’s attention with its smiling smiley face and funny noises. A non-contact measurement of the refractive power of both eyes is carried out from a distance of one meter in less than one second. The baby or toddler can sit on a parent’s lap.
Price between 6350 and 8000 euros
The binocular autorefractometer is specially designed for ophthalmology practices. Its handling does not differ from the Vision Screener, but it delivers a more differentiated result. Autorefractometers use the measurement principle of the fluoroscopy test. The pupils remain large even without dilated drops. In a fluoroscopy test, a beam of light is projected into the eye and reflected off the retina. The beam of light illuminates the central part of the cornea, lens, vitreous and retina. By using infrared light, Plusoptix devices avoid patient glare, unlike other fluoroscopy tests, and are easy to use.
Plusoptix manufactures other measuring devices. The sales prices depend on the performance characteristics and are between around 6350 and a good 8000 euros. Customers in Germany can also borrow the devices. They paid 4 euros for each measurement, says Christian Schmidt.
Customers are ophthalmologists, optometrists, orthoptists, paediatricians, American school nurses, opticians, health authorities and non-profit organizations. Eva Schittek is an orthoptist. She deals with the diagnostics and therapy of eye misalignments and visual disorders, mainly in children, and works in five ophthalmological practices in the district of Ortenau in Baden-Württemberg. “Four of the practices have the Plusoptix autorefractometer,” she says. Many paediatricians used the Vision Screener. According to Schittek’s experience, the child-friendly design of the device puts the child in a good mood and can take away their fear of the examination. A big advantage of the device is the speed of the measurement. “In just a few seconds, I can get an overview of the refraction ratios in both of the patient’s eyes; this is very helpful, especially when examining very small or restless children.”
“Everyone asked us what our devices should be good for”
The devices are only sold directly to end customers in Germany because the healthcare market is fragmented. The company sells more than 80 percent of the devices to its dealers abroad, who then sell them to end customers. The products are sold from Ethiopia to Malawi to Congo. By far the largest dealer is the subsidiary Plusoptix Inc. in the USA. In 2021, she resold a little more than 50 percent of all devices, a good 1000, to customers in the USA. In 2020 Plusoptix sold 1284 products, in 2021 it was 2052, almost twice as many.
“The 2020 financial year was marked by the first corona lockdown,” explains Schmidt. “For a long time, we and our dealers were unable to demonstrate any devices to win new customers.” In 2021 there were catch-up effects and sales were 7.2 million euros. Schmidt states the market share in Germany as 100 percent; abroad it is 36 percent. We are still struggling with supply bottlenecks, he says. Some parts that were ordered in spring 2021 have still not arrived.
“When we sold the first devices in 2006, we were the only ones and the sales market was tiny. Everyone has asked us what our devices are supposed to be good for,” says Schmidt. There are now many competitors, for example Welch Allyn in the USA, Adaptica in Italy and Suoer in China. “The Chinese government excludes foreign suppliers from public tenders in the healthcare sector. This means that we cannot receive any public contracts in China because of the Suoer company,” says Schmidt. “So Suoer blocks the Chinese market for us and is therefore a competitor, although the company does not appear anywhere else.”
The article comes from the student project “Youth and Business”, which the FAZ organizes together with the Association of German Banks.