Optometric Management Tip # 231   -   Wednesday, June 21, 2006
Pretesting the Contact Lens Wearer

Iíve written frequently about delegating clinical procedures, but Iím often asked about pretesting techniques for the contact lens patient. It can get a little complicated, with lenses coming out for some tests and going back on for others.

Admittedly, a wide variety of clinical philosophies exist on what tests to include and what sequence to do them in. Show me five ODs and Iíll show you five different ways to approach an eye exam and contact lens evaluation. Here are some ideas that may make you more efficient in a routine eye exam for a patient already wearing contacts.

Preparation Pretesting sequence by technician

Here is the pretest sequence we have used in my office. Doctorís exam Itís interesting to note that the majority of the tasks for the doctor are in patient communication, not data gathering.

I recommend charging a comprehensive exam fee, a refraction fee and a separately itemized contact lens evaluation fee. The contact lens fee covers the corneal topography and lens fit evaluation. I donít feel the exam fee needs to relate to the amount of doctor time spent. Even with a contact lens patient, as described above, the exam could be performed fairly quickly. I think patients actually prefer eye exams that donít take a long time.

Another approach

My practice purchased two computerized refraction systems six months ago and these have proven to be even more efficient than the protocol above. The digital exam rooms are equipped with an auto-refractor/K, autolensmeter, digital refractor with display pad and a digital acuity chart. Each of these computerized exam rooms also has a table-mounted slit lamp. In addition to all the pretests mentioned above, a subjective refraction is obtained by the technician when the lenses are off. The tech may also perform a basic lens fit evaluation with the slit lamp and can check anterior chamber angles.

Food for thought

Most of us were trained to always take visual acuity first, before any other testing, to avoid the potential for liability if it were alleged that we caused some eye damage with our exam procedures. Also, some contact lens fitters would say that the slit lamp exam and fit evaluation should be performed by the doctor before the lenses are removed, so that the lens surface, fit characteristics and tissue integrity are not disturbed in the act or removing and re-inserting. I donít find those issues to be a concern in the vast majority of contact lens cases today, but if you do, by all means adjust your sequence of procedures accordingly.

I do think itís necessary to remain flexible in your approach with testing, and adapt to the needs of the patient. A well-trained staff is key here, since a technician most likely sees the patient before the doctor. For example, if the exam was not routine and a medical emergency is present, the entire sequence would change.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management