It's easy to drop a few tests from your standard exam routine when the appointment schedule gets full and the demands of a practice are great. In fact, dropping some tests could be a good thing. I don't believe in doing tests that don't yield useful information and if we did every test we learned in optometry school, a typical exam would take all day. But sphygmomanometry is a test that I believe should be performed at every eye exam - and I think it should be delegated to a technician. If you've dropped it, or just never did it, consider adding it to your routine exam.
The reasons why the test is important seem obvious. It can be a life saving screening for a serious health problem that might go otherwise undetected. There are often no symptoms in hypertension - and many people see an eye doctor, but no other doctor. If you discover very high BP readings (and you will), the education of the patient and prompt referral will bond the patient and family to you for life - and the good will is tremendous. In addition to discovering the systemic health problem, we all know the major effects hypertension can have on the retina. If we needed an ocular reason to perform the test, we have it.
Additionally, taking blood pressure as a pre-test impresses patients with the thoroughness of your exam, and that is a major way to set your practice apart from others. It clearly demonstrates that you are a health care practitioner and are concerned with much more than prescribing glasses. It affects patient perception in a positive way. One more practice building benefit of testing for hypertension: you will develop strong relationships with primary care physicians in the area - which builds your reputation in the community and could result in two-way referrals.
To remain efficient, teach a technician to perform sphygmomanometry on all patients before you see them, along with a few other tests. It can be done in a pre-test room, or in the exam room before you enter. The instrument is inexpensive - you could even have one in each exam room. It is easy to learn, and if there is any worry about the manual stethoscope and cuff method, there are some very good electronic cuffs with a digital display of the readings.
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