Choreograph the use of diagnostic technology in the exam lane


The normal day in an optometric practice can be anything but normal: Patients come in for their refractive care, but often end up with a need for their O.D. to diagnose and treat an ocular disease, such as glaucoma or meibomian gland dysfunction. And so, the delicate dance of how to best manage these patients, while optimizing patient flow occurs.

With this in mind, here I provide tips on how optometrists can utilize technology to better choreograph this delicate dance.


When investigating the purchase of new diagnostic technology, I recommend O.D.s consider instruments that attach to slit lamps in addition to stand-alone units, depending on office space and flow. Examples include an attached anterior segment camera and meibographer.

Regarding the attached anterior segment camera, its images can be acquired on the same day as the comprehensive eye health exam because the patient is in the exam chair already. Additionally, the importing of the photos into the patient’s EHR is very simple and, therefore, efficient.

Being able to show meibography while the patient is in the exam chair is a huge time-saver in terms of providing patient education and getting patient buy-in on the importance of therapeutic treatment: I have found that seeing equates to learning and believing. I should also add that using meibography as a screening tool on all comprehensive eye health exams can lead to more efficient refractions and contact lens evaluations by virtue of the fact that a poor ocular surface can affect prescriptions.


Retinal screenings are an area that can take very little time, but can save in the exam lane today and in the future by creating a seamless experience for the patient without requiring extra wait time for the patient and, as research below shows, better outcomes. These technologies may be as simple as a non-mydriatic retinal camera or as advanced as ultra-wide field photography with OCT or fundus autofluorescence. Specifically, these devices take a screening photo — the patient pays out of pocket — to get an image of the retina. The field of the picture can be just the posterior pole or can show out to the equator and sometimes beyond, depending on the retinal camera. Remember, these are not a true substitution for dilation, but patients may, when medically appropriate, opt out of drops in favor of a retinal photograph.

In a study done at the New England College of Optometry in 2013, the image-assisted dilated fundus examination was determined to be more accurate in detecting retinal pathology than dilation alone. This can lead to a huge time savings on the front end because the photograph is done before any drops are put in the eye. The doctor gets to review with the patient and can show possible findings. It gets buy-in from the patient, the doctor and the practice on the importance of catching something on a screening photo. Again, it can’t be stated enough that it is not a substitution for dilation, and there will be times in which pathology is present in the eye and not on a photograph.

Additionally, technician-driven tonometry can be a fantastic tool that saves time in the exam lane by reducing the need for performing Goldmann tonometry. Numerous studies show that a hand-held tonometer and a non-contact tonometer can correlate with Goldmann. The testing takes minimal time from a technician and can eliminate taking IOP measurements in the slit lamp.


It’s no secret that fundus findings identified during a comprehensive eye health exam can easily derail patient flow. Posterior segment pathology, especially if not seen on a screening — another reason to consider performing retinal screenings — can take extended amounts of time to both diagnose and to provide patient education. (Remember that screenings are defined as tests done before the doctor sees the patient. If something needs further testing after discovery through screening and then exam, further testing can be done while the patient is dilating or scheduled to be seen at a later date.)

In cases in which optometrists identify a possible diagnosis, especially a chronic condition, such as glaucoma or AMD, I recommend O.D.s acquire an image while the patient is dilated and then having her return for additional testing via VF, gonioscopy, OCT and pachymetry (in a glaucoma patient).

When faced with a more acute finding, such as a suspicion for retinal holes, tears or detachments, I suggest getting the full diagnostic picture on the original date of service.


The optometric office is becoming more equipped to handle the growing need for patient care, as well as adapting to all the newest diagnostic technology. While diagnostic technology should enhance the patient experience, aid in diagnosis and management, facilitate patient education, increase patient compliance, provide a return on investment and fit the practice’s available space, choreographing the delicate dance of patient management and optimized patient flow is important to prevent derailing the schedule, which frustrates waiting patients. OM

Integrating Diagnostic Devices



Lori Mazza, O.D., of Family Vision Center in Wellington, Fla., says that because staff buy-in is critical, the starting point should always be a staff meeting in which the O.D. presents what the instrument is and what it does.

“During that meeting, it’s important to convey what the advantage to patients will be, so that this message can start to become a natural part of the script that staff will use on a daily basis,” continues Dr. Mazza. “Whether or not patients see the value in this new diagnostic equipment ultimately comes down to how staff talks about it.”

Paul Super, O.D., of Eyesite Optometric Group, in California, adds that O.D.s should “always start with the ‘Why?’”

“As you present to the staff, think about why did I purchase this equipment in the first place? When this can be genuinely conveyed to staff, it can make a difference in their own understanding,” he says.

Following a meeting like this, Dr. Mazza says she transitions into training, taking advantage of opportunities the manufacturer offers, including suggested patient scripts.

“We usually customize this suggested script to fully meet our patients’ needs,” Dr. Mazza adds. “We’ll also look at whether we need to add any new questions to our patient intake form.”

In terms of staff encouragement, Dr. Mazza offers this incentive:

“. . . After five tests, all of the technicians and front desk staff receive $5,” she says. “It makes a big difference in helping transition new equipment usage into a regular habit.”

Dr. Super says that he has set up a comparison game for speed and accuracy to ensure his team is performing maximally.

“Incentivize rewards of time versus accuracy,” he says. “This may be as simple as keeping track of times by charting and placing stickers as to the best results achieved,” he explains. “Winners get $5 reward cards to places like Amazon or Starbucks. Accurate data collection creates improved outcomes and patient satisfaction.”

Finally, Dr. Mazza says that following up with staff is key. “It’s important to make sure all staff are using the equipment the same way and to track how often we’re using it,” she says. “We’ll review all of that information at the next staff meeting. We never want to make the data gathering process so lengthy that it starts to have a negative impact on our optical sales, so we are constantly evaluating the way new equipment incorporates into our processes. There’s often room for fine-tuning.”