Your Office Procedure
GARY GERBER, OD
We've all done it. Your patient is in for what
you anticipate will be an uneventful checkup. He reports the comfort with his lenses
is great and his vision has never been better. After you apply fluorescein
you notice some staining on the inferior cornea of the right eye and make a mental
note of it. Moving on to an unremarkable left eye, you complete the examination
and evaluation. Because he reported no complaints, 30 minutes later at the conclusion
of your examination, you decide to stay with the same lenses. Hey wait a
minute. What about that staining you saw?
Most of us acknowledge that contact lenses have gotten much
better in the last few years. Improvements in examination technologies, newer lens
polymers and solutions, as well as manufacturing techniques, make our lives easier.
However, with all of these changes, many of us are still running
our offices with policies and procedures that originated 50 years ago. Just as lens
technology has changed, so too should the administration surrounding the care of
When extended wear lenses were launched, most of us saw patients
at 24 hours, one week later, two weeks later and then every three to six months
afterward. Given the marginally successful performance of those early lenses, those
visits were probably warranted. However, with newer lenses come fewer problems.
Having fit hundreds of patients in silicone hydrogel continuous wear lenses and
rarely seeing any problems, particularly early on, I question the necessity of a
24-hour visit. While my expertise is practice building and not corneal physiology,
I wonder if the newer high-Dk/t lenses we're fitting are delivering enough oxygen
so that most eyes need more than 24 hours to exhibit potential problems. Similarly,
for patients who do well with the lenses, I might argue that you could eliminate
the six-month visit. Here's a case of 1950 procedures being applied to 2005 lenses.
Performing procedures out of habit is another common pitfall.
As our fluorescein example illustrates, we're so accustomed to happy patients not
having problems that we put our clinical skills on autopilot to cruise through a
seemingly uneventful patient encounter.
Other Habits That Die Hard
If a patient you fit with lenses last year reports no complaints
to your staff and demonstrates excellent acuity, and you anticipate staying with
the same lenses, is it absolutely critical to examine the lenses on the patient
before he removes them to do other tests? After all, if he'll be leaving with the
same lenses, couldn't you check the fit and acuity then?
Ancient Office Forms
While not necessarily papyrus, the layout and items on our office
forms and computer screens often need updating. With so few patients wearing PMMA
lenses and using heating units with salt tablets, is it necessary to have check-off
boxes that relate to those devices? Take a few minutes to update and streamline
how you record your clinical data. These few minutes of redesigning your forms or
computer fields can mean significant time savings and also provide you with more
accurate record keeping.
Examining Your Practice
I don't want to overstep my boundaries as a practice-building
consultant and tell you how to care for your patients. Rather, I'd like to tell
you how to care for your practice. If you're examining your patients out of historical
habit, I strongly recommend reviewing each patient on a case-by-case basis.
Dr. Gerber is the president
of the Power Practice® – a company offering consulting, seminars and
software solutions for optometrists. You can reach him at (800) 867-9303 or
Contact Lens Spectrum, Issue: January 2006