Letters

Readers Voice their Opinions

The phenylephrine difference

To the editor: I've always enjoyed Neil Gailmard's "Management Tip of the Week," but one stands out far above all the others for me.

Some years ago, Dr. Gailmard suggested we consider instilling 2.5% phenylephrine at the pre-testing sequence's start to save time during the comprehensive eye exam. (See www.optometric.com/mtotw/tip.asp?tip=222.) It wasn't easy to get up the nerve to change something so basic as waiting until the exam was almost over before asking the patient's permission to dilate. But, once I got over my concerns — and carefully trained my technician — the pre-dilations went off without a hitch. Phenylephrine doesn't interfere with accommodation, so all nearpoint tests were possible. Also, it doesn't interfere with contact lens fittings. For patients visiting the optical area, we delayed tropicamide instillation until frame selection. Patients would wait an extra five or 10 minutes (while the order was being written up, for example) before the retinal exam. This saved a lot of time. If a full dilation was refused, the phenylephrine enlarged the pupil somewhat, which, of course, enhanced the "undilated" exam.

Nothing I've learned in my 28 years of practice has enhanced my practice efficiency as much as this process. OM

Margaret Placentra Johnston, O.D.
McLean, Va.
via e-mail