Regular screenings can aid in identifying patients at-risk of glaucoma or retinal disease earlier in the disease process, helping to slow vision loss. But testing can be costly, inconvenient for the patient, and disruptive to the flow of one’s practice. Testing protocols specific to your practice, however, can help build efficiencies to ensure at-risk patients are screened timely, while preventing over-testing.

KNOW YOUR PATIENT POPULATION

Understanding exactly who should be screened, and for what conditions is the first step in creating efficient testing protocols, points out Mohammad Rafieetaary, OD, FAAO, of Charles Retina Institute, a tertiary eye care clinic with locations in Tennessee, Missouri and Arkansas. “As a general rule, I recommend a macular OCT for every patient who is over 60 years old,” he advises. “The rate of AMD in these patients is about 10%, and a lot of these cases go undetected.”

Dr. Aaron Werner, of Werner Optometry in El Cajon, Calif., takes a specific approach: “The first thing to look at is the office demographics,” he says. “Then, look at prevalence rates of different retinal disease and glaucoma. OCT screening is part of our protocol for every patient over the age of 50 because we know that’s the demographic where we start to see those retinal diseases. When I walk into the exam room, those images are up on the computer and within 30 seconds I know whether this is an area we need to focus on.”

COLLABORATE

Dr. Rafieetary also suggests collaboration: “Colleagues who have identified something during a screening and refer the patient to us don’t always send us the images,” he notes. “Primary care optometrists can ask their patients, most of whom have smartphones, to take a picture of the image and bring it to their visit. Then, we don’t have to spend extra time figuring out what we should be looking at, or if what we see is the same thing that the primary care OD saw.”

THINK PROCESSES, NOT PEOPLE

“It’s incredibly important to develop systems that are repeatable,” says Dr. Werner. “If we handle everything the same way every time, it allows us the freedom to not think about the process, but pay more attention to the results and the patient.”

Dr. Werner offers one caveat: “Many of our systems that we build around a person failed,” he says. “That’s interesting because many optometrists have learned, when they create a new process or bring something new into the practice, to identify a ‘champion’ who will get everyone on board. But what ends up happening is that you don’t end up with a true system,” he says. “When that person leaves, the initiative falls apart because it wasn’t a system, it was a person. You have to think: Can you replace the people and still have the system work?” OM