TO STAY AHEAD of the competition, optometrists must differentiate themselves. Additionally, in the age of high-staff turnover, it makes sense to have in place a tool to facilitate staff learning. My practice has been able to accomplish both action steps with pre-written patient scripts used by staff during pretesting. This article names the pretesting most, if not, all primary care optometrists employ, along with the patient scripts my staff use for each.

COLOR PLATE TEST

Patient script. “This test aids in the diagnosis of color blindness, or the inability to discern certain colors. I’m going to ask you to look at an image that contains colored dots that make up a specific number or shape in the center. If you cannot identify the specific number or shape, you may have color blindness.”

RANDOM DOT STEREO TEST

Patient script. “This test is performed to see how your eyes work together to perceive depth. We will ask you to put on a pair of polarized glasses and in looking at the six spots, tell us whether you can see the change in them. This will tell us whether your eyes are working together correctly. If they are not, it could indicate a condition called ‘lazy eye,’ in which there is decreased vision in one eye that is caused by a muscle issue.”

PUPILLARY DISTANCE (PD) TEST

Patient script. “This test is used to determine the distance between your pupils at both distance and near to center your prescription lens accurately in your frames. Additionally, a change in this measurement can be a sign of a breakdown in how your eyes work together, or the presence of a mass. For this reason, PD should be performed yearly. There are several ways to perform this test, from using a PD stick or what we use in our office, which is called a pupillometer. We ask you to look into this hand-held instrument and look at a stimulus, while we align the eyes. This takes only a few seconds.”

PUPIL SIZE TEST

Patient script. “Many neurological disease processes can manifest with a change in the pupil. Examples range from head injuries, to ischemic strokes, and Holmes-Adie syndrome, to name a few. An unequal pupil is just one of the key elements for the doctor to assess to determine your health. This test helps determine whether the pupils are equal and round and, thus, healthy. There are many ways to measure the pupil size, from a pupil diameter stick, to computer assessment. In our office, we use a computer. This test needs to be performed annually for any changes.”

HORIZONTAL VISIBLE IRIS DIAMETER (HVID) TEST

Patient script. “As you have expressed an interest in specialty contact lenses, we are going to use the value provided by this test (a PD stick in normal light) to increase the likelihood that your first fit will be successful. This test literally takes a few seconds and is done by you looking at the examiner’s nose, while the examiner uses a PD stick. This is the horizontal measurement for the color part of your eye called the iris. Other instruments can also do the measurement. The corneal topographer in our office does this measurement automatically.”

VA WITH AND WITHOUT CORRECTION

Patient script. “This is done in the exam room with a Snellen eye chart, using normal light level. The Snellen chart is the standardized way we determine the vision of your eyes. The standard way we assess vision is using the 20/20 rule. You will see different versions of the eye chart and will be asked to name the letters and/or signs you see.”

TONOMETRY

Patient script. “This test will determine whether you are at risk for or have any changes in your eyes that could be related to a condition called glaucoma. Glaucoma damages your eye’s optic nerve, which carries messages from your eye to your brain to create an image. This damage typically occurs when too much fluid builds up in the front part of your eye. Tonometry measures the amount of fluid, or intraocular pressure, in your eye. A common way to test the pressure in your eye is the air puff test, which blows air into your eyes. (See “Take a Tour of Tonometers,” at bit.lymarch23Tonometer .) At my practice, we hold a hand-held computer up to your eye. You will look at a green light and, within milliseconds, the device acquires your eye pressure per eye.”

AUTOREFRACTOR/AUTOKERATOMETER

Patient script. “This instrument is crucial to get starting points for the doctor to complete the comprehensive eye examination. The results will give some information to refine your final prescription for distance. Keratometry is the measurement of the curvature of the eye. This aids in watching for disease processes and helps to fit patients in all types of contact lenses. Also included are such findings as pupil sizes, pupillary distances and pachymetry, which is the thickness of your cornea, used for refractive surgery, among other reasons. This test can also be used for an over refraction over the contact lenses to look for the residual refraction left with the contact lens. I’m going to align you within the testing device and use the joystick to move you into position. Once I have done that, I will ask you to look at the target presented by the device.”

For the autokeratometer, look into the computer and focus on a hot air balloon as it goes in and out of focus until it’s in focus.”

CORNEAL TOPOGRAPHER

Patient script. “This instrument aids in evaluating the cornea for disease processes, such as keratoconus, an irregular cornea, and for contact lens fitting. Keratoconus is the progressive thinning of your cornea, which can lead to vision distortion. We are going to place your chin in the device’s chin alignment and use the device’s joystick to position you, so that your pupil is the target.”

“Next, you’ll see red lights appear in the center of your view. Please focus on those red lights. We will ask you to blink and then to hold your stare without blinking, while the computer acquires the image of your corneal shape. When the test is complete, the red light will flash.”

OPTICAL COHERENCE TOMOGRAPHY (OCT)

Patient script. “This is a non-invasive imaging test that uses light waves to take cross-section pictures of the optic nerve and the macula. Assessing these two areas helps the doctor determine the health of your retina, which captures incoming images and sends them to your brain, so you can process them. In the optic nerve, the doctor will look for signs of diseases, such as glaucoma. In the macula, the doctor can determine the presence of diseases, such as macular degeneration, or the loss in the center of your field of vision. Please use the chin rest.”

“When you are aligned properly, I’m going to ask you to look at a green star within red lines and blink once and hold your stare on the green star. Next, the green star will shift off to the side, follow it, blink once and hold your stare on it.”

AUTOPERIMETER

Patient script. “This instrument tests your peripheral vision, aiding the doctor in detecting signs of disease progression, such as glaucoma and strokes, as examples.”

“I’m going to need you to place your chin on the far left of the chin rest on the blue line, so I can test your right eye first. Next, I’m going to align you with the pupil in the center of the bullseye. I want you to look only at the target during the test and not look around. You’re going to see some wavy black lines flashing on and off. Every time you see these lines flash, I want you to click the button I’ve given you. Then, I’ll do the other eye.”

COMPETE WITH COMMUNICATION

I take pride in having each of my staff members explain to patients why they are performing a specific test and what the patient can expect, in terms of their role in testing. By treating every patient this way prior to and during their appointment with me in the exam room, they know they are receiving stellar care. This, in turn, leads to my patients consistently telling me, “that was the most comprehensive exam I ever had!”

Additionally, these pre-written patient scripts used during pretesting allow for a seamless transition among staff members during this age of staff turnover. OM

DR. WHITE practices at Complete Family Vision Care, in San Diego. Additionally, he is a clinical investigator for several contact lens companies, and he has participated in over 450 clinical studies. Further, he has lectured extensively in the United States.