Efficient and accurate testing are paramount to patient care and practice management. Fortunately, Optometric Management’s contributors are here to share their favorite “hacks” for the pretesting area. These hacks include tips for comfortably using the slit lamp, taking accurate topography images and retinal photos, performing perimetry, tonometry, and using the phoropter and autorefractor.   

Autorefractor
April Jasper, OD, FAAO, and owner of Advanced Eyecare Specialists in West Palm Beach, Fla. (and OM’s chief optometric editor), recommends aligning patients carefully at the start of an autorefraction and telling them what you are doing, so they know not to undo the alignment. The advantage of this, says Dr. Jasper, is it allows for faster setup in the autophoropter because the accurate pupillary distance will carry over to the digital phoropter.

Next time you’re setting up a patient in the autorefractor, try saying something like: “I am lining your eye up in the instrument for more accurate results. Please keep your chin in the chin rest and head against the headrest during the entire test.” Similarly, telling the patient when it’s OK to blink and when they need to hold their eyes open can also improve test accuracy.

Image acquisition
Susan Resnick, OD, FAAO, president and managing partner at Drs. Farkas, Kassalow, Resnick, and Associates, New York (as well as OM’s “Contact Lens” columnist), instills an artificial tear prior to topography. This aids in acquiring accurate images, reducing the need for retakes, by improving patient comfort, addressing any dryness on the eye’s surface. She recommends the artificial tear be unpreserved with low viscosity.

Cecelia Koetting, OD, FAAO, DipABO at the University of Colorado School of Medicine (and OM’s “Dry Eye” columnist), says she employs a similar hack. Her practice instills artificial tears in patients before using optical coherence tomography (OCT) and nonmydriatic cameras, to stabilize the front of the eye prior to capturing clinical images to ensure greater image accuracy.

For acquiring accurate images, Jessilin Quint, OD, MBA, MS, FAAO, Quint, co-owner of Smart Eye Care, Maine (and OM’s “As I See It” columnist), notes that the mental down time and silence between pretesting procedures can cause loss of attention and fidgeting. This can lead to blurry image acquisition and, therefore, inaccurate test results, she has her technicians make small talk with the patients throughout, so that they are listening and their minds are engaged. This keeps the patient focused, resulting in clearer images.

Phoropter
Dr. Jasper advises ODs to be mindful of putting too much stress on their arms, neck, and shoulders when manually refracting a patient. Too much stress on your body can limit your ability to refract long-term, she says. To avoid this, Dr. Jasper recommends switching between sitting and standing when seeing patients and, if your clinic layout allows, switching between right-handed and left-handed set-ups between patients. Moving from a manual phoropter to a digital phoropter can also help lessen stress on your body by reducing repetitive movements, Dr. Jasper says.

Perimetry
When tackling visual fields (VFs), Austin Lifferth, OD, FAAO, practitioner at Center for Sight, Carmel, Ind. (and OM’s clinical editor and “Glaucoma” columnist), uses “the three Ps” to help increase the test’s accuracy.

• Patients: make sure they understand that they can take a break when they need to, and what they will see and not see during the testing. Taking a break and reminding the patient of what they may or may not see will help improve accuracy and minimize the need for repeat testing.

• Posture: make sure patients are seated comfortably. If the patient is distracted because they are in an uncomfortable position, they are probably not focusing on the test. 

• Provider: Make sure the technician can explain the test well, repeat it, and make adjustments, as needed. Close monitoring by the support staff throughout the test improves its accuracy.

Tonometry
Dr. Lifferth recommends a tonometer prism for patients who have thinner corneas, such as those who have undergone LASIK. In his experience, the prism tonometer’s bicontinuity of surface and fit to the corneal surface have aided him in gathering more accurate eye readings for this specific patient population.  

Slit Lamp
Dr. Koetting knows firsthand the importance of staying comfortable behind the slit lamp, having thrown her back out early in her career. Now, she practices moving the patient to herself and ensuring her posture is good (using principles from yoga), specifically tailbone down, sit up straight, and shoulders back.

Employing these techniques will help bolster your own health and flexibility, preventing discomfort or pain that can interfere with your ability to treat patients quickly and accurately, Dr. Koetting says. (For a video demonstration of Dr. Koetting’s suggested posture technique, see the online version of this article.)

Dr. Resnick agrees. The advice she often relates to other doctors is, “The patients are only behind the slit lamp for a few seconds, the optometrist is behind the slit lamp for decades.”

Share a hack
As each practice operates differently, the hacks can be adjusted accordingly (and see “Additional hacks related to the pretesting area” [at right] for non-equipment hacks). And if you have your own hack you’d like to share, tell us about it on Optometric Management’s social media channels, and be sure to tag OM! OM