With rapidly growing online sales for both eyewear and contact lenses, as well as a growing presence of online refractions, it is time for optometry to embrace our full scope of practice by focusing on the comprehensive eye exam. I am a bit biased after working many years in a medical-only practice within a MD/OD group setting—that's right, zero vision plans.
Now that I am in a group OD private practice, balancing both medical and vision plans can be frustrating. Educating patients who are “just here for glasses” to the importance of the dilated eye exam has proven to be a challenge.
We all have had the patient who is very adamant at the beginning of the exam, stating, “I am just here for my glasses and do not want any eye drops!”
Previously from Dr. O'Dell: Don’t let bad beauty habits suck the fun out of Halloween
I have had teens come in with specific instructions from their parents saying, “No dilation”
Coming from a medical-only practice in which dilation was never a question, this push back from patients has been frustrating. I can't imagine patients and parents not wanting the very best care.
My motto: Don't wait, dilate!
My favorite lifesaving story is of a patient with 20/20 visual acuity and no complaints. I detected a small choroidal melanoma during dilation, which saved her life. Recently, another patient of mine was diagnosed with a choroidal melanoma. Like the saying goes, "It's not rare if it's in your chair."
Ordering labs and imaging
Another part of embracing medical eye care was the frequency in which I ordered lab work and imaging for patients. My move to a group OD practice found that no lab slips were in the office and the doctors referred to patients’ primary-care physician (PCP) for lab work and imaging.
Flash back to my optometry school days, a favorite professor educated ODs to understand the patient as a whole body, not just the eye. A must-read book for ODs is Clinical Medicine in the Optometric Practice (Edition 1 and 2).
Related: ODs: Rulers of the Land of Presbyopia
I wanted to see what my OD peers were up to regarding ordering labs and imaging, so I turned to ODs on Facebook and asked a polling question:
Do you order blood work?
• 58 percent: No
• 22 percent: Yes
• 5 percent: Occasionally
• 15 percent: Out of scope of practice
Getting started with labs
The first step in ordering labs is having the right paperwork. This is changing with electronic medical record (EMR) systems and can be generated on a printed form for patients. If you have a system that, like mine, does not allow form generation, call your local hospital to request lab slips sent to your office. The hospital will have forms for both imaging and lab work. You can also consider using your personal Rx pad or having pre-printed Rx pads for your commonly used labs.
If using the hospital’s lab form, familiarize yourself with what is on the form. This is straightforward because the common labs are usually listed in alphabetical order. There is a space for write-in labs that ODs will often need to use. For imaging, options are grouped into the type of testing, i.e.—ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), etc.