|
|
|
|
|
||
|
COMANAGEMENT Q&A How to Screen More Patients For Glaucoma Edited by Paul C. Ajamian, O.D. Question: I'm looking to increase my glaucoma practice, as well as strengthen my relationship with my comanaging ophthalmologist. Any suggestions on how I can identify more glaucoma patients earlier in the course of their disease?
Answer: It's a simple matter of arithmetic. If you
increase the number of patients you screen for glaucoma, you'll likely detect more cases. The reason many O.D.s don't routinely screen more patients for glaucoma is the set up for the visual field test. Just sitting the patient
at the visual field device and explaining what the patient has to do can take about three times longer than the actual screening test itself. Screening test time—less than two minutes—is about the same among different visual
field instruments in the screening mode, but entering the patient's name and information, among other tasks, can take up to eight or nine minutes per test. So, routine screening has been time-prohibitive when you're seeing many
patients in a day. However, there are newer field screening devices that do a good job in screening for visual field damage, and don't take as long to set up. Murray Fingeret, O.D., of the St. Albans Veterans Affairs Center in
Brooklyn, N.Y., uses Humphrey System's Frequency Doubling Technology (FDT) field screening instrument. He's a self-described "convert" to screening fields now that he can do them quickly. He can screen both eyes in less than
five minutes. Quick screening fields are useful, Dr. Fingeret says, if you detect a loss and want to repeat the test right away. "Then if I do get a repeatable visual field loss, I start the exam with a suspicion of what to look
for," he explains. Routine screening fields can also send up a flag even though the patient may have low intraocular pressure, as in the case of a patient taking medication such as an oral beta-blocker. The screening field exam
is fast enough that Dr. Fingeret includes it for many of his patients as part of the pretest routine. Indeed, at the office of Jonathan Geller, O.D., every patient gets an automated perimetry exam in screening mode as part of
pretesting. His practice, Golden Triangle Optometric in Murrieta, Calif., is not new at this; it has been doing screening fields for the past 10 years. In addition to the FDT, the technician at Dr. Geller's practice also does
screenings with Dicon's LD400. "If the staff is pretesting the patient already, I'm more than happy for us to devote another four minutes to both improve the quality of my exam and to let the patient benefit," Dr. Geller
explains. Patients are not charged extra for the screening; it's part of the comprehensive exam. Screening fields are comparable to dilation, Dr. Geller suggests. Very rarely do you find anything, and sometimes question why you
continue to do them. But it's all worthwhile, because when you least expect it, you'll find something This year, he explains, a screening visual field gave the first clue to a brain tumor in an 18-year-old girl. Dr. Geller
acknowledges that he might have caught it without the test, but the screening field certainly proved itself valuable in this case. In terms of comanagement, screening visual fields help you practice at a higher level, Dr. Geller
says. If there's a finding in the screening field, then you can be the one to take the threshold exam. If the patient requires a consult, you've provided the comanaging ophthalmologist a good deal of information and saved him or
her considerable time and effort. "If it's a true comanaging relationship, then the ophthalmologist will be happy to have all the data, and the patient will be better served," Dr. Geller notes. |
||
Ask It in CMQA |
||
|
| | | | | | | |