1. Types of Eye Examinations

2. There are 5 main types of exams. ­C­C­C­Comprehensive Eye Health Exam ­C­C­C­Contact Lens Exam & Professional Services ­P­P­P­Problem Visits ­F­F­F­Follow-Up Visits ­S­S­S­Special Testing Exam Any clinic procedure will fall under one of these five main headings. Let’s take a closer look…

3.  Preliminary Testing  Doctor Exam

4. Comprehensive Eye Health Exam Full Exam Comprehensive Eye Health Examination = Full Exam A full exam is a complete eye check-up that includes all typical procedures of checking an individual’s eye health & vision.

5. Comprehensive Eye Health Exam Full Exam Comprehensive Eye Health Examination = Full Exam A full exam is a complete eye check-up that includes all typical procedures of checking an individual’s eye health & vision. The full exam includes preliminary tests & the doctor examination. Patients should have a full exam every year.

6. Comprehensive Eye Health Exam 1) Preliminary Testing (a.k.a. Pre-Test)

7. Preliminary Testing (Pre-Test) Comprehensive Eye Health Exam Preliminary Testing (Pre-Test) O BJECTIVE FOR P RE -T EST : To gather information & prepare a patient for an examination before the doctor examines the patient.

8. Preliminary Testing (Pre-Test) Comprehensive Eye Health Exam Preliminary Testing (Pre-Test) O BJECTIVE FOR P RE -T EST : To gather information & prepare a patient for an examination before the doctor examines the patient. > The pre-test preparatory work gives the doctor necessary information for a thorough, yet time efficient exam with the patient. > Pre-test includes tests, screenings, & the documentation of necessary information regarding a patient’s current status & health history.

9. Pre-Test Comprehensive Eye Health Exam Pre-Test K EY P LAYER ( S ) FOR P RE -T EST : Optometric Technician Special Testing Optometric Technician Refractive Optometric Technician

10. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : The Greeting Pre-Test Room Dilation Drops Case History Visual Acuity Other Tests Refraction

11. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : The Greeting The patient is greeted in the reception (waiting) room by a technician & escorted to the pre-test room in the clinic.

12. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : The Greeting The patient is greeted in the reception (waiting) room by a technician & escorted to the pre-test room in the clinic. The greeting is an important first impression. The tech should make the greeting as personable as possible.

13. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Pre-Test Room The tech is in charge of running each test or screening. All paperwork must be signed by the patient before running any tests.

14. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Pre-Test Room A pre-test room may include the: Autorefractor * Keratometer * Corneal Topography * Tonometer Automatic Lensometer Retinal Camera * * Corneal Spectrometer Wave Front Technology * The autorefractor, keratometer, and corneal topography may be separate instruments or all three may be in one instrument. ** The retinal camera may have an extra fee that insurance does not cover. If this is the case, the office must have patient permission before taking a picture.

15. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Dilation Drops The tech usually dilates the patient’s eyes while in the pre- test room. Dilation drops can be given at various times during the exam, depending on the doctor’s routine or strength of the drops. Follow the doctor’s instructions.

16. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Case History The tech escorts the patient to an exam room where the patient’s case history is taken (sometimes it can be taken in the pre-test room). A case history is not complete until the doctor has finalized it, thus, it is ‘left open’ during the patient’s entire exam for the doctor to close. The history is taken by the same tech that did the pre- tests.

17. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Visual Acuity The technician does a visual acuity on the patient in the exam room. Visual acuity is a measurement of the resolution ability of the eye, meaning the clarity of which an individual can see objects at a given distance.

18. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Other Tests The technician will do all other tests and/or screenings as required by the doctor. This includes, but is not inclusive to ­ Color vision test ­ Extraocular Muscles screening (E.O.M.) ­ Cover test ­ Near point conversion

19. Pre-Test Comprehensive Eye Health Exam Pre-Test O RDER & P ROCEDURES OF P RE -T EST : Refraction A refracting technician will do the refraction. The doctor will do the refraction if there is no refracting tech within the office.

20. Comprehensive Eye Health Exam 2) Doctor Examination (a.k.a. the Exam)

21. Doctor Examination Comprehensive Eye Health Exam Doctor Examination O BJECTIVE FOR THE D OCTOR E XAM : To medically analyze the patient’s situation & make a medical diagnosis from the pre-tests & doctor observations. To explain clearly the patient’s situation & give the proper care & treatment based upon medical expertise.

22. Doctor Examination Comprehensive Eye Health Exam Doctor Examination K EY P LAYER ( S ) DURING THE D OCTOR E XAM : Doctor Chair-Side Optometric Technician / Scribe

23. Doctor Examination Comprehensive Eye Health Exam Doctor Examination The patient will wait in the exam room for the doctor once the pre-test portion of the exam is over. The doctor analyzes all information collected during the pre-test and makes his own medical observations before giving a complete diagnosis and making treatment decisions that reflect the patient’s unique situation.

24. When the doctor goes into the exam room, he may or may not have a chair-side technician follow him in the room. ­The chair-side technician’s job is to accompany the doctor in the exam room and work alongside him, assisting in all aspects of the exam. Doctor Examination Comprehensive Eye Health Exam Doctor Examination

25. The tests and screenings during the doctor’s exam:  Review of Case History  Slit Lamp Exam  Goldman Tonometer  Indirect Ophthalmoscope  Refraction Doctor Examination Comprehensive Eye Health Exam Doctor Examination

26. At the end of an examination, the patient is escorted to the check- out counter or to the optical. Generally, the chair-side technician or another technician will escort the patient out of the clinic area to save the doctor time in-between patients.

27. Comprehensive Eye Health Exam

28. Contact Lens Exam & Professional Services A Contact Lens Exam & Professional Services is for patients who currently wear CL & who have come into the office for their yearly eye health checkup (full exam) or for patients who want to wear contact lens & who need to be evaluated to see if they are candidates for contact lens

29. Contact Lens Exam & Professional Services full examcontact lens exam and the professional services If a patient has contact lenses or wants contact lenses, they will have a full exam plus a contact lens exam and the professional services that go along with it. separate exam The contact lens exam & professional services are a separate exam from the full exam, but these exams are generally done on the same visit.

30. Contact Lens Exam & Professional Services The contact lens exam & professional services includes: healthfitvisionwear ­looking at the health, fit, vision, & wear of contact lens how to wear & take care ­teaching the patient how to wear & take care of their contact lens Professional services also include: follow-up visits ­necessary follow-up visits.

31. Contact Lens Exam & Professional Services every year A patient with contact lenses must have a contact lens exam every year to renew their contact lens prescription and to continue to wear contacts as governed by the FDA.

32. Contact Lens Exam & Professional Services O BJECTIVE : The contact lens exam is designed to evaluate the fit & wear of a patient’s CL & to make sure that the cornea is healthy. ­This evaluation checks the vision, comfort, curvature, & oxygen flow for the contacts and makes sure that the patient is not over-wearing their CL. ­Contact lens professional services include insertion & removal (I & R) lessons, contact lens care & cleaning lessons, as well as other professional services.

33. Contact Lens Exam & Professional Services K EY P LAYERS : Doctor Chair-Side Optometric Technician / Scribe Contact Lens Specialist (CLS)

34. Contact Lens Exam & Professional Services new contact lens wearer The Contact Lens Exam & Professional Services for a new contact lens wearer has 5 main components: Pre-Test procedures plus the topographer & corneal spectrometer Contact lens exam (including the fitting of the lenses) Contact Lens Lesson: Insert and Removal (I & R) Contact Lens Lesson: Care and Cleaning Follow-Up Appointment(s)

35. Contact Lens Exam & Professional Services patient who already wears contact lenses The Contact Lens Exam & Professional Services for a patient who already wears contact lenses is similar, minus a couple of things: Pre-Test procedures plus the topographer & corneal spectrometer Contact lens exam (including the fitting of the lenses) Contact Lens Lesson: Insert and Removal (I & R) Contact Lens Lesson: Care and Cleaning Follow-Up Appointment(s)

36. Contact Lens Exam & Professional Services Only when a patient gets a new type of contact lens will they have another I & R and care & fitting class.

37. Contact Lens Exam & Professional Services The contact lens exam is conducted by the doctor or by a Contact Lens Specialist (CLS) at the end of a full exam. THERE MUST BE A NOTABLE TRANSITION BETWEWEN THE FULL EXAM & THE CONTACT LENS EXAM!!! THIS MUST CLARIFIED OUT LOUD TO THE PATIENT!!!

38. Contact Lens Exam & Professional Services The patient is given a contact lens prescription & is fit with the contact lens that works best for their eye. Through vision acuities and the slit lamp, the doctor (or Contact Lens Specialist): ­checks the patient’s vision ­looks at the health of the eye (by looking at the cornea & overall health) ­looks at the fit of the lenses while the patient is wearing their contact lenses ­checks the cell count to see if there is any swelling from lack of oxygen

39. Contact Lens Exam & Professional Services At the end of an examination, the patient is escorted to the check-out counter or to the optical. Generally, the chair-side technician or another technician will escort the patient out of the clinic area to save the doctor time in-between patients.

40. Comprehensive Eye Health Exam Contact Lens Exam & Professional Services

41. Problem Visits Problem visits are scheduled when a patient is experiencing problems with pain or with their vision, but do not need a full comprehensive eye health exam. specific problem These appointments are tailored to solving a specific problem. Depending on the situation, the patient may need immediate attention.

42. Problem Visits Problem visits are usually short in duration, but will last as long as needed to get the situation under control. Examples of problem visits include: ­pain in the eye ­allergies ­loss of vision ­other emergency or problem situations

43. Problem Visits O BJECTIVE OF P ROBLEM V ISITS : To gather the necessary information to problem solve & ultimately resolve the patient’s eye issue.

44. Problem Visits K EY P LAYERS FOR P ROBLEM V ISITS : Optometric Technician Special Testing Optometric Technician Refractive Optometric Technician Doctor Chair-Side Optometric Technician Contact Lens Specialist (if the problem is related to contact lenses)

45. Problem Visits The types of tests & screenings needed for a problem visit depend on the type of problem the patient is having. The technician should know office protocol.

46. Problem Visits Order & Procedure of Visit The Greeting The patient is greeted in the reception (waiting) room by a technician & escorted to the pre-test room in the clinic.

47. Problem Visits Order & Procedure of Visit The GreetingPre-Test Room In the pre-test room, the technician is in charge of running the necessary tests needed to solve a specific problem. The technician must be sure all paperwork has been signed by the patient before running tests.

48. The patient’s eyes may or may not be dilated and depends solely on the problem at hand. The doctor may have a preference of when a patient’s eyes are dilated; the technician should know the doctor’s preferences. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation Drops

49. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase History The technician gathers the patient’s case history.

50. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase History The technician gathers the patient’s case history. A case history is not complete until the doctor has finalized it, thus, it is “left open” during the patient’s entire visit for the doctor to close.

51. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual Acuity The technician does a visual acuity on the patient in the exam room.

52. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual AcuityOther Tests The technician will do all other tests and/or screenings as required by the doctor that directly relate to solving the problem.

53. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefraction Refraction may or may not be needed and depends solely on the problem at hand. A refracting technician or the doctor will do the refraction.

54. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor Exam The patient will wait in the exam room for the doctor once the necessary information has been gathered. The doctor will analyze all the information collected and make his own observations to make a diagnosis decision for the patient’s unique situation.

55. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor ExamContact Lens Exam A patient may not need to go through pre-test and other tests if they have a contact lens problem. The doctor or Contact Lens Specialist (CLS) will evaluate and work with a patient who is having a contact lens problem.

56. Problem Visits Order & Procedure of Visit The GreetingPre-Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor ExamContact Lens ExamEscorting the Patient Out At the end of an examination, the patient is escorted to the check-out counter or to the optical. Generally, the chair-side technician or another technician will escort the patient out of the clinic area to save the doctor time in-between patients.

57. Comprehensive Eye Health Exam Contact Lens Exam & Professional Services Problem Visits

58. Follow-Up Visits Patients are scheduled for follow-up exams to receive further care concerning a problem or situation that must be monitored over a period of time. Patients will be asked to come back into the office for as long as the situation remains.

59. Follow-Up Visits specific issue Follow-up visits are usually short in duration and are tailored to a specific issue. Examples of follow-up visits include: ­ contact lens follow-ups ­ post-operative visits for cataracts or Lasik surgeries ­ infections ­ diabetes ­ minor surgeries ­ follow-up care after a problem visit

60. Follow-Up Visits O BJECTIVE OF F OLLOW -U P V ISITS : To follow-up and give further care to patients concerning a problem or situation that must be monitored.

61. Follow-Up Visits K EY P LAYERS F OR F OLLOW -U P V ISITS : Optometric Technician Special Testing Optometric Technician Refractive Optometric Technician Doctor Chair-Side Optometric Technician Contact Lens Specialist (if the problem is related to contact lens)

62. The types of tests & screenings will vary depending on the type of follow-up appointment. The doctor has specific tests that he requires to be run every time a patient comes in for specific follow-up visits. The technician should know office protocol. Follow-Up Visits

63. For eye pathologies, the doctor will have special tests run on the patient. These tests are specific to the situation. The special tests are: ­Visual Fields ­OCT ­HRT or GDx ® ­Spectrometer ­Retinal Photo ­Fluorescein Angiography Follow-Up Visits

64. The Greeting The patient is greeted in the reception (waiting) room by a technician & escorted to the pre-test room in the clinic. Follow-Up Visits Order & Procedure of Visit

65. The GreetingPre-Test Room In the pre-test room, the technician is in charge of running the necessary tests needed to solve a specific problem. The technician must be sure all paperwork has been signed by the patient before running tests. Follow-Up Visits Order & Procedure of Visit

66. The GreetingPre-Test RoomSpecial Test Room In the special test room the special test technician is in charge of running the necessary tests needed for the follow-up visit. Follow-Up Visits Order & Procedure of Visit

67. The GreetingPre-Test RoomSpecial Test RoomDilation Drops The patient’s eyes may or may not be dilated and depends solely on the problem at hand. The doctor may have a preference of when a patient’s eyes are dilated; the technician should know the doctor’s preferences. Follow-Up Visits Order & Procedure of Visit

68. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase History A case history is usually not taken on a follow-up visit because it should have been gathered during a previous visit. If the case history is not complete, the technician should gather the necessary information. Follow-Up Visits Order & Procedure of Visit

69. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual Acuity The technician does a visual acuity on the patient in the exam room. Follow-Up Visits Order & Procedure of Visit

70. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther Tests The technician will do all other tests and/or screenings as required by the doctor that directly relate to the follow-up visit. Follow-Up Visits Order & Procedure of Visit

71. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefraction Refraction may or may not be needed and depends solely on the reason for the follow-up visit. A refracting technician or the doctor will do the refraction. Follow-Up Visits Order & Procedure of Visit

72. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor Exam The patient will wait in the exam room for the doctor once the necessary information has been gathered. The doctor will analyze all the information collected and make his own observations to make a diagnosis decision for the patient’s unique situation. Follow-Up Visits Order & Procedure of Visit

73. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor ExamContact Lens Follow-Up A patient may not need to go through pre- test and other tests if the visit is for a contact lens follow-up, depending on the situation. The doctor or Contact Lens Specialist (CLS) will evaluate and work with the patient. Follow-Up Visits Order & Procedure of Visit

74. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsRefractionDoctor ExamContact Lens Follow-UpEscorting the Patient Out At the end of an examination, the patient is escorted to the check-out counter or to the optical. Generally, the chair-side technician or another technician will escort the patient out of the clinic area to save the doctor time in-between patients. Follow-Up Visits Order & Procedure of Visit

75. Comprehensive Eye Health Exam Contact Lens Exam & Professional Services Problem VisitsFollow-Up Visits

76. Special Testing Exam Special test examinations are for patients with specific eye problems, diseases, or pathologies identified by the doctor. The doctor orders this type of exam when he wants to know further information about a patient’s situation.

77. Special Testing Exam Special test exams include: ­visual fields ­GDx ­HRT ­OCT

78. Special Testing Exam Special tests are usually conducted about every six months or as the doctor orders. Sometimes special tests are considered part of the pre- tests, depending on what the patient is in the office for.

79. Special Testing Exam O BJECTIVE OF F OLLOW -U P V ISITS : To gather information to help monitor and maintain specific eye problems, diseases, and pathologies.

80. Special Testing Exam K EY P LAYERS F OR F OLLOW -U P V ISITS : Optometric Technician Special Testing Optometric Technician Doctor Chair-Side Optometric Technician

81. The Greeting The patient is greeted in the reception (waiting) room by a technician & escorted to the pre-test room in the clinic. Special Testing Exam Order & Procedure of Visit

82. The GreetingPre-Test Room In the pre-test room, the technician is in charge of running the necessary tests needed to solve a specific problem. The technician must be sure all paperwork has been signed by the patient before running tests. Special Testing Exam Order & Procedure of Visit

83. The GreetingPre-Test RoomSpecial Test Room In the special test room the special test technician is in charge of running the necessary tests needed for the follow-up visit. Special Testing Exam Order & Procedure of Visit

84. The GreetingPre-Test RoomSpecial Test RoomDilation Drops The patient’s eyes may or may not be dilated and depends solely on the type of special test being conducted. The doctor may have a preference of when a patient’s eyes are dilated; the technician should know the doctor’s preferences. Special Testing Exam Order & Procedure of Visit

85. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase History A case history is usually not taken during a follow-up visit because it should have been gathered during a previous visit (unless the special test is conducted during a full exam). If the case history is not complete, the technician should gather the necessary information. Special Testing Exam Order & Procedure of Visit

86. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual Acuity The technician does a visual acuity on the patient in the exam room. Special Testing Exam Order & Procedure of Visit

87. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther Tests The technician will do all other tests and/or screenings as required by the doctor that directly relate to the follow-up visit. Special Testing Exam Order & Procedure of Visit

88. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsDoctor Exam The patient will wait in the exam room for the doctor once the necessary tests have been run. The doctor will analyze all the information collected and make his own observations to make a diagnosis decision for the patient’s unique situation. Special Testing Exam Order & Procedure of Visit

89. The GreetingPre-Test RoomSpecial Test RoomDilation DropsCase HistoryVisual AcuityOther TestsDoctor ExamEscorting the Patient Out At the end of an examination, the patient is escorted to the check-out counter or to the optical. Generally, the chair-side technician or another technician will escort the patient out of the clinic area to save the doctor time in-between patients. Special Testing Exam Order & Procedure of Visit

90. Comprehensive Eye Health Exam Contact Lens Exam & Professional Services Problem Visits Follow-Up Visits Special Testing Exam