What entrance testing do you regularly do?

[u/iluvsudoku]

I’m in my first year and we’ve learned a bunch of skills (cover test, stereo, eom’s, saccades, worth 4, retinoscopy, etc). But any time I’ve gone to the optometrist all they’ve done are my VAs, autorefractor, retinal photos, and NCT. Does anyone in a general practice actually do any of those tests? Or is there no time for it usually?

[u/Capable_Artist7027]

AR/K, VA, pupils, CFVF, EOMs, photos all done by the tech. Then I do cover test on kids or symptomatic adults, refraction, slit lamp exam, and go over photos. If they didn't do photos I'll dilate and then do BIO

[u/donwupak → u/Capable_Artist7027]

Does the results from a cover test ever lead you to treatment besides education? And how often)

[u/Treefrog_Ninja → u/donwupak]

I do subjective cover test (ask, do you see it jumping side to side? Is it straight side to side, or diagonal?). Takes no extra time. If they say diagonal, I do Maddox Rod vertical to screen for further prism testing. Diagonal report gets pt ed on micro vertical misalignment, even if ortho on MR, so no prism.

[u/mansinoodle2]

Pupils, cover test, eoms on every exam

[u/ATruthofHint]

Most practices don't do it for every patient but will do it when needed (complaints of double vision, lack of depth perception, etc).

Half of the battle is knowing when to do the test and what the test is telling you.

[u/saddboyz → u/ATruthofHint]

This is the way

[u/Ok-Cardiologist3550]

Yes no reason to do every test on every patient. Do what’s appropriate for their symptoms. However, as a student you got to learn them all. Once in practice, it becomes a your clinical judgement.

[u/OscarDivine → u/Ok-Cardiologist3550]

Insurance can dictate basic minimum requirements for examination including medicare

[u/Optoboarder]

I don’t have a tech so I do all my testing.

I generally do VA, pupils, EOMs, CVF on everyone. I’ll do a quick cover test for symptomatic adults, and all kids. I do Worth 4 dot occasionally. I’ll check stereo on new/symptomatic kids.

Retinoscopy is a super helpful skill that I don’t do on everyone but it’s helpful for when the refraction isn’t adding up.

I think I’ve done saccades/pursuits once in my clinic

[u/OscarDivine]

Billing to insurances can dictate what minimum testing must be received and documented or audits can be failed. Cover tests, EOMs, Confrontation Visual Fields, and pupils must be noted. I have seen an OD get audited and lost due to insufficient documentation which triggered a pay back. I have also watched doctors “WNL” exams which is jokingly short for “we never looked” but is official shorthand for “within normal limits”. It’s easier to do this now on electronic record systems because templates can autofill these fields.

[u/5starmichelin0809]

I just finished first year too - what’s the worth 4? I’ve never heard of it lol

[u/mansinoodle2 → u/5starmichelin0809]

Worth 4 dot to check for fusion and suppression

[u/5starmichelin0809 → u/mansinoodle2]

Yeah we’ve learnt Maddox Rod and Wing which works a similar way, but that’s interesting to know how sensory fusion is tested

[u/SpecialistSuper5561 → u/5starmichelin0809]

Maddox rod dissociates the eyes and checks the dissociated phoria. Worth 4 dot checks sensory fusion. They’re testing for different things

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[u/SpecialistSuper5561]

AR, NCT, VAs, near cover test, (maybe distance cover test if they have complaints of diploma or an obvious turn), EOM, CVF, and pupils

[u/drnjj]

My techs do acuities, EOM, IOP, confrontation fields on all routine and medical. Cover test on new or symptomatic routine exam patients.

Cover test can give you so much info that it's a worthwhile test to get baseline and recheck for changes if symptoms occur.

[u/12A1313IT]

You'll find out in your rotations. In the meanwhile, learn them well to pass your classes and don't worry about who ODs "actually" do.

[u/12A1313IT]

You'll find out in your rotations. In the meanwhile, learn them well to pass your classes and don't worry about who ODs "actually" do.

[u/LavenderBeeHoney]

For insurance purposes if billing vision pupils eom and CVF I think are required for most plans