Ординатура / Офтальмология / Английские материалы / Diagnosing and Treating Computer-Related Visual Problems_Sheedy, Shaw-McMinn_2003

Positioning Your Practice to Care for Computer-User Patients 15

Do you wish to receive electronic updates on the latest developments in vision and ocular health-related issues? _____

E-mail address _________________

How many hours a day do you use a computer? ______

How long before your eyes grow tired or get irritated? ______

These questions show patients you are up on the latest technology (e-mail and perhaps a Web site) and encourage them to think about whether eye discomfort can be related to computer use. Many patients still do not make the connection, or they assume it is normal to have symptoms after 1 or 2 hours on the computer (Shaw-McMinn, 2001). An example of a history form specific to computer users developed by a CVS doctor is illustrated in Figure 2-4.

Examination Form

A typical examination for a computer user may include testing for all visual skills and eye conditions. Because patients of all ages are using computers today, any possible procedure can be important for your patient. As our older patients begin to use computers more frequently, many pathologic conditions must be addressed in playing a role in computer-use comfort. Figure 2-5 shows an examination form that may be used for computer users. Note the label “Computer-User Examination Form” at the top. Patients will notice the label and discern that you administer an examination tailored for their particular concerns. Providing an examination specific to computer users sets you apart from other eye care practitioners.

Treatment Routing Slip

Many doctors use a slip to indicate the treatment by checking off options and handing it to the optician with the words, “Please demonstrate the following to Ms. Rom. Ms. Rom, Jennifer will show you the prescribed treatment I explained to you and set up a follow-up appointment.” Figure 2-6 is a sample routing slip.

Positioning Your Practice to Care for Computer-User Patients 17

Direct/BIO/90 D

1% tropicamide/2.5% Neo-Synephrine

Media

C/D

E

Depth

Shape

Macula/FR

A/V

Dx/Imp/Rec/RTC

FIGURE 2-5. Computer-user examination form. (AA = amplitude of accommodation; A.C. = anterior chamber; APD = afferent pupillary defect; A/V = artery/vein diameter ratio; BI/BO = base in–base out; BIO = binocular indirect ophthalmoscopy; C/D = cup-to-disk ratio; CT = cover test; Dx = diagnosis; E = esophoria; FR = foveal reflex; EOM = extraocular movements; Imp = impression; Ks = corneal curvature; NPC = near point of convergence; NRA = negative relative accommodation; PERRLA = pupils equal, round, reactive to light and accommodation; PP = punctum proximum; PR = punctum remotum; PRA = positive relative accommodation; Rec = recommendations; Ret. = retinoscopy; RTC = return call; Subj. = subjective; Supp = suppression; TBUT = tear breakup time; va = visual acuity; VF = visual field.)

Positioning Your Practice to Care for Computer-User Patients 21

essary helps the patient to understand the value of your specialized service. Figure 2-8 is an example of an explanation handed to patients.

Office forms should be customized for computer users. Include computer-related vision services and products on all your office communications. Mention of computer-related offerings in your practice positions you as the eye care professional a computer user needs to see.

Positioning Your Practice in the Pretesting Room

You can communicate your expertise in computer vision by designing the proper pretesting room appearance, training the assistant on how to recognize CVS patients and to say appropriate statements to the patient, explaining the value of pretesting to computer users by use of scripts for the assistant.

Pretest Room Appearance

The room can be decorated similarly to the reception area to provide educational opportunities for the patient to learn more about services and products for computer users. Counter cards, brochures, testimonials, and certification of eye care professionals should be available to the patient to review when waiting for the assistant or technician.

Assistant Review of History and Pretesting

The assistant has an opportunity to further educate the patient during the review of the history and pretesting. An alert technician can recognize when certain treatments may be recommended by you and prepare the patient to avoid a surprise.

“Ms. Apple, I see from your history form that you use computers. Did you know that more than 100 million Americans use computers at work every day? And more than 70% of them have problems with their vision or their eyes! Dr. Gates will complete an examination customized to your needs and may prescribe eye exercises, lenses, or other treatments to make things easier on your eyes

22 Diagnosing and Treating Computer-Related Vision Problems

THE COMPUTER VISION EVALUATION

Understandably, many of our patients wonder what services are provided during a computer vision evaluation in addition to those provided in a general vision examination. Below is a list of additional services we may include during our computer vision examination. The actual procedures vary depending on the type of the computer demands, complexity of problem solving required, and individual patient characteristics. We want to do all we can to be the best provider of vision care for you. Do not hesitate to ask us any questions regarding the following:

1.Review of computer vision history

2.Review current vision, comfort, visual demands, and patient concerns

3.Acuity at the computer screen distance

4.Retinoscopy at the working distance with PRIO computer simulator instrument

5.Subjective refraction with PRIO computer simulator instrument

6.Visual acuity with the retinoscopy finding

7.Visual acuity with the subjective finding

8.Biomicroscopy evaluation of the tear film

9.Lid evaluation with lid eversion

10.Evaluation of tear breakup time

11.Schirmer’s test for tearing

12.Dry eye test

13.Blink rate measurement

14.Corneal topography

15.Color vision testing

16.Assessment of the workstation

17.Present recommendations and treatment options

18.Review patient concerns

19.Complete the computer lens prescription

20.Demonstrate the prescribed computer lenses

21.Order the computer glasses

22.Review proper use of and handling of computer glasses

23.Provide educational materials on computer vision

24.Verify proper computer glasses order delivery

As you can see, there is much that goes on during the computer vision evaluation that you may not be aware of. You can be sure that if any new technology appears that can improve our care for your eyes, we will add it to our procedures. We are dedicated to the goal for you to have “Good Vision for the Rest of Your Life!”

Positioning Your Practice to Care for Computer-User Patients 23

when using a computer. Ms. Apple, how often do you have problems focusing? (At this point the assistant may continue investigating the frequency, duration, intensity, and related factors of the patient’s signs and symptoms.)

Because you use computers, I’m going to give you a few preliminary tests to give the doctor an idea of how he can best assist you.

Stereoacuity test: “This test will give us an indication of how well you are using your eyes together at near distances, like that of a computer screen. Many people ignore one eye or strain to keep the eyes turned in for long periods of time, causing discomfort or irritation.

Visual fields: “This computerized instrument lets us know how well you see objects in your peripheral vision, like when scanning across a computer screen at work.”

Lensometry: “I see from your prescription that you are using general-use lenses at your computer. There are many lenses designed specifically for use at the computer—lenses that focus at the proper computer distance with no glare and designs that allow a patient to have his or her head in a comfortable position when viewing the screen. Here is a brochure about one such possible lens that Dr. Gates may prescribe.”

Assistant Script for Introducing the Doctor

After the pretesting, the assistant typically seats the patient in the examination room and may say,

“You’ll like Dr. MacIntosh. He explains everything thoroughly, has 25 years’ experience here in Woodcrest, and specializes in treating computer-user patients. Ask him about the computer lenses we discussed.”