Eye exams: medical vs. routine vision in optometry

This expert guest post reviews when a routine eye exam becomes a medical eye exam, and why it's important to know the difference.
Published 10.27.2020

The biggest misconception about eye care is that the services provided by eye doctors are only for a glasses and/or contact lens prescriptions.

More than just vision, we are health providers too

How many times has a patient been referred to your practice by an urgent care because of an injury or infection? Why is that? Perhaps it's because patients associate medical attention with only medical practitioners. Perhaps it's the lack of knowledge in the extent of eye care an optometrist can provide.

Chances are it may be both. This is the dilemma many Doctors of Optometry (O.D.) face because “medical eye exams” is not a term often recognized outside of the optometric community. Thus, more actions could be taken to educate your staff and patients on how eye health is part of medical healthcare.

Understanding the difference between vision and medical

The fundamentals of what makes an eye exam standard routine or medical is based on what happens during the exam.

For instance, if the standard of care for your practice is a comprehensive eye exam, a patient often begins an exam with a paraoptometric assistant or technician who starts preliminary testing. The series of tests allows the paraoptometric assistant to determine a baseline for the patient’s prescription. Once the paraoptometric assistant gathers the patient vitals, symptoms, preliminary testing results, and medical and family history, the information is documented and ready for the doctor to review.

When the doctor examines the patient he/she will address common vision complaints and refract the patient to determine their final spectacle prescription. If the doctor's findings of a spectacle prescription is due to refractive errors, this exam is a “routine vision exam.”

In my 10 years of experience as an optician, I can truly say that a medical eye exam is not as clear as night and day. In fact, it’s more complex in understanding what criteria deems an exam medical, not to mention having your staff explain medical exams to your patients.

The primary reason I found confusion between the two was the majority of medical exams were NOT predetermined. That means the visit turned medical during a “routine check-up.” Every case varies, but I would say the majority of the medical exams I observed came through the doctor’s clinical findings, although the patients came in for their annual eye exams.

My universal definition for a medical eye exam is: A comprehensive eye examination resulting in a medical diagnosis based on the clinical findings by an optometrist. The first thing we must understand about medical exams is that there are several variables that could shift a routine exam to medical despite the patient’s chief complaint.

Therefore, if during the eye exam the doctor finds an eye health concern or risk that goes beyond a refractive error, then this may warrant additional procedures for the doctor to assess a treatment plan, which is why it has now turned into a medical exam. Understanding this difference is what will help distinguish a routine vs. medical exam.

Educating your staff

Whether you are an eye care professional or OD, both must coordinate on presentation. Plan ahead your approach to how your practice manages everything as it relates to medical eye exams:

  • Medical insurance billing & coding
  • Appointment time management
  • Emergency appointments
  • Specialist referrals

Discuss strategies your staff could take to better anticipate those medical patients. Take an extra couple minutes on the phone making an appointment by asking additional questions, such as: “Is there any additional eye health concerns you may have for the doctor besides your routine exam for glasses?”

You’ll be surprised to know how many explain a concern with diabetes, dry eyes, eyelid bump, allergies, etc. By implementing medical screenings as a norm in your practice, your staff will be adequately prepared to detect a possible medical eye exam.

Lastly, emphasize to your staff the importance of obtaining the patient’s vision AND medical insurance at the time of scheduling. There will be push-back from patients at the beginning, but explain to patients that as a healthcare provider your practice requires obtaining both. A short but effective explanation to your patients as to why both are necessary will make all the difference.

A takeaway message for your staff and patients about routine vs. medical exams is that when potential eye health risk factors present themselves that require medical attention and further evaluation will result in a medical eye exam.

Roxana Vasquez
Roxana Vasquez
Roxana Vasquez is a senior optician and communication specialist for practice relations based in Houston, Texas.

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