In optometry practice, I keep falling behind in my patient schedule and end up keeping some of my patients waiting. This is not in the best interests of the patients nor the business. My colleagues are much quicker than me at completing an eye examination. I asked them how they could be so quick and still carry out a good exam and keep good clinical records. They told me they carry out symptom-led examinations. What does this mean?

I’ll never forget my first time working in community optometry practice. I had three years of experience working in hospital practice where I was expected to determine the prescription and nothing else. Orthoptists did the binocular vision work and ophthalmologists the external and internal eye examinations. I knew how to conduct an eye examination but couldn’t complete one in under 45 minutes. My colleagues were conducting good eye examinations in 10 to 20 minutes. When I spoke to them they told me they conducted the tests that they considered necessary based on the patient’s symptoms with the exception of monocular visual acuity and retinal examination which they conducted on every patient. Whereas I was conducting the same examination I had been taught to do at optometry school which included almost every possible test.

I quickly learned to carry out a symptom-led eye examination with the mandatory history and symptom taking, monocular visual acuities, an internal and external examination and, where the patient age required it, intraocular pressure measurement. Everything else, binocular vision evaluation (vergences, cover test, prism cover test, near point of convergence, amplitude of accommodation, ocular motility), pupil reflexes, visual fields, Amsler grid and slit-lamp examination, performed when the patient’s symptoms deserved them. I managed to stay on my patient schedule, conduct good examinations and help in the prosperity of the business.