Technology, pathways and dilation at BBR Optometry

What can you do to give patients the best standard of care?

For Nicholas Rumney, senior optometrist and chairman at BBR Optometry, “You’ve got to give yourself all the available tools.”

Speaking with OT, Rumney gave a behind the scenes insight into his approaches, the equipment he uses in practice, and what a typical sight test looks like at BBR Optometry.

A key tool for the practice is dilation, he shared, with 75-80% of patients he sees in the practice dilated as part of their eye examination.

The majority of symptoms-based appointments arrive through the COVID-19 Urgent Eyecare Service pathway, such as by GP or self-referral. But routine recalled examinations are also dilated. Rumney shared how the practice communicates their approach to dilation to patients, and any issues to be aware of when dilating.

Outlining what a 40-minute examination looks like at the practice, he described the journey a patient will take through the different tests conducted by a clinical assistant, including – I-care tonometry, Optos colour and Optos Autofluorescence, and recently the Rodenstock DNE scanner.

“We are just about getting back to the realms of more routine supra threshold field testing,” he said, and so this would be added when indicated.

In the consulting room, following a discussion about history and symptoms, Rumney would take a measurement of habitual distance and near visual acuity, alongside basic binocular vision and pupils.

“I’m a little bit of a stickler for taking a measurement of unaided vision as well,” he admitted.

After observing the anterior chamber and front of the eye with a slit lamp, the device is removed and Rumney might look at the patient’s pupils and ocular motility before he then uses a drop of 0.5% tropicamide in each eye.

The patient then moves onto refraction with an automated phoropter, before moving to optical coherence tomography conducted by a clinical assistant. By that time, the drops have taken sufficient effect for a really good slit lamp and Volk lens fundus examination, Rumney said.

Watch the full interview with OT below.

Reflecting on his experiences, Rumney discussed how to best introduce new technology into practice.

“It’s all about the pathway. If you have a piece of kit that you drop in, and you don’t have a pathway developed, it’s not going to work,” he said.

Not all tests fit into a routine assessment pathway, he observed, adding: “The tough bit is getting the pathways worked out and getting consistency across maybe four optometrists.”