Is my O.D. trying to upsell me?

[Goofyone]

Question for you all:

I go to one of those popular eyecare franchises that does mainly contacts/eyeglasses. Last time I went in for my yearly, the doc is insistent on this visual field screening test. You look into this box and click a mouselike device everytime you see a wavy spot.

From what I understand, this mainly detects problems with the optic nerve (please correct me if I'm wrong).

After a normal external and fundus exam, and if I'm not having any problems with my vision (other than the fact that I need glasses, obviously), is this really necessary? I could sort of see doing it maybe once as a baseline, but he is recommending it every year, and is really insistent.

Anyway, I went ahead and paid the $15 (over the price of the normal exam fee) and of course the result was negative. Now I know it's not a lot of money and I would be kissing his feet if he had found a serious problem early, but is it really necessary or is he just trying to get his healthy patients to help pay for his new machine?

Ultimately, I guess what I'm asking is whether this is a screening test, or a test to use after discovering some other abnormality?

Thanks in advance for the responses.

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[TPMOH]

It's a good screening tool, but the ODs that I've seen that use it usually make it part of the pre-testing and it is included in the cost of the general eye exam.

 

[Richard_Hom]

Dear Goofyone,

I will only add to the prior post regarding your experience at the doctor's office.

Visual field testing does focus on the integrity of optic nerve head. As such, there are numerous conditions which can evolve without manifest vison loss or blur and would therefore can lead to vision loss subclinically.

I think the trend to using technology in the normal course of an office visit has permeated throughout health care. Such proliferation has certainly, in my opinion, accelerated an "arms race" to create a competitive advantage wherever possible.

Regards,
Richard_hom

 

[r_salis]

I agree it's a good screening tool, I think it's a little odd that you had to pay an additional fee for the test, though. Do you have vision insurance? Could it have not been covered by it?

 

[Simisn]

I've trained with an optometrist before and I'm working with one now, and at both places the visual field is an extra test that is optional for patients (at one place it cost $15 for the test, and at the other place $35). At the place where I work most people's insurance does not cover the visual field test. Also on most weekends I volunteer with an organization called Prevent Blindness and we screen people all over the Houston area, and at the Prevent Blindess screenings we do the visual field test for free.

 

[Goofyone]

Originally posted by r_salis
I agree it's a good screening tool, I think it's a little odd that you had to pay an additional fee for the test, though. Do you have vision insurance? Could it have not been covered by it?

I don't have vision coverage. I paid something like $70 for the exam.

Anyway thanks for your responses. Sounds like it's worth the $15 on the off chance it may catch something.

Is this a new technology, or has it been around for awhile? Maybe after it becomes more commonplace as part of a normal vision screen they will do it for no additional cost?

 

[Richard_Hom]

Dear Goofyone,

This technology has been around for 15-20 years but it has not quite been packaged in an easy to use and compact configuration until the last 10 years. In addition, studies have been completed that have established the correlation of its findings with more traditional approaches (or "gold standards").

Although, this technology has been focused on screening, Zeiss MedOptics has introduced a version called "Matrix" which can actually monitor glaucoma or other progressive optic nerve pathology with the same degree of simplicity as the earlier technology.

As you may know, visual field testing complements a sound case history, careful physical examination with other objective testing to differentiate the normal from abnormal/pathologic.

Regards,
Richard Hom, OD,FAAO
San Mateo, CA

Originally posted by Goofyone
Is this a new technology, or has it been around for awhile? Maybe after it becomes more commonplace as part of a normal vision screen they will do it for no additional cost?

 

[Goofyone]

Thanks Dr. Hom, very informative!

 

[eyedream82]

Hey goofyone,

Visual fields is only done when you're intraocular pressure hits the mid 20's range and that your OD suspects you have glaucoma. Most cases where you have a history of glaucoma in your family, it's always a good idea to have the test done every year. I don't know how old you are, but in most cases, the test is rarely done in patients my age (20).

I can't believe your OD only charged you $15. Most of our patients paid more than that, but i guess it's mostly because they come in for a Heidelberg and D-Curve every 3 months as well. But anyway, if i were you, one test that costs only $15 isn't a big deal. Better safe than sorry! I don't know why people are so cheap when it comes to get their eyes exam, you only come in once a year anyway!

Faith

"For we walk by faith, not by sight." -2Cor5:7

 

[Goofyone]

Originally posted by eyedream82
Hey goofyone,

Visual fields is only done when you're intraocular pressure hits the mid 20's range and that your OD suspects you have glaucoma. Most cases where you have a history of glaucoma in your family, it's always a good idea to have the test done every year. I don't know how old you are, but in most cases, the test is rarely done in patients my age (20).

I can't believe your OD only charged you $15. Most of our patients paid more than that, but i guess it's mostly because they come in for a Heidelberg and D-Curve every 3 months as well. But anyway, if i were you, one test that costs only $15 isn't a big deal. Better safe than sorry! I don't know why people are so cheap when it comes to get their eyes exam, you only come in once a year anyway!

Faith

"For we walk by faith, not by sight." -2Cor5:7

Dear Faith,

Thanks very much for the info. I don't have any glaucoma in my family. I'm 25, and I would hope if i had elevated IOP this Dr. would have told me. He said he recommends the exam to everybody every year.

I see your point about the test being cheap, but that's not my problem with it. I just don't agree with doing unneccesary testing. If I had any problems with my vision, any history of glaucoma in my family, or had any risk factors for it (which I don't), or had any other reason for my O.D. to suspect optic nerve pathology that couldn't be detected by any other means than this test, then I'd be all for it.

There are a lot of cheap tests out there to screen for everything from hemochromatosis to gonorrhea, but the tests just aren't warranted for everyone. I know healthcare is a business, but the patients come first, and I would feel wrong about doing any tests on my patients that I knew weren't necessary. It's doing a disservice to patients. Ultimately, it drives the cost for healthcare up and decreases the quality of care for us all. Not to mention, when patients find out about this stuff they tend to get angry, and carry bad feelings and mistrust for the entire healthcare industry. By the way, I'm not criticizing just this doctor, and I know this happens in every field of health care. This is just another example of how our healthcare system has gone amiss in this country.

Just my .02

 

[Richard_Hom]

Dear eyedream82 and doctor,

Although your comment about age and screening visual field is mainly on point, I'm hoping that your comment regarding the prerequisites for visual field testing and "glaucoma" was a misprint. I don't believe that visual field testing should be or is restricted to just "high pressures". If you believed that you would miss more than 2/3 of the glaucoma that occurs in the normal to moderately above average ranges (according to recent study).

The index of suspicion for the use of visual field test is most often a constellation of factors as before mentioned. It may be the personal or familial history (recent CVA, Grave's, recent occurence of blurry vision of unexplained cause), abnormal appearance of the optic nerve head (possible only in stereo with dilated pupils), etc.

I apologize ahead of time if I misinterpreted your post but I thought that your post may have misconstrued the value of the visual field.

Yours truly,
Richard_Hom

Originally posted by eyedream82
"...Visual fields is only done when you're intraocular pressure hits the mid 20's range and that your OD suspects you have glaucoma. Most cases where you have a history of glaucoma in your family, it's always a good idea to have the test done every year. I don't know how old you are, but in most cases, the test is rarely done in patients my age (20)..."

Faith

"For we walk by faith, not by sight." -2Cor5:7

 

[cpw]

Since you described the tests as "squiggly waves of light" I think your OD did an FDT screening. It's a different kind of visual field test (much much faster than the giant white bowl with single flashes of light). The bowl test (the traditional visual field) can be set to test different areas of the retina and is MUCH MUCH more sensitive for things.

The test you did, FDT, is also a good VF test, but a lot of OD use it as a routine screening test on EVERY patient. The office I work for did FDT on everyone (included in the cost of the yearly exam) to catch people who might have fallen through the cracks otherwise.

If people had to come back because of something found on FDT for a more thorough visual field exam with the Humphy tester (in the big bowl) it did cost a lot more money. up to like, 75 dollars some times.

Everyone also seems to be focusing on glaucoma. Yes, VF can catch glaucoma when it's starting to damage nerve tissue.. but, it can also detect brain lesions, optic nerve problems, and depending on what the field looks like it tells you just what part of the visual system is being effected.

I'm not saying you personally have the things mentioned. I'm just explaining the many reasons for using VF for routine screening and yearly eye care. It's a very powerful test.. be glad your OD has one. It's not something I've ever seen done to "upsell" someone.. they do it because it's important.

 

[Goofyone]

Yeah, I think it must have been an FDT by what you described. It took about 2 minutes. If this is indeed a screening test, then I'm all for it, and I retract what I said before.