Originally Posted by
ilanh
I am very ambivalent regarding the routine visual fields and fundus photos that are so prevalent in optometric practices. Let me assure you, as a board certified fellowship trained glaucoma specialist, that there is absolutely no reason whatsoever to do a visual field on a normal individual who has normal IOP's and optic nerves. I don't see any justification for it other than the billing. Occasionally the visual field will catch an homonymous hemianopia or some other neurological defect which usually represents an old stroke. I have never seen it detect glaucoma that I wouldn't have detected otherwise. However, I have seen numerous cases in which a "suspicious" field was sent for exhaustive workups which never benefitted anybody. I simply don't feel that they're necessary and would suggest that optometrists stop doing them.
Secondly, I cannot see any justification for routine fundus photos either. I dilate every new patient that I see, every patient with pathology and any patient coming for an annual visit. If the patient is young, is there only for refraction and has big pupils I will use my small pupil BIO to get an adequate look without dilation. Therefore, I can't really justify doing and charging for a fundus photo which will not help me in any way.
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