The document outlines the procedures and examinations that a junior technician is expected to complete as part of a patient's eye exam work up prior to the doctor's visit. It involves preparing the patient's file, taking a history, performing various vision and eye health tests, documenting findings, and preparing notes for the doctor. The work up includes tests of visual acuity, refractive error, eye alignment and movement, eye pressure, visual fields and external and slit lamp examinations of the eyes. The technician is responsible for gathering all relevant health information and performing examinations to thoroughly assess the patient's eye health.

1. Complete Patient
Work Up – Junior
Technician
An outline of the detailed examinations, scans, and tests
that are to be completed by the Jervey Eye Group intern or
junior technician prior to the doctor’s visitation.

2. Outline of the Procedures
• Preparation of patients’ files
and past appointments
• Collection of patient history
• Completion necessary scans
• EPIC Refractions
• OCT
• SDP
• Chief complaint
• Visual acuity
• Manifest refraction
• Confirmation of glasses
prescription
• Examination of pupils
• Measuring intraocular
pressure
• Applanation tonometry
• Check visual fields
• Check ocular motility
• Complete external
examination
• Apply dilation drops
• Slit lap examination
• Examine fundus
• Indirect method through 90D
• Justify assessments
• Scribe

3. Preparation of Patient Files
• Prior to each examination, the
patient’s file is retrieved from
its designated, alphabetized
section.
• The folder contains
information about the
patient’s past medical history,
past appointments, past
scans, and chronic
symptoms/diseases of the
eyes.
• It is the technician’s
responsibility to transfer
pertinent material and
information from the previous
documentation on to a new
file designated for that day’s
appointment

4. Samplework
up sheet
utilized by
Jervey Eye
Group

5. TopHalfoftheWorkUpSheet
The more prominent steps of the examination are labeled above

6. Reviewing Patient History
• Prior to examination, the technician must review the
patient’s medical history with them.
• The history must be updated at least every year.
• This includes reviewing family history, listing current
medications, noting any hospitalizations/surgeries, and
their past eye history.
• The technician must also check if the patient’s mental
status is in good condition.
• Additionally, if the patient is new to Jervey Eye Group, or
it is required as such, the technician will complete an
EPIC scan prior to examination.
• The EPIC scan gives a rough estimate of the dimensions of the
eye, the curvature of the lens, and characteristics of the cornea

7. Chief Complaint & Vision Check
• CC/HPI
• In this section, the technician will write any previously noted
problems with the eye and take down the patients’ main reason
for the visit
• Additionally, it is the technicians responsibility to ask what the
problem is, how long it has bothered the patient, the severity of
the problem, what the problem is causing, and why this might be
a problem?
• V
• In this section, you will be testing the patient’s visual acuity (VA):
the sharpness of vision, measured by the ability to discern letters
or numbers at a given distance according to a fixed standard.
• V(s) – the patient’s visual acuity without glasses of contact lenses
• V(c) – the patient’s visual acuity with glasses or contact lenses

8. Vision Check
• The technician will ask the patient to take the guard and hold it
over one eye
• On the work up sheet, the VA for the right eye (OD) is written
above the VA of the left eye (OD)
• Based on the line that the patient can clearly read in its
entirety, that distance will be recorded for each eye

9. Reading Prescriptions
• W
• This portion of the work up sheet is where the technician will write out
the prescription for the patient’s glasses (as needed)
• The prescription is read using a machine that is adjusted using dials until
the sphere, cylinder, and axis are perfectly aligned. These numbers are
written in this format: [+/-] sphere # [+/-] cylinder # x axis #
• Prism is read by the optical shop only if necessary and then “Add” is
determined by the physician.

10. Refraction
• Refraction - Manifest
• A manifest refraction is the manual way of determining the best
suited lenses for a patient’s eyes
• The technician will place the phoropter in front of the patient and
place a block in front of one eye
• The same will later be repeated for the other eye
• The technician will single out a line mirrored on the wall.
• Then, the tech will adjust the sphere on the phoropter, giving the
patient two different options; asking them to pick which one they
like better
• The tech will move their adjustment of the sphere in the direction of
the favored option. This will be continued until the patient sees no
notable difference between the options.
• Next, the tech moves on to the adjustment of the cylinder, and
carries this out in the exact same manner

11. Refraction
• Lastly, the tech moves on to the
axis
• The cross-cylinder is placed in front
of the eye. The tech will flip the
cross-cylinder lens and adjust to axis
based on the chosen option.
• The axis is turned in the direction of
the colored dots
• This is repeat until there is no
noticeable difference
• The manifest refraction is written
in the same format as a
prescription for glasses.
• An important point that must be
emphasized is that the patient
must not analyze the options
with too much depth. They
should answer as soon as
possible.
• “If you think during the test, then
you are going to get glasses that you
will have to think in” – Dr. Myers

12. ExcerptoftheWorkUpSheet(cont.)
The more prominent steps of the examination are labeled above

13. PUPILS
• In this section, the technician
dims the light and has the
patient focus on an object
straight ahead.
• The tech shines a light briefly
in to the patient’s eyes to see
the reaction of the pupil
• Under normal circumstances,
the pupil will constrict once the
light hits it
• The tech will write down the
change in the pupil’s size
• If the pupil enlarges, or only
one constricts, the patient
likely has an afferent pupillary
defect (APD)
• This could be due to damage to
the nervous/muscular tissue of
the eye

14. Measuring Intraocular Pressure
• TA - Applanation Tonometry:
Goldman
• The first step in this process
involves the tech applying a
fluorescein-anesthetic drop into the
eye(s) that the pressure is to be
measured in.
• It is important to warn patients that
there will be a yellow hue over their
eye and in their vision, but it will
fade within minutes.
• The tech will adjust the patient so
that he/she can comfortably place
his/her forehead and chin in the slit
lamp’s holsters.

15. Measuring Intraocular Pressure
• TA - Applanation Tonometry: Goldman
• The tech will adjust the piece, the light and the filter so that a large range
of blue light is cast on the tip of the tonometer.
• Instructing the patient to open both eyes wide (tech may lift lids as
needed), the tech will move the slit lamp towards one of the eyes and
gently rest the tonometer on the center of the cornea
• Simultaneously looking through the slit lamp, the tech will adjust the
calibrated dial of the tonometer until the two fluorescent semi-circles
seen through the lenses form a horizontal “S” shape
• The number that the dial is adjusted to will be the intraocular pressure
(mmHg)

16. Measuring Intraocular Pressure
• TA - Applanation Tonometry: Perkins
• The Perkins method determines
intraocular pressure in a different
process.
• Different process are performed based
on variables including medication,
sensitivity and characteristics of the
eyes
• For this procedure, a hand-held
tonometer is used to collect the data.
• The tech applies an anesthetic drop in
the desired eye.
• Zeroes out the device
• And in the same manner, brings the tip
of the tonometer to gently touch the
cornea of the eye. It is held there until
the device displays the pressure.

17. Motility
• For this portion of the exam, the
tech has the patients keep their
head facing forward, and
instructs them to follow the light
with just their eyes.
• The light is moved in the shape of
a box and then across from
corner to corner in front of the
patient.
• If there is no noticeable strain or
inability, all boxes are checked
• If the patient is unable to follow
the light in a certain direction,
this could be caused by damage
to muscle tissue.
Additional Motility Tests:
• If the tech notices that the patient is constantly adjust his/her eyes, it is the tech’s responsibility to
check for things like diplopia or confusion
• This is done by having the patient focus on a single letter on the mirrored wall. The tech will
place a hand in front of one eye and move over to the other, back and forth.
• If the eyes move to refocus, the direction is noted and the diagnosis is written in this section.

18. Visual Fields
• VF
• For this portion of the
examination, the tech is
determining if there is any
defect to the patient’s
peripheral vision.
• Asking the patients to look
straight ahead while covering
one of their eyes, the tech will
hold up numbers in the four
corners of the patients’
peripheral vision
• It is advised that the tech hold up
either a 1, 2 or 5 for the sake of
clarity.
• If all four numbers are correctly
read, the exam sheet is marked
“Full OU”
• Inability to correctly call the
number presented will be noted
on the sheet by drawing the eyes
and shading in the quadrant that
the number was missed

19. External Examination
• EXTERNAL
• For this portion of the examination, the tech will comfortably place
the patient in the holsters of the slit lamp and use varying filters and
intensities of light to observe any abnormalities in exterior portions
of the eye.
• If there is something abnormal about these parts of the eye, the box is
circled and a description is place beside
• Otherwise, all boxes would be checked
Slit lamp beam shot
across eye
Source – OcuQuest

20. BottomHalfof theWorkUpSheet
The more prominent steps of the examination are labeled above

21. Slit Lamp Examination
• SLE
• Similar to the external
examination, the tech will
bring the slit lamp up to the
patient and utilize different
powers, filters and ranges of
light to analyze more
characteristics of the eyes
• In this sections, commonly
observed abnormalities
include some of the following:
• Scratches on the cornea
• Thick lenses (cataracts)
• Defect in the iris
• Tear film dysfunction
• Any additional notes will be
specified under the eye that it
pertains to

22. Slit Lamp Examination
A variety of different
defects seen through the
slit lamp. Source linked to
picture

23. Fundus Examination
• FUNDUS
• During this portion of the examination, the tech will dilate the
patient’s eyes, as needed.
• There are important requirements and restrictions with regards to
dilation that all techs must be aware of.
• The tech must be conscious of the patient’s history, medications, and
diagnoses prior to dilating
Effects of
dilation, source
linked in
picture

24. Fundus Examination
• Examination with 10D Lens
• Combining the 10D lens with
the lights and the
magnification of the slit lamp,
the examiner will be able to
get a more detailed look at
the optic nerve within the eye.
• The lens’s distance is adjusted
to create clear images.
• The purpose of this
examination is to observe the
cup-disc ratio of the optic
nerve

25. Examinationwith10DLens
The cup [blue, inner circle] is measured in comparison to the disc [green, outer circle]
The normal ratio is 0.3

26. Fundus Examination
• Examination with 90D Lens
• Using the light and
magnification of the
headlamp in combination
with the 90D lens, the
examiner will be able to
explore more areas of the
retina
• The lens is held above the
patient’s eye and creates an
inverted, opposite image of
the interior of the eye
• The patient will be told to
look in different directions
• This allows the tech to observe
the components of the retina
more in depth

27. Mechanism of the 90D lens
with the headlamp
Refracted image of the retina
in the lens

28. Scribe: Assessment & Plan
• Following the complete work up of the patient, the tech also
has the responsibility of serving as a scribe for the specialist
upon entering the room.
• These responsibilities include writing any additional notes that
the physician deems necessary. Based on the context of the
observation, it is the tech’s job to correctly write this
description in the correct area of the exam sheet.
• For each assessment that is made in the examination and
listed at the bottom of the exam sheet, the tech must ensure
that there is some comment written next to it.
• Regarding the plan, the tech must mare certain that each
assessment is addressed in this section.
• Tasks following the completion of the visit include writing
prescriptions, completing scans, validating ICD-10-CM codes, and
double checking for missed sign-offs or dictations.

29. Complete Scans
OCT : Optical Coherence Tomography
• This diagnostic
technique employs light
waves through the
anatomy of the eye to
achieve high resolution
pictures of the structural
layers located in the back
of the eye.
• Physicians analyze these
images to determine if
there is an underlying
determinant that is
affecting a patient’s
vision
SDP: Stereo Disc Photos
• Stereo disc photography
enhances the evaluation of
the fundus examination.
• This photography allows
for a more in depth
analysis of the optic nerve.
• The technique used at
Jervey involves taking two
pictures from different
angles and using a
stereoscope viewer to
superimpose the images,
giving it a 3D effect

30. Jervey Eye group uses a machine that
takes both OCT’s and SDP’s when the
system preferences are reset

31. Standard OCT Data Layout

32. Standard images printed from SDP