Over 60 Health Center Eye Care Clinic

Attending Clinical Instructors

Thursdays:
Meredith Whiteside, OD
mwhitesi@berkeley.edu 510 367-7032
Fridays:
Sarah Arneal, OD
sarah.arneal@berkeley.edu

Background Information

Welcome to the optometry clinic at the Over 60 Health Clinic (O6C). This clinic specializes in eye care for patients who are 60 years of age or older who have a wide variety of abilities and systemic and ocular health conditions. The optometry clinic has two examination rooms that are housed within a general medical clinic and is staffed by a variety of health care providers, including medical doctors, nurse practitioners, podiatrists and medical assistants. Patients from the O6C may come to the clinic through self-referral or on the recommendation of their primary care provider. In addition, a small number of patients come from other Berkeley community health care centers.

Location and Hours of Operation

The O6C is located in Berkeley at 3260 Sacramento Avenue, which is on the corner of Sacramento Street and Alcatraz Avenue. Limited parking is available below the health center via the driveway off of Sacramento Street. Park only in the spaces marked Over 60 Staff.  Please do not park in spaces for Mable Howard apartments, Over 60 patients or MDs. No permit is required. The eye clinic is in rooms 1 and 2 on the first floor of the clinic, and the hours of operation are every Thursday and Friday. 8:30 am-5:00 pm

Goals

To advance the knowledge, proficiency, and exposure of the optometric clinician in the diagnosis, treatment and management of eye and vision disorders in the geriatric population.

The optometric intern…

• will advance their diagnostic skills in determination of refractive error and binocular vision status. Because many patients may have cognitive limitations, good retinoscopy skills are a must and need to be done be done on most cases preceding subjective refraction. A basic assessment of the binocular system (EOMs and cover test at distance and near) should be done for every new patient and then annually thereafter.  For patients that have signs or symptoms requiring additional evaluation, the clinician should perform testing as needed.
• will advance their diagnostic skills in ocular health due to the high prevalence of ocular disorders in patients. Prevalent causes of vision impairment in patients seen at the Over 60 Health Center include cataracts, glaucoma and diabetic retinopathy.
  • Since clinicians have completed the anterior and posterior segment disease didactic course work, it is expected that clinicians will have familiarity with diabetic eye disease as well as the common glaucoma medications, their dosages and contraindications.
• Will advance their knowledge of systemic disorders and associated eye findings in this diverse clinical population. Common systemic disorders include hypertension and diabetes mellitus.
• Will gain improved skills in working with patients with multiple cognitive and physical disabilities.
• Will interact with a multi-disciplinary assessment team and obtain skills in discussing the optometric findings with both caregivers and other health care professionals.

Clinic Policies

Attendance: Calling in sick or late: the clinician is to notify UCB Clinic Director’s office (510) 642-0945 AND your attending instructor (see contact numbers above).

Attire:All clinicians need to be in professional clinic attire, including white lab coat with name tag.

Clinic records: Student clinicians at O6C are expected to follow the same professional guidelines that are set forth in the clinic manual at UCBSO and the regulations set forth by the Health Insurance Portability and Accountability Act (HIPAA). Note that when we will refer patients to UCBSO for further testing or photo-documentation, we will either input them to the patient’s electronic record (which can be accessed from Over 60).  For patients that are referred to outside doctors, a referral form may be used.

Misc: No food or drinks (including water) are allowed out in the open in patient care areas at the Over 60 Clinic.  There is a staff lounge upstairs with a refrigerator where you may have lunch.

Eye Clinic Equipment

The O6C is limited to one main exam room, which is equipped with a slit lamp, a phoropter, and a keratometer. The second room is for all other functions (e.g., screening visual field testing, digital photos, confrontation testing, frame selects and frame adjustments). Similar to when you are in primary care clinic, each clinician must bring all of his or her own equipment, including, but not limited to, condensing lenses (78D, 20D) BIO, handheld instruments (retinoscope, ophthalmoscope), cover paddles, near point cards, gonioscopy lenses, prisms, stereo tests, and so forth.  Trial lenses are provided but it is the responsibility of each intern to check to make sure that the trial lenses are complete at the beginning of the day.  If any trial lenses are noted missing before patient care, it is critical that to notify the attending clinical instructor—otherwise it will be assumed the trial lens was lost during the day and the last intern who used the room that day will be held responsible for replacing any missing lenses.

Patient Care

Examination slots are 45 minutes each, including dilation time! During this time, one clinician examines the patient while the other either cares for another patient, acts as support staff (e.g., neutralizes the first patient’s current spectacles), prepares for the next patient (chart review) or completes charting from a previous patient. Since the optometry clinic is set in a general medical setting, student clinicians have access to each patient’s complete medical file, and each student clinician is expected to review the file in its entirety. This includes the patient’s general medical record, which states systemic conditions, current medications, allergies, consultations and lab reports. If possible, please perform this review when you first arrive at the O6C.

The electronic health records system (EHR) at Over 60 is NextGen. Typically on the first day of clinic, interns will be given a 1 hour EHR training session at the beginning of the day and will then will practice using the new system by initially scribing for the attending faculty. As the intern demonstrates increasing competence, progressive responsibility in patient care is given. After the eye examination has been completed, interns are expected to complete the assessment to indicate 1) relevant diagnoses (with the appropriate ICD-9 or 10 code) and 2) the plan for follow-up of each condition. The assessment and plan should always address the chief complaint(s), if applicable, the cause (e.g., cataracts, AMD, etc) of the patient not achieving 20/20 vision and any additional areas requiring follow up evaluation. If a patient needs to be rescheduled, a form may be given to the patient who may take it up to the front desk staff who will reschedule the patient.

For most patients at Over 60, there will be a medical indication for the examination (e.g., diabetic eye exam, dry eye follow-up, cataract check, etc.) In these cases, a medical procedure code should be indicated that correlates to relevant medical diagnoses. When a refraction is performed, it is also important to indicate the appropriate procedure and diagnostic codes for refraction.

Spectacle Frame Selects, Orders and Dispensing

Spectacle Prescriptions Covered by Over 60 Clinic: There is a selection of spectacle frames that are covered by the patients’ health insurance. O6C patients are allowed to get one set of spectacles that are either CR-39 single vision or bifocal (FT 28) lenses. If the patient desires additional spectacle options (e.g., UV coat, tinting, photochromatic, etc), these options can be added on for a specific fee that is outlined in a file at O6C.

Very Important!:

1. Before the student intern goes to Over 60, it is the intern’s responsibility to check the outbox (located in the back of the EWC lab) for the Over 60 Clinic for any spectacle orders that need to be taken to the Over 60 Clinic. This may be done either 1 day before your assigned day or the morning before clinic starts.
2. At the conclusion of each day, the intern is to bring the spectacle orders back to the school and drop off the spectacle orders in the Over 60 inbox which is located in the back of the Eyewear Center lab.
3. The copy of the patient log should be given to Mary Harris (behind the front desk at Minor Hall Clinic).

If any questions arise pertaining to the overall organization of the O6C or your rotation through it, you may e-mail your attending Dr. Whiteside at mwhitesi@berkeley.edu.