A Day In the Life Of A COA

The ages and sexes of patients have been modified to protect patient information.

5:30- I hear my alarm go off.

5:35- I acutally get up.

5:45- My wife and I go for a stroll around the apartment complex.

6:05- Shower.

6:20- Start making 4 eggs…. exactly no more, no less.

6:55-Head to work.

7:15- Clock in. I look at the schedule and see that I will be doing special testing. This means that I will be doing visual field testing and OCTs (Optical Coherence Tomography) . Review the days schedule, open rooms, and work up patients until a patient who needs special testing comes in. 

8:30- The first visual field patient walks in. I collect their AR (Auto Refraction) and check their glasses. If the glasses are new then I will use that perscription in calculating the lenses that are used for the automated perimetry. If they are older than 4 years I will use the AR. I then explain the purpose of the visual field and give them instructions. After the test is complete I look at the results and notice a scatoma in the left eye. I then ask the patient to follow me to the OCT room so that we can collect information about their optic nerve.

8:45- I instill artificial tears in the patients eyes and explain the purpose of the OCT and give the patient instructions. After the test, I see that there is thinning of the optic disc which seems to be consistant with the scatoma in the visual field results. I then dilate the patient in preparation to see the doctor.

9:10- I record information into EHR (Electronic Health Records)

9:30– A patient that takes plaquenil walks into the clinic. I take the patient to the OCT room to get a picture of their macular. I explain the purpose of the test and give instructions. After taking the picture I look at the image. I see that the macula has become flat over time. The patient states that she has been taking plaquinel for many years and just started to notice changes in vision within the last 6 months. Her symptoms and my results of the macular OCT seem consistant. I then prepare the patient to see the doctor.

10:00- 11:30- Continue to see patients who need special tests.

11:15- I eat lunch. Most of the time this is a spring salad with feta cheese and dressing, but sometimes I go to the gas station and get a hot dog.

12:15- After lunch I am no longer doing special testing. I am working up for a doctor.

12:30-The first patient of the afternoon comes in. This patient is 12 years old. For patients 18 or younger we check their stereo acuity and color vision. I do AR, Lensometry, and NCT (Non-Contact Tonometry). I then take the patient into the exam room. She is complaining of blurry vision. She can’t read what the teacher is writing on the board. She is in the clinic to get glassses. I test her vision. it comes out to be 20/30 OD and 20/40. After pinhole she is at 20/20 and 20/25. Her vision would definitely improve with glasses. I then check her ocular motility by having her look at the red cap of my dilation drops and have her follow a double h pattern. I then test her periphreal vision by asking her to look at my nose while I hold my fingers in her periphreal vision and ask her to count the fingers that I am holding up. She does well. I then asses her pupils using PERRL. I record all findings in EHR.

1:00- The next patient is in for a Diabetic Evaluation. I do the normal AR, NCT, Lensomtry. In the exam room, I ask the patient how long he has been DM (Diabetes Mellitus). I ask if he is taking insulin. I also ask for average blood sugar, last blood sugar, and A1C. The patients stats are high. I read the doctor’s last impression and plan. Last time the patient was here the doctor noted PDR. The patient states that the last glasses that he recieved are not working well. This is consistent with the last exam findings. The patient can’t see well because vessels are growing over the retina. I dilate the patient and record exam findings in EHR.

1:30- A patient comes into the clinic who has slept in their contact lenses for 3 days and has an ulcer on her cornea.

2:00- An elderly patient comes in for a yearly exam as required by their health insurance. The patient has the same visual acuity as last year, but tells me that he has been having dry eyes. I talk about different types of eye drops that are available and that the doctor will discuss which drops are best suited for their condition

2:15- A one day cataract post- op comes in. I take of the patient’s patch and clean any blood or mucous around the eye. I explain the importance of wearing a shield over the eye while sleeping and following their eye drop schedule. I then record the patient’s visual acuity and eye pressure and have them wait to see the doctor.

2:30 – A patient comes into the clinic for a cataract evaluation. I perform a corneal topography then take them to the exam room. After checking their visual acuity I use the phoropter to get a manifest refraction. It turns out that this patient can see ²⁰⁄₃₀ out of both eyes with the refraction. Insurances don’t cover the cost of cataracts until vision is worse then ²⁰⁄₄₀. To get their vision to ²⁰⁄₄₀ I perform a glare test. The patient can now only read the ²⁰⁄₆₀ line. Patients with dense cataracts have a significant decrease in visual acuity with glare. I record the findings in EHR and dilate the the patients eyes before seeing the cataract surgeon.

3:00- I start working on authorizing prescription refills. We get these faxes to the clinic when a patient goes to pick up a drop from the pharmacy, but they are out of refills. The pharmacy then faxes us to authorize more refills.

3:30- I start working on prior authorizations. This is when we prescribe a medication that is not covered by the patient’s insurance. We then have to provide a list of medications that have been tried, but failed to produce significant results.

3:45- I go help at the front desk fax letters to PCPs (Primary Care Providers).

4:00- I clean and stock my history room.

4:15- I clock out.

4:35- I get home and stuff a snack in my face.

4:45- I play with my boy.

5:30- I make some delicious spaghetti.

6:00- We all eat some delicious spaghetti.

7:00- My boy goes to bed. I work on this website.

8:00- Chat with my wife about the day.

8:45- Get ready for bed and wind down.

10:00- Fall asleep.

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