In a busy glaucoma clinic, inefficiency rarely appears as a single problem. It accumulates in small delays—waiting for a visual field room to open, repeating instructions about drops, or navigating documentation during a patient encounter. Over the course of a day, those minutes add up, limiting both access and physician bandwidth.
At the ASCRS 2026 Glaucoma Subspecialty Day in Washington, DC, Sahar Bedrood, MD, PhD, of Advanced Vision Care in Los Angeles, outlined a set of practical adjustments aimed at improving clinic workflow. Presenting on behalf of Davinder Grover, MD, Dr. Bedrood focused on how glaucoma specialists can use existing resources—staff, testing modalities, and scheduling templates—to increase efficiency without major structural changes.
Virtual Perimetry in Practice
Her discussion began with visual-field testing, a known bottleneck in many practices. Dr. Bedrood highlighted the use of virtual reality–based perimetry as an alternative to traditional platforms. The primary advantage, she said, is logistical. “It helps with things like not needing to change patient positioning,” she explained. “If they’re in a wheelchair, they can stay there.” The ability to perform testing in the exam room, without requiring a dedicated dark room, reduces patient movement and room turnover.
The approach also simplifies setup. Devices can be used over patients’ glasses and do not require extensive infrastructure. “It really does create a sense of efficiency that you can use right in the exam room,” she said. “You do have to train a technician to administer it, but I don’t think it’s particularly difficult and most patients prefer this method.”
Some platforms also integrate additional assessments, including visual acuity, pupil testing, extraocular motility, and color vision, allowing multiple data points to be collected in a single session. The cumulative effect is a reduction in testing time and room utilization.
Earlier Intervention, Fewer Visits
Dr. Bedrood then turned to procedural strategy, framing the shift toward minimally invasive glaucoma surgery (MIGS) and earlier use of selective laser trabeculoplasty (SLT) as both clinical and operational decisions. Traditional filtering procedures, she noted, are resource-intensive and require frequent postoperative visits. By contrast, MIGS and SLT may reduce follow-up burden.
“If you implement SLT earlier in your practice and try to get patients off drops, you actually have fewer discussions about drops at every visit, fewer medication adjustments, and fewer phone calls about drops,” she said. “Having an interventional mindset, and using SLT early in the disease process, can improve overall clinic efficiency.”
Delegating Care Across the Team
Staffing models were another focus. Dr. Bedrood described how incorporating optometrists into glaucoma practices can offload routine care. Optometrists can manage stable patients, post-laser followups, and intraocular pressure checks, while the glaucoma specialist concentrates on surgical cases or more advanced disease.
“If you clearly outline parameters in the chart, the optometrist or other provider can follow those guidelines,” she said. Patients who remain stable continue along the pathway; those with changes are referred back to the opthalmologist. The structure allows for redistribution of clinical volume without compromising oversight.
The use of scribes, she added, can further improve efficiency at the physician level. After an initial training period, scribes can assume responsibility for documentation, allowing physicians to focus on patient interaction. “You can then focus less on entering data into the chart,” said Dr. Bedrood. “The physician’s time is better spent talking to the patient.” In her own workflow, the scribe completes the note and reinforces instructions, such as medication regimens, after the physician leaves the room. This division of labor reduces repetition and supports patient understanding while maintaining clinic flow.
Structuring the Clinic Day
Finally, Dr. Bedrood addressed scheduling templates, emphasizing alignment between appointment types and clinic flow. Early time slots, she suggested, should be reserved for shorter visits like postoperative checks and intraocular pressure measurements. “You can often see 5 or 6 postoperative patients within the first hour without difficulty,” she said.
She advised against scheduling multiple patients who require both visual fields and optical coherence tomography for early in the day, as this can delay the start of clinic and create bottlenecks. Alternating testing types and minimizing duplicate testing can improve throughput. Dedicated slots for new patients, urgent visits, and procedures such as needling or SLT can further stabilize the schedule by matching time allocation to visit complexity.
In all of these areas, the goal is incremental improvement rather than wholesale redesign. “Efficiency is essential for survival,” Dr. Bedrood said. “As patient volumes increase and reimbursement decreases, your time becomes your most valuable commodity. The more efficient you are in clinic, the more time you get back.”