Dear colleague,

How do you define vision? Have you ever met someone who truly has a clear and focused vision? "The Dictionary of Vision Science" defines vision as: The special sense by which objects, their form, color, position, etc., in the external environment are perceived... . I'll come back to that in a minute. Webster describes vision as: Unusual discernment or foresight. In either case, it's safe to assume that vision is an attribute we'd all like to optimize.

Our profession has progressed at an incredible pace. Technology has provided diagnostic and therapeutic insights never imagined possible. In the end, however, patients judge how well we perform the technical aspects of our job by how well they see and how their eyes feel.

So, how do we determine visual performance? If you're like most, you project a Snellen acuity chart on a high-quality screen in a dimly lit room to optimize contrast. Snellen, a Dutch ophthalmologist, devised this chart in 1862. That's right, 1862. Even then, the test wasn't universally accepted. Critics said its veracity was complicated by familiarity, experience with letters and other psychological factors.

I often hear colleagues wonder aloud about patients who can attain 20/20 vision in the office yet aren't satisfied with the way they see. Are we doing enough to determine optimum vision? Is Snellen acuity testing adequate? Maybe we should be trying to simulate "real world" environments for our patients. High luminance and low luminance, high contrast and low contrast, it's really not difficult, and doing so will provide so much more information to help you maximize your patient's performance. Not only that, you may find, for example, that all contact lenses really don't perform the same when challenged in different luminance and contrast environments.

When the time comes to make a decision about adding technology to your practice, I strongly encourage you to do so and do so aggressively. However, be sure to look at all aspects of the practice, particularly those critical to maximizing your patient's performance. Don't be afraid to challenge the traditional methods and do your best to optimize vision by challenging patients in the office so there will be fewer surprises and more smiles when they leave the office.

All the best,

Howard B. Purcell, O.D., F.A.A.O.
New England College of Optometry '84
VISTAKON^® consultant to new O.D.
(800) 876-6622, ext. 1019; (904) 443-1019
HPurcell@visus.jnj.com