Street Smarts

What Is Standard?

By Dan Beck, OD
Leland, N.C.

Standard of care. We all hear that phrase thrown around. We hear it at educational conferences and read it in optometric journals. We're told we must provide the standard of care to patients. But what is standard?

With all of the new ophthalmic technology that has exploded onto the market over the last 20 years, standard of care has become increasingly difficult to define and implement. Let's take a look at a few examples.

Corneal Topography

Most practitioners wouldn't even consider performing a contact lens examination without a corneal map. Irregular astigmatism, early keratoconus and subtle corneal edema are just some of the conditions only revealed by topography. Yet, the American Optometric Association's (AOA) standard of care for contact lens exams doesn't mandate corneal topography.

Retinal Photography

Any optometrist who believes he can pick up everything that a retinal camera can is lying, delusional or both. I miss small dot hemes and microaneurysms that are clearly visible with a good retinal image. Now, I refuse to examine a diabetic patient without retinal images. Although the AOA says retinal images are helpful, they're not required to meet the AOA definition for standard of care.

Optical Coherence Tomography

In glaucoma patients, there must be significant loss of retinal nerve fiber layer before optic nerve head cupping changes can be observed. Macular traction from epiretinal membranes or macular edema from diabetes can't be fully appreciated without OCT scans. So even though OCT may be cost prohibitive for many practices, it will surely become standard of care in the not-too-distant future.

I believe standard of care requirements are about minimum levels of care—not the best possible care. To practice at the highest level, we must go beyond the “standard.” nOD