O.D. to O.D.

STRIVE FOR BEST VISUAL OUTCOME

ARE WE DOING EVERYTHING WE CAN, OR JUST ENOUGH?

Scot Morris
O.D., F.A.A.O.,
Chief Optometric Editor

HAVE YOU ever thought about “vision” as you’ve performed a refraction or written a prescription? What are you really doing as you perform these tasks?

The answer is that you are changing people’s lives by bringing the world into clearer focus — we hope — which begs the question: Are you doing everything you can to help patients see better?

OFFER FOR THE BEST OUTCOME

Spectacle lenses can enhance vision through higher quality materials, coating and appropriate colors to truly enhance a persons’ perceptive visual ability. I am guessing that most of you are reading this through high-quality anti-glare lenses. Do you prescribe these for every one of your patients? If no — why not? If our goal is to help our patients/consumers see better, then shouldn’t we prescribe the best options for them?

THE COST CONUNDRUM

We can have the same discussion for contact lenses. Are we treating the 0.75D of cylinder? What about multifocals instead of monovision? Specialty lenses, or is 20/30-ish good enough? Are we discussing multifocal or toric IOL options with each person we send for cataract surgery? If we are the vision experts, then we must be an integral part of the decision-making process as to what form of premium IOL is best for each of our patients.

EXTRA FIVE MINUTES

What about perceptive issues? Sure, it is really easy to figure out sphere, cylinder axis and add. What about those individuals who have more than just refractive error? Are we measuring and treating issues like fixation disparity, binocular function and stereopsis, or are we just “close enough”?

On crazy days when I am already behind, that is when I see the patient who needs that little bit of extra time to really “figure out” his or her problem(s). I take a deep breath and remember that my job is to help each person see his or her best. We may see 10 to 50 patients a day, but to that person our results are what they will see “out of” for the next 1 to 5 years. When we look at it from that perspective, how important does that extra five minute seem now?

BEYOND REFRACTION

Vision is not just a factor of refractive error. Visual clarity is largely a function of the various refractive media that light has to pass through on the way to the fovea and other parts of the retina. If we really want to give patients their best vision possible, then the entire ocular system is also our responsibility. This means truly evaluating the ocular surface and tear film.

A simple question, such as “Does your vision fluctuate and if so, does it get better when you blink?” helps analyze how much of the “visual” problem is poor tear dynamics or ocular surface issues.

Remember, at least 20% of all patients suffer from some form of ocular surface disease. Are we treating ocular surface disease in 20% of the patients on our schedules each day? The same can be said for crystalline lens media changes, vitreal opacities and even minute changes in the retina and macula. Sure, it is easy to “take a quick look.” It is more time consuming to truly assess eye health in each patient who presents in the chair.

BEYOND ENOUGH

Are we all doing everything we can or are we just doing “enough?”

The next time you sit in front of a patient and hear the question, “How is my vision?” what answer are you going to give? The quick one or the right one? This is just something to think about! OM.