THE UNBUNDLING OF REFRACTION

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I still remember quite vividly the first time I refracted a patient. I was a second-year student at Pennsylvania College of Optometry (now part of Salus University) and part of a pilot clinical methods program. My patient was an eight-year-old boy who lived a few blocks from the clinic in downtown Philadelphia.

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I went through a carefully rehearsed history and began the exam in earnest. Being a bit nervous, a bead of sweat began to form on my forehead. I continued with the exam and finally got to the point of performing a refraction. I positioned the patient behind the phoroptor, and as I began using my retinoscope, the sweat that was slowing building went into overdrive. Before I could finish, my glasses fogged up””an unexpected development. I nonchalantly removed my glasses and completed the exam without them. (At the time, being a mild myopic astigmat was an inconvenience for driving, but not an impediment indoors.) The patient had healthy eyes and didn’t need glasses. The clinic optometrist confirmed my diagnosis and treatment plan.

Over the next two decades in clinical practice, I examined thousands of patients, not all of whom had healthy eyes or even overall health. Every OD can share their experience of examining a patient who just wanted a new pair of glasses or contact lenses and ended up with a diagnosis of glaucoma, hypertension, diabetic retinopathy, or neurological disease. It’s quite remarkable and unfortunate that many disabling diseases progress silently without initial symptoms. But what is exciting is that an experienced ECP today can detect disease during a thorough exam.

New technology is quickly providing alternative methods to perform refractions in ways we couldn’t have dreamed of just a few years ago, such as using laptop computers and low-cost pocket-sized autorefractors powered by smartphones. When these devices are combined with new business models that disrupt the current eye health exam, it’s easy to understand why many ODs are upset. Rather than discard new technology that will continue to improve, it’s time to review the concept that most eye exams must be performed in an office. Perhaps the driving force behind these new business models is not the technology, but underserved patients who demand a more convenient way to receive vision care. The technology is forcing us to address this issue. If practitioners embrace it as a way to provide comprehensive care in a more convenient setting for some patients, everyone achieves their goals.

Richard Clompus, OD, Professional Editor
rc@optometricoffice.com

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