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Enjoy expanded scope, but remain a refractive care expert

Issue: March 2005

ByMichael D. DePaolis, OD, FAAO

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Necessity drives innovation. It’s true in every aspect of life, and eye care is no exception. In fact, it was the need for safe and effective cataract surgery that resulted in small-incision phacoemulsification.

Similarly, consumer interest in extended wear drove the development of silicone hydrogel technology. Likewise, microbial resistance has been the impetus for the development of fluoroquinolone antibiotics. And in our search for increased efficacy and compliance in glaucoma therapy, we’ve seen the emergence of prostaglandin analogs. The list goes on and on.

Validate new technologies

While new technology is largely a good thing, it can also be a challenge. As clinicians we should not simply accept a new technology for its face value. Rather, we need to understand its principles as well as validate its efficacy. Only then should it be implemented to complement existing technologies. Of course, all of this takes time. Precious time.

Undoubtedly, optometry has been swept up in a technology “surge” over the past decade. Advances in diagnostic instrumentation, contact lenses, therapeutics and surgical comanagement have necessitated a substantial commitment from all clinicians. We’ve spent countless hours in continuing education courses, reading professional publications and meeting with industry representatives to stay abreast of new developments.

Technology lag in refractive care

With time at such a premium, it’s understandable how some aspects of practice have actually experienced technology “lag.” For many of us, this technology lag is especially evident in the area of refractive care.

Yes, in this age of rapidly expanding technology, many of us still default to the time-honored manifest refraction. And for good reason. The manifest refraction has proven itself as a fairly effective way in which to accurately measure lower-order aberrations. But while lower-order aberration correction provides an adequate visual outcome for most patients, it just might not be the end-all.

Advances in aberrometry have demonstrated that there is more to ametropia than just sphere and cylinder. With higher-order aberrations (HOAs) accounting for upwards of 20% of the refractive error in certain eyes, it is clearly an area that warrants our attention. As we learn more about measuring, validating and correcting HOAs, it will ultimately influence how we provide refractive services.

Refractive care is paramount

We have long been recognized as the profession that best understands the visual system, determination of its refractive status and the means by which to correct ametropia. Even today – as comprehensive eye care providers – refractive care remains paramount in many patient visits.

Herein resides another challenge: to expand practice scope and embrace new technologies, while remaining experts in refractive care. Aberrometry and HOA management provides a perfect venue to do such. It ultimately provides us with a better understanding of refractive error while laying the foundation for improved visual outcomes. Perhaps just as importantly, it will preserve optometry’s heritage as the vision care profession.